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Involvement of the Anterior Portion of the Subacromial-Subdeltoid Bursa in the Painful Shoulder

Bernard Stallenberg1, Nathalie Destate1, Véronique Feipel1 and Pierre Alain Gevenois1

1 All authors: Department of Radiology, Université Libre de Bruxelles and Erasme Hospital, Route de Lennik 808, Brussels 1170, Belgium.


Figure 1
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  		Fig. 1A —Shoulder of nonembalmed cadaver in neutral position. Sonography scan (A), CT scan (B), and anatomic section (C) obtained at level of tip of coracoid process (C) of shoulder in neutral position show hypoechoic tissue corresponding to anterior part of subacromial-subdeltoid bursa (asterisk), filled by iodinated contrast material on CT image, lying between hyperechoic lines of peribursal fat and between long head biceps (LB) and subscapularis (SUB) tendons deeply and deltoid muscle (D) superficially. Medial portion of bursa (arrow) is well identified facing coracoid process. Humeral head (H) is shown.

 

Figure 2
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  		Fig. 1B —Shoulder of nonembalmed cadaver in neutral position. Sonography scan (A), CT scan (B), and anatomic section (C) obtained at level of tip of coracoid process (C) of shoulder in neutral position show hypoechoic tissue corresponding to anterior part of subacromial-subdeltoid bursa (asterisk), filled by iodinated contrast material on CT image, lying between hyperechoic lines of peribursal fat and between long head biceps (LB) and subscapularis (SUB) tendons deeply and deltoid muscle (D) superficially. Medial portion of bursa (arrow) is well identified facing coracoid process. Humeral head (H) is shown.

 

Figure 3
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  		Fig. 1C —Shoulder of nonembalmed cadaver in neutral position. Sonography scan (A), CT scan (B), and anatomic section (C) obtained at level of tip of coracoid process (C) of shoulder in neutral position show hypoechoic tissue corresponding to anterior part of subacromial-subdeltoid bursa (asterisk), filled by iodinated contrast material on CT image, lying between hyperechoic lines of peribursal fat and between long head biceps (LB) and subscapularis (SUB) tendons deeply and deltoid muscle (D) superficially. Medial portion of bursa (arrow) is well identified facing coracoid process. Humeral head (H) is shown.

 

Figure 4
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  		Fig. 2A —Shoulder of nonembalmed cadaver in neutral position. Transverse sonography scan (A) and CT scan (B) obtained at level of tip of coracoid process (C) show humeral head (H) and subacromial-subdeltoid bursa (asterisk).

 

Figure 5
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  		Fig. 2B —Shoulder of nonembalmed cadaver in neutral position. Transverse sonography scan (A) and CT scan (B) obtained at level of tip of coracoid process (C) show humeral head (H) and subacromial-subdeltoid bursa (asterisk).

 

Figure 6
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  		Fig. 2C —Shoulder of nonembalmed cadaver in neutral position. Transverse sonography scan (C) and CT scan (D) obtained while humerus was extended and internally rotated, at same level and on same cadaver shoulder specimen as A and B, show anterior bulging (black arrow) and deformation (white arrows) of medial part of bursa (asterisk). Humeral head (H) and tip of coracoid process (C) are shown.

 

Figure 7
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  		Fig. 2D —Shoulder of nonembalmed cadaver in neutral position. Transverse sonography scan (C) and CT scan (D) obtained while humerus was extended and internally rotated, at same level and on same cadaver shoulder specimen as A and B, show anterior bulging (black arrow) and deformation (white arrows) of medial part of bursa (asterisk). Humeral head (H) and tip of coracoid process (C) are shown.

 

Figure 8
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  		Fig. 3 —Graph illustrates comparisons of width of subacromial-subdeltoid bursa in volunteers, asymptomatic side in patients, and symptomatic side in patients, respectively, in neutral position (z) and while humerus was extended and internally rotated ({). Error bars show SEM. Values above brackets show p values.

 

Figure 9
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  		Fig. 4 —Graph illustrates comparisons of width of subacromial-subdeltoid bursa in neutral position in shoulders that were not painful, in shoulders with anteromedial pain, and in shoulders with pain experienced elsewhere. Error bars show SEM. Values above brackets show p values.

 

Figure 10
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  		Fig. 5 —Graph illustrates comparisons of width of subacromial-subdeltoid bursa while humerus was extended and internally rotated in shoulders that were not painful, in shoulders with decreased or unchanged anteromedial pain compared with neutral position, and in shoulders with increased anteromedial pain compared with neutral position. Error bars show SEM. Values above brackets show p values.

 

Figure 11
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  		Fig. 6A —Images of symptomatic side in 46-year-old man. Coracoid process (C) is shown. Transverse sonography scan of subacromial-subdeltoid bursa in neutral position (A) shows widest part of bursa (arrows) measured 2.5 mm; patient experienced pain anteromedially.

 

Figure 12
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  		Fig. 6B —Images of symptomatic side in 46-year-old man. Coracoid process (C) is shown. Transverse sonography scan of subacromial-subdeltoid bursa while humerus was extended and internally rotated shows widest part of bursa (arrows) measured 4.3 mm; patient experienced increased pain compared with shoulder in neutral position.

 

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