The Shoulder

CHRONIC SUBDELTOID BURSITIS

There is no improvement with the ongoing treatment or the complaints recur after an initial improvement

Sporadic relapses after complete recovery

With a relapse after an initially successful treatment, the treatment can be repetead. However, in this case it is important to provide a thorough follow up: the treatment is continued until the clinical examination is completely negative. A treatment can again be set up if there are not too many relapses (not more than two to three relapses)
Repeated relapses

With repeated or rapidly successive relapses one should bear in mind an underlying cause:
- Functional disorders: Does the added examination indicate an instability
- Calcifications can be the cause of a chronic irritation. With recurrent bursitis, one can try to remove the calcifications via a number of infiltrations with procaïne.
- Anatomical deviations:
- Degenerative osteophytes at the level of the acromioclavicular articulation
- Abnormal form of degenerative deformity of the acromion
- Deformities at the level of the coracoid or an abnormal thickening of the coraco-acromial ligament
- Deformities at the level of the tuberculum majus of the humerus
If an anatomical deviation causes the relapse of the bursitis, then a surgical decompression with removal of the front and lower part of the acromion and of the coraco-acromial ligament can offer a definite solution.