Removal or retention: evolving views on possible roles of the subacromial bursa in rotator cuff disease

The subacromial bursa is located below the acromion, coracoacromial ligament, and deltoid deep fascia, above the rotator cuff and greater tuberosity of the humerus, and plays a crucial role in physiological processes such as exercise and pathological processes of rotator cuff diseases. The subacromial bursa is associated with inflammatory pain in patients with rotator cuff disease. Removing the bursa during surgery and intra-articular drug injection can both relieve this pain to some degree. Resection of the subacromial bursa improves intraoperative visualization and may loosen an already stiff shoulder joint; however, excessive resection appears to result in more severe adhesion. Current evidence suggests that the subacromial bursa is a source of reparative cytokines and mesenchymal stem cells that may contribute to and enhance the healing of the injured rotator cuff and improve prognosis. Research studies related to the utilization of the subacromial bursa for bioaugmentation is ongoing and shows potential to promote patient recovery. Preservation or bioaugmentation with the subacromial bursa during rotator cuff surgery might lead to a better prognosis, but there is not yet sufficient evidence to prove this.