The Journal of Bone and Joint Surgery, Vol 64, Issue 2 196-201, Copyright © 1982 by Journal of Bone and Joint Surgery, Inc
Subacromial bursography. An anatomical and clinical study
AM Strizak, L Danzig, DW Jackson, D Resnick and T Staple
Impingement of the rotator cuff beneath the coracoacromial arch without
associated rupture of the cuff or reactive bone changes on the undersurface
of the acromion is a well established clinical diagnosis. The value of
subacromial bursography in the assessment of this condition was
investigated in an anatomical study of fifteen cadavera and a clinical
study of thirty-one patients. The subacromial bursa is situated like a cap
over the rotator cuff and can be demonstrated roentgenographically by the
injection of contrast material in shoulders from cadavera and living
subjects. This bursa is composed of subacromial and subdeltoid portions as
well as a subcoracoid extension in some individuals. However, it is the
anterior portion of the bursa, under the coracoacromial arch, that is most
significant, since this overlies the deep structures involved in the
impingement syndrome. The normal subacromial bursa easily accepts five to
ten milliliters of contrast medium. However, if the bursal walls are
thickened and edematous, the bursa will be difficult to demonstrate
roentgenographically or it will accept only a few milliliters of contrast
material. The findings in this study suggest that when the findings on the
bursogram are normal, a diagnosis of chronic impingement by the
coracoacromial arch should be questioned.
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