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HELP : TREATMENT

CHRONIC SUBDELTOID BURSITIS


1. There is no improvement with the ongoing treatment

1.Are you sure of your diagnosis?

Diagnosing a chronic subdeltoid bursitis is not always easy.

2 .Are you sure of the location?

The acromio-deltoid bursa is rather extensive. A local infiltration can only show a result if the exact location is being found. Therefore, the following tips may be of interest:

 

3.The local anaesthetic results in improvement for only a couple of hours

Infiltrate the same location with a mixture of local anaesthetic and triamcinolone (depending on the extension of the lesion with 10 to 40 mg).

Repeat the injection every two weeks until the complaints have completely disappeared.(normally after two to three injections).

 


2. The complaints recur after an initial improvement

 

1. 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)

 

2. Repeated relapses

With repeated or rapidly successive relapses one should bear in mind an underlying cause:

  1. Functional disorders: Does the added examination indicate an instability
  2. 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 proca´ne.
  3. Anatomical deviations:
  4. Degenerative osteophytes at the level of the acromioclavicular articulation
  5. Abnormal form of degenerative deformity of the acromion
  6. Deformities at the level of the coracoid or an abnormal thickening of the coraco-acromial ligament
  7. 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.

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