Limitation of active elevation

1
Limitation of active elevation
Acute subdeltoid bursitis
both passive elevation and passive
scapulohumeral abduction limited

• most painful disorder in orthopaedic medicine
•    swift onset, recover in about 6 weeks, recur
• within 5 years
•    develop without cause, maximal pain in 3 days,
• hand to chest without motion
•   active and passive movement is hardly
• possible, empty end feel

2
Acute subdeltoid bursitis
characteristics

• marked limitation of passive scapulohumeral
• abduction gt lat. rotation
•  painful arc () in 1 st. day, (-) in 3rd day,
• elevation is impossible
• tender on superficial part of bursa,
• subacromial part also involved
•   710 days, pain begin to decrease
•   34 weeks, only ache
•   46 weeks, pain disappear, normal ROM

3
Acute subdeltoid bursitis
4
D/dx with acute subdeltoid bursitis
Gouty arthritis
Septic arthritis
Pathologic fracture
dislocation
5
Treatment of ASDB

• infiltration with triamcinolone
• in 10days from onset
• 2 procaine 4 ml40mg triamcinolone 1ml
• x 2 (superficial and deep bursa)
• recheck after 2 days, incomplete remission,
•   re-injection with half dose of 1st.
  injection.