As its name implies, the subcoracoid bursa lies beneath the joint capsule and the coracoid process between the short head of the biceps muscle and the musculotendinous unit of the subscapularis muscle (Fig. 49.1). The bursa serves to cushion and facilitate sliding of the musculotendinous unit of the subscapularis muscle. The bursa is subject to inflammation from a variety of causes with acute shoulder trauma and repetitive microtrauma being the most common. If the inflammation of the bursa is not treated and the condition becomes chronic, calcification of the bursa with further functional disability may occur. The patient suffering from subcoracoid bursitis most frequently presents with the complaint of severe pain especially with forward movement and abduction of the shoulder. These patients will often exhibit a positive abduction release test. Activities requiring abduction of the affected upper extremity are particularly painful, and the patient may complain bitterly of a knife-like catching sensation when using the shoulder upon first awakening. The patient will often be unable to sleep on the affected shoulder. The pain of subcoracoid bursitis is localized to the area of the coracoid and is often referred to the medial shoulder.

Physical examination of the patient suffering from subcoracoid bursitis will reveal point tenderness at the acromion process as well as in the subcoracoid region. If there is significant inflammation, rubor and color may be present and the entire area may feel boggy or edematous to palpation. Passive elevation and active internal rotation of the shoulder may exacerbate the pain of subcoracoid bursitis, and the patient will often exhibit a positive adduction release test when the affected upper extremity is adducted against the examiner’s resistance and the resistance is suddenly and unexpectedly released (Fig. 49.2A and B). If calcification of the bursa and surrounding tendons has occurred, the examiner may appreciate crepitus with active range of motion of the affected shoulder.

Plain radiographs are indicated in all patients who present with shoulder pain to rule out occult bony pathology. Based on the patient’s clinical presentation, additional testing may be indicated, including complete blood cell count, sedimentation rate, and antinuclear antibody testing. Magnetic resonance imaging or ultrasound imaging of the affected area may help confirm the diagnosis and also help delineate the presence of subdeltoid bursitis, calcific tendonitis, rotator cuff tendinopathy, or other shoulder pathology (Figs. 49.3 and 49.4). Magnetic resonance imaging or ultrasound imaging of the affected area may also help delineate the presence of calcific tendonitis or other shoulder pathology.

Rarely, the inflamed bursa may become infected, and failure to diagnose and treat the acute infection can lead to dire consequences (Fig. 49.5).

The subcoracoid bursa lies beneath the joint capsule and the coracoid process between the short head of the biceps muscle and the musculotendinous unit of the subscapularis muscle (Fig. 49.6). Compromise of the subcoracoid space by tendonitis, bony deformity following fracture of the coracoid, or osteophytes can irritate the subcoracoid bursa and cause bursitis. It
is also susceptible to irritation during extreme arm movement when the short head of the biceps presses against the humeral head. This process can be accelerated if previous trauma to the shoulder joint has compromised its stability and abnormal movement of the head of the humerus in the glenoid fossa occurs.