The subacromial bursa may be entered inadvertently during conventional arthrography, but direct injection has been used to demonstrate cuff tears, and particularly those partial tears of the superficial surface of the cuff which cannot be shown by conventional arthrography. It has also been used in the investigation of impingement syndrome, when pooling of contrast in the subdeltoid part of the subacroacromial space. When pooling of contrast in the subdeltoid part of the subacromial bursa during abduction and external rotation is noted . The technique is rather more difficult then shoulder arthrography, and the normal bursa can be problematic to find with a needle. It is not widely practised, and many reports of its use come from Japan, where it has also been used in the diagnosis of adhesive capsulitis.