Casuistry of Fibrotic Bursitis and Impigement Syndrome

Anamnestic data

A patient (74) feels night pains, he cannot lie on the affected side. A main problem is rather a restricted motility of the shoulder joint which annoys him when he does the basic everyday needs.

Objective Finding

Palpation

tenderness of the shoulder at palpation about 2 cm under the acromion

Movements of the glenohumeral articulation

Complex movements of the shoulder girdle

type of movement       

extension of movement

soresness of movement       

elevation in abduction 0 90 from 45 degrees
elevation in flexion 0 - 90 from 45 degrees

Isolated examination of the glenohumeral articulation 

type of movement

extension of movement

flexion - extension

45/0/10

outer inner rotation

10/0/45

abduction- adduction

45/0/30

Examination of the Muscular Function at the Examination of Isometric Resistance

type of movement

strength of contraction

evoking of pain at contraction

outer rotation

-

+

inner rotation - +
abduction m. deltoideus1 - +
m.supraspinatus2 - +

flexion

- +

extension

- +
flexion of the elbow    

symmetrically the strength of the contraction is smaller against the resistance, but there is no difference in the strength of both sides to each other.

Ultrasound Finding

In the place, where the patient feels pains, hyperechogenic spread subdeltoid bursa is present, otherwise there is a normal ultrasound finding on the other structures.

fibX.jpg (38483 bytes)

ultrasound picture and scheme of the longitudinal section on m. supraspinatus with the  finding of spread fibrotic bursa

 

fibsrX.jpg (42062 bytes)

picture and scheme of the comparison of the normal and affected side with a fibrotization of bursitis

 

Commentary

The ultrasound examination found fibrotic changes in the bursa. But nor after 2 steroid peritendinous injections the state did not get better. The motility was still very restricted. We sent the patient to the MRI examination with a diagnosis of fibrotic bursitis at the impigement syndrome. MRI supported this diagnosis simultaneously with a finding of possible etiology of impigement syndrome which was evoked by arthrosis and prominence of the acromioclavicular articulation.