Diagnostic Musculoskeletal Ultrasound in the Evaluation of the Subacromial Bursa

The subacromial and subdeltoid bursa commonly communicate and, for all intents and purposes, function as a single bursa. The subacromial bursa lies between the supraspinatus and the acromion process, while the subdeltoid bursa is the lateral extension of the subacromial bursa. These bursae function to limit frictional forces between the various structures. These bursae can become irritated and inflamed when they are impinged between the greater tubercle of the humerus and the acromion and/or the coracoacromial ligament when one lifts the shoulder into elevation and internal rotation.

It is difficult to determine whether the bursa, the supraspinatus tendon, or both are irritated when diagnosing shoulder pain. An accurate diagnosis of bursitis is essential for appropriate treatment planning and optimizing patient outcomes. Diagnostic musculoskeletal ultrasound (MSKUS) has become a widely used imaging modality for assessing several shoulder pathologies. It offers a portable, real-time, and cost-effective alternative that is gaining traction in rehabilitation and sports medicine settings. MSKUS has emerged as a valuable, non-invasive imaging modality for evaluating shoulder bursal tissue. This manuscript will review the utility of MSKUS in evaluating the quality, size, and sonographic features of subacromial and subdeltoid bursal tissue, as well as the clinical implications for professionals in the rehabilitation field. By integrating MSKUS into clinical practice, providers can improve diagnostic accuracy, enhance diagnostic confidence, monitor healing progression, and guide rehabilitation strategies to achieve optimal patient outcomes for those with shoulder bursal injuries.