Subacromial-subdeltoid bursa

Last revised by David Carroll on 22 Mar 2023

The subacromial-subdeltoid bursa (SASD), also simply known as the subacromial bursa, is a bursa within the shoulder that is simply a potential space in normal individuals.

  • found deep to the deltoid muscle and the coraco-acromial arch

    • medially in close relation to the acromio-clavicular joint

    • the mid-point of the bursa commonly corresponds to the most anterior extent of the acromion

    • extends laterally over the greater tuberosity of the humerus, terminating in its sub-deltoid reflection an average of 4 cm from the mid-point of the acromion

      • this osseous landmark also corresponds to the posterior bursal reflection

    • envelops the bicipital groove as it extends inferiorly

  • superficial anatomic relations include the rotator interval and the supraspinatus tendon

    • invested by parallel layers of peri-bursal fat

    • relationship with supraspinatus tendon consistent, whereas it may or may not interface with the infraspinatus

  • anatomically discontinuous with the gleno-humeral joint

    • communication may occur in the presence of rotator cuff pathology

  • the hyperechoic peri-bursal fat forms a prominent interface between the deltoid and/or acromion and the underlying supraspinatus allowing identification of the potential space representing the bursa

    • anechoic fluid may interpose between the layers of peri-bursal fat forming a tri-laminar interface

    • bursal thickness is typically less than 1 mm in the presence of physiologic amounts of bursal fluid

    • color flow Doppler examination should reveal an absence of bursal vascularity

  • dynamic visualization during shoulder abduction and adduction should demonstrate smooth translocation of the bursal reflection beneath the acromion

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