33-year-old patient working in construction presenting with shoulder pain during elevation and overhead activities. Symptoms are likely activity-related.
Ultrasound examination of the shoulder demonstrates mild distension of the subacromial-subdeltoid (SASD) bursa, consistent with mild bursitis.
During dynamic ultrasound with guided active abduction, there is clear subacromial impingement. The supraspinatus tendon and SASD bursa are seen to impinge against the coracoacromial ligament, indicating a mechanical conflict within the subacromial space.
No additional structural abnormalities are described.
1. Final diagnosis
Subacromial pain syndrome due to mild SASD bursitis with dynamic subacromial impingement.
2. Differential diagnosis
Consider early supraspinatus tendinopathy or subtle rotator cuff pathology not clearly visualized.
3. Teaching points
Dynamic ultrasound is essential for diagnosing subacromial impingement. Even mild bursitis can contribute to symptoms by reducing the subacromial space and causing mechanical conflict during movement.
4. Injury/disease information
Subacromial pain syndrome is commonly caused by a combination of bursal inflammation and mechanical impingement of the rotator cuff. Early-stage findings may be subtle on imaging but still clinically relevant.
Marc is founder of, and trainer at, SonoSkills. SonoSkills is an organization dedicated to MSK ultrasound education. He's also an MSK Sonographer at EchoConsult in Roermond, the Netherlands.
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