Journal of Medical Ultrasonics

, Volume 45, Issue 2, pp 287–294 | Cite as

Sonographic assessment of subacromial bursa distension during arm abduction: establishing a threshold value in the diagnosis of subacromial impingement syndrome

  • Gokhan Soker
  • Bozkurt Gulek
  • Eda Soker
  • Omer Kaya
  • Ibrahim Inan
  • Muhammet Arslan
  • Kaan Esen
  • Derya Memis
  • Cengiz Yilmaz
Original Article



In this study, we aimed to establish a quantitative threshold value in the diagnosis of subacromial impingement syndrome by measuring the thickness of the subacromial bursa during abduction and adduction.

Materials and methods

Forty-five patients with subacromial impingement syndrome and 54 healthy individuals underwent dynamic shoulder ultrasonography. The subacromial bursa, between the supraspinatus tendon margin and peribursal adipose tissue, was measured between the acromion and humeral head at its widest part. The subacromial impingement ratio was calculated by dividing the subacromial bursa thickness during abduction to the subacromial bursa thickness during adduction. Shapiro–Wilk test was used in the assessment of normal distribution of parameters.


The mean subacromial bursa thickness in the abduction position was 1.8 ± 1.1 mm in the study group and 0.9 ± 0.3 mm in the control group. The mean subacromial bursa thickness in the adduction position was 0.9 ± 0.5 mm in the study group and 0.8 ± 0.3 mm in the control group. The subacromial impingement ratio showed a statistically significant difference between groups (p < 0.0001), and the ratio being 2.0 ± 0.5 in the study group and 1.2 ± 0.1 in the control group. For measurements performed in the abduction position, the best cut-off value was calculated as 1.3 mm, and sensitivity and specificity were 70.6 and 85.2%, respectively. The best cut-off value was 1.4 for the subacromial impingement ratio, and sensitivity and specificity were 88.2 and 96.3%, respectively.


Subacromial impingement ratio is a very practical and reliable method in subacromial impingement syndrome diagnosis.


Dynamic shoulder ultrasonography Subacromial bursa Subacromial impingement syndrome 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests and source of funding.

Ethical statement

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008.

Informed consent

Informed consent was obtained from patients for being included in the study.


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Copyright information

© The Japan Society of Ultrasonics in Medicine 2017

Authors and Affiliations

  • Gokhan Soker
    • 1
  • Bozkurt Gulek
    • 1
  • Eda Soker
    • 2
  • Omer Kaya
    • 1
  • Ibrahim Inan
    • 3
  • Muhammet Arslan
    • 1
  • Kaan Esen
    • 4
  • Derya Memis
    • 2
  • Cengiz Yilmaz
    • 1
  1. 1.Department of RadiologySBU Adana Numune Training and Research HospitalAdanaTurkey
  2. 2.Department of Physical Therapy and RehabilitationSBU Adana Numune Training and Research HospitalAdanaTurkey
  3. 3.Department of Radiology, Faculty of MedicineAdiyaman UniversityAdiyamanTurkey
  4. 4.Department of Radiology, Faculty of MedicineMersin UniversityMersinTurkey

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