Subacromial-subdeltoid bursa

Changed by David Carroll, 22 Mar 2023

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The subacromial-subdeltoid bursa (SASD), also simply known as the subacromial bursa, is a bursa within the shoulder that is simply a potential space in normal individuals.

Gross anatomy

~~extends from below~~
found deep to the deltoid muscle and the coraco-acromial arch
- medially in close relation to the acromio-clavicular joint
- the mid-point of the bursa commonly corresponds to the most anterior extent of the acromion,
- extends laterally over the greater tuberosity of the humerus
- ~~laterally~~, terminating in its sub-deltoid reflection an average of 4 cm from the ~~bursa lies over the superior surface~~mid-point of the ~~supraspinatus and infraspinatus tendons~~
- ~~it sits deep~~acromion
  - this osseous landmark also corresponds to the posterior bursal reflection
superficial anatomic relations include the rotator interval and the supraspinatus tendon
- invested by parallel layers of peri-bursal fat
- relationship with supraspinatus tendon consistent, whereas it may or may not interface with the infraspinatus
anatomically discontinuous with the gleno-humeral joint
- communication may occur in the presence of rotator cuff pathology

Radiographic features

Ultrasound

the hyperechoic peri-bursal fat forms a prominent interface between the deltoid ~~muscle~~and/or acromion and the underlying supraspinatus allowing identification of the potential space representing the bursa
- anechoic fluid may interpose between the layers of peri-bursal fat forming a tri-laminar interface
- bursal thickness is typically less than 1 mm in the presence of physiologic amounts of bursal fluid
- colour flow Doppler examination should reveal an absence of bursal vascularity
dynamic visualisation during shoulder abduction and adduction should demonstrate smooth translocation of the bursal reflection beneath the acromion

Related pathology

subacromial impingement
bursitis
- septic bursitis
rheumatoid arthritis
rotator cuff tear

-<p>The <strong>subacromial-subdeltoid bursa (SASD), </strong>also simply known as the <strong> subacromial bursa</strong>, is a <a href="/articles/bursa">bursa</a> within the <a href="/articles/shoulder">shoulder</a> that is simply a potential space in normal individuals.</p><h4>Gross anatomy</h4><ul>
~~-<li>extends from below the <a href="/articles/acromion">acromion</a>, over the shoulder and the <a href="/articles/greater-tuberosity">greater tuberosity</a> of the humerus</li>~~
~~-<li>laterally, the bursa lies over the superior surface of the supraspinatus and infraspinatus tendons</li>~~
~~-<li>it sits deep to the <a href="/articles/deltoid-muscle">deltoid muscle</a>~~
+<p>The <strong>subacromial-subdeltoid bursa (SASD), </strong>also simply known as the <strong>subacromial bursa</strong>, is a <a href="/articles/bursa">bursa</a> within the <a href="/articles/shoulder">shoulder</a> that is simply a potential space in normal individuals.</p><h4>Gross anatomy</h4><ul>
+<li>
+<p>found deep to the <a href="/articles/deltoid-muscle" title="Deltoid muscle">deltoid</a> muscle and the coraco-acromial arch</p>
+<ul>
+<li><p>medially in close relation to the <a href="/articles/acromioclavicular-joint-1" title="Acromio-clavicular joint">acromio-clavicular joint</a></p></li>
+<li><p>the mid-point of the bursa commonly corresponds to the most anterior extent of the <a href="/articles/acromion" title="Acromion">acromion</a></p></li>
+<li>
+<p>extends laterally over the <a href="/articles/greater-tuberosity" title="greater tuberosity">greater tuberosity</a> of the humerus, terminating in its sub-deltoid reflection an average of 4 cm from the mid-point of the acromion </p>
+<ul><li><p>this osseous landmark also corresponds to the posterior bursal reflection </p></li></ul>
~~-</ul><h4>Related pathology</h4><ul><li><a href="/articles/subacromial-impingement">subacromial impingement</a></li></ul>~~
+<li><p>envelops the bicipital groove as it extends inferiorly </p></li>
+</ul>
+</li>
+<li>
+<p>superficial anatomic relations include the <a href="/articles/rotator-cuff-interval" title="Rotator interval">rotator interval</a> and the supraspinatus tendon</p>
+<ul>
+<li><p>invested by parallel layers of peri-bursal fat</p></li>
+<li><p>relationship with supraspinatus tendon consistent, whereas it may or may not interface with the <a href="/articles/infraspinatus-muscle-1" title="Infraspinatus muscle">infraspinatus</a> </p></li>
+</ul>
+</li>
+<li>
+<p>anatomically discontinuous with the gleno-humeral joint</p>
+<ul><li><p>communication may occur in the presence of <a href="/articles/rotator-cuff-tear" title="Rotator cuff tear">rotator cuff</a> pathology</p></li></ul>
+</li>
+</ul><h4>Radiographic features</h4><h6>Ultrasound</h6><ul>
+<li>
+<p>the hyperechoic peri-bursal fat forms a prominent interface between the deltoid and/or acromion and the underlying supraspinatus allowing identification of the potential space representing the bursa</p>
+<ul>
+<li><p>anechoic fluid may interpose between the layers of peri-bursal fat forming a tri-laminar interface</p></li>
+<li><p>bursal thickness is typically less than 1 mm in the presence of physiologic amounts of bursal fluid</p></li>
+<li><p><a href="/articles/color-flow-doppler-ultrasound" title="Color flow Doppler (ultrasound)">colour flow Doppler</a> examination should reveal an absence of bursal vascularity</p></li>
+</ul>
+</li>
+<li><p>dynamic visualisation during shoulder abduction and adduction should demonstrate smooth translocation of the bursal reflection beneath the acromion </p></li>
+</ul><h4>Related pathology</h4><ul>
+<li><p><a href="/articles/subacromial-impingement">subacromial impingement</a></p></li>
+<li>
+<p>bursitis</p>
+<ul><li><p>septic bursitis</p></li></ul>
+</li>
+<li><p>rheumatoid arthritis</p></li>
+<li><p><a href="/articles/rotator-cuff-tear" title="Rotator cuff tear">rotator cuff tear</a></p></li>
+</ul>

References changed:

2. Beals T, Harryman D, Lazarus M. Useful Boundaries of the Subacromial Bursa. Arthroscopy. 1998;14(5):465-70. <a href="https://doi.org/10.1016/s0749-8063(98)70073-8">doi:10.1016/s0749-8063(98)70073-8</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/9681537">Pubmed</a>
3. Messina C, Banfi G, Orlandi D et al. Ultrasound-Guided Interventional Procedures Around the Shoulder. BJR. 2016;89(1057):20150372. <a href="https://doi.org/10.1259/bjr.20150372">doi:10.1259/bjr.20150372</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/26313499">Pubmed</a>
4. Pourcho A, Colio S, Hall M. Ultrasound-Guided Interventional Procedures About the Shoulder. Phys Med Rehabil Clin N Am. 2016;27(3):555-72. <a href="https://doi.org/10.1016/j.pmr.2016.04.001">doi:10.1016/j.pmr.2016.04.001</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/27468666">Pubmed</a>

Tags changed:

msk
msk ultrasound
emergencymedicine
pocus
ultrasound
rheumatology
physical

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