Subacromial-Subdeltoid Bursa

This is a supplement to page 15-16 of The Resident’s Manual of Ultrasound-Guided Procedures. Get the book here.

This first video is what usually happens during this injection. The goal should be to avoid the ballooning of the fascial wall of the bursa such as this (no, I’m not pointing fingers; this is me doing the injection).

In both of these last two videos I wasn’t able to catch the visual of the fluid flowing into the deep bursal recess because my transducer placement wasn’t perfect. Ideally, you should see something similar to what is shown in my tibialis posterior video.

There is a “right” way to do this injection, but as I mention in the book, outcomes are similar. This is important if you care about improving your own skills and challenging yourself to do it perfectly, even if it “doesn’t really matter”.

The subacromial bursa and subdeltoid bursa are usually confluent. The subacromial portion travels deep under the acromion proximally, into what is called the deep bursal recess.

It is particularly difficult to aim perfectly into this potential space between fascial planes.