Subacromial-subdeltoid bursitis and acromioclavicular arthrosis presenting as a palpable shoulder mass

Subacromial-subdeltoid bursitis and acromioclavicular arthrosis presenting as a palpable shoulder mass | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Subacromial-subdeltoid bursitis and acromioclavicular arthrosis presenting as a palpable shoulder mass Malvik Patel This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9523683/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 3 You are reading this latest preprint version Abstract A 56-year-old man presented with a firm, non-tender 2 × 2 cm mass over the superior aspect of the right shoulder without restriction of motion. Plain radiographs demonstrated severe acromioclavicular (AC) joint osteoarthritis with joint space narrowing and osteophyte formation. Magnetic resonance imaging revealed supraspinatus tendinosis, mild subacromial-subdeltoid bursitis, and advanced AC joint arthrosis without rotator cuff tear or labral injury. The imaging findings explained the palpable prominence at the AC joint. The patient was managed conservatively with non-steroidal anti-inflammatory drugs and physiotherapy, resulting in symptomatic improvement. This case highlights that common degenerative shoulder conditions can present as a palpable mass, potentially mimicking neoplastic lesions. Careful clinical and radiological correlation is essential to avoid unnecessary invasive procedures. Shoulder Subacromial-subdeltoid bursitis Acromioclavicular joint osteoarthritis Shoulder mass Magnetic resonance imaging Rotator cuff Figures Figure 1 Figure 2 Figure 3 Case Palpable shoulder masses are uncommon and often raise concern for neoplastic or cystic lesions. Common causes include lipoma, ganglion cyst, and osteochondroma. Subacromial-subdeltoid bursitis is a frequent cause of shoulder pain, but rarely presents as a discrete mass ( 1 ). In contrast, acromioclavicular joint osteoarthritis is highly prevalent with aging and may produce a palpable bony prominence ( 2 ). We report a case where combined bursitis and AC joint arthrosis presented as a painless shoulder lump, emphasizing the importance of imaging in diagnosis. A 56-year-old male presented with a 3-month history of a right shoulder lump. He was otherwise healthy, with no history of trauma, systemic disease, or substance use. The mass was firm, approximately 2 × 2 cm, located over the superior aspect of the shoulder, and initially asymptomatic. There was no associated redness, warmth, or limitation of motion. On examination, the mass was hard and fixed at the AC joint region. The shoulder demonstrated a full active and passive range of motion without pain. There was mild tenderness over the AC joint on direct palpation, while the cross-body adduction test was negative. No rotator cuff weakness or impingement signs were noted. Plain radiographs revealed severe AC joint arthrosis with joint space narrowing and osteophyte formation. Magnetic resonance imaging showed supraspinatus tendinosis with intact fibers, mild subacromial-subdeltoid bursitis, minimal glenohumeral effusion, and advanced degenerative changes of the AC joint. No rotator cuff tear, labral injury, or neoplastic lesion was identified. The patient was treated conservatively with non-steroidal anti-inflammatory drugs and physiotherapy focusing on rotator cuff strengthening and range-of-motion exercises. Symptoms improved over a 4-week period, and no invasive intervention was required. Discussion This case demonstrates an unusual presentation of common shoulder pathologies as a palpable mass. The differential diagnosis of a palpable shoulder mass includes lipoma, ganglion cyst, osteochondroma, and soft tissue tumors. In such cases, clinical examination alone may be insufficient, and imaging plays a crucial role in distinguishing benign degenerative conditions from potentially malignant lesions. Subacromial-subdeltoid bursitis typically presents with pain and impingement symptoms rather than a discrete swelling ( 1 ). Similarly, acromioclavicular joint osteoarthritis is frequently asymptomatic despite its high prevalence in older individuals ( 2 ). However, osteophyte formation at the AC joint can produce a visible and palpable prominence. This presentation is clinically important as it can closely mimic a neoplastic lesion, potentially leading to unnecessary biopsy or surgical intervention if not correctly identified. In this patient, the combination of AC joint osteophytes and associated bursitis contributed to the clinical presentation. Imaging played a crucial role in excluding sinister causes and confirming a benign etiology. Interestingly, despite advanced acromioclavicular joint arthrosis on imaging, the cross-body adduction test was negative, underscoring the potential discordance between clinical examination and radiological findings. Radiographs are useful for identifying bony changes, while magnetic resonance imaging provides a detailed assessment of soft tissue structures (3). Management of both conditions is primarily conservative, including rest, non-steroidal anti-inflammatory drugs, and physiotherapy ( 1 , 4 ). Corticosteroid injections may be considered for persistent symptoms, while surgical intervention is reserved for refractory cases. To our knowledge, presentation of combined subacromial bursitis and acromioclavicular arthrosis as a discrete palpable mass in a patient without systemic disease is rarely reported ( 5 ). This case highlights the importance of correlating clinical findings with imaging to accurately diagnose benign degenerative conditions presenting as a palpable shoulder mass and to avoid unnecessary invasive procedures. Declarations Acknowledgements None. Author contributions MP: Concept, data collection, manuscript drafting, and revision. Data sharing statement No additional data available. Funding: None Conflict of interest: None declared Ethical approval: Not required for a single case report as per institutional policy Patient consent: Written informed consent was obtained References Jain NB, Khazzam MS. Degenerative Rotator-Cuff Disorders. N Engl J Med. 2024;391(21):2027–34. 10.1056/NEJMcp1909797 . Rossano A, Manohar N, Veenendaal WJ, Van Den Bekerom MPJ, Ring D, Fatehi A. Prevalence of acromioclavicular joint osteoarthritis in people not seeking care: A systematic review. J Orthop. 2022;32:85–91. 10.1016/j.jor.2022.05.009 . Draghi F, Scudeller L, Draghi AG, Bortolotto C. Prevalence of subacromial-subdeltoid bursitis in shoulder pain: an ultrasonographic study. J Ultrasound. 2015;18(2):151–8. 10.1007/s40477-015-0167-0 . Diercks R, Bron C, Dorrestijn O, Meskers C, Naber R, de Ruiter T, et al. Guideline for diagnosis and treatment of subacromial pain syndrome: a multidisciplinary review by the Dutch Orthopaedic Association. Acta Orthop. 2014;85(3):314–22. 10.3109/17453674.2014.920991 . Kashid M, Rai SK, Chakrabarty B. Rare Presentation of Subacromial Bursitis Mimics Neoplasm in a Case of Rheumatoid Arthritis. J Orthop Case Rep. 2020;9(6):23–6. 10.13107/jocr.2019.v09.i06.1572 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editor assigned by journal 04 May, 2026 Submission checks completed at journal 04 May, 2026 First submitted to journal 25 Apr, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9523683","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":631099736,"identity":"6165640c-8334-405d-909f-72f0f7a6d05e","order_by":0,"name":"Malvik Patel","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/0lEQVRIiWNgGAWjYFAC5gaGhAMMcvwMzAcffADy2dgJamEEazGWbGBLNpwB0sJMjBaGAwyJGxp4zKR5wNYS0KDbfrBN4sEZBsYNDDzGxja/tsnzMTMwfviYg1uL2ZnENomEGwzM5gxshY9z+24btjEzMEvO3IZHy4HEZoOEDwxslg3Mm41ze24zArWwMfPi03L+IVgLj8EBBjNpy57b9oS13EhsfAB0mITBARYzaYYftxOJ0PIQqOWMhIFkMzCQextuJ7cxMzbj98v55AMHfxyzqe9nbz744Mef27bz25sPfviIRwsUSECig7ENxAHFFPHgDymKR8EoGAWjYKQAAOCEU/Lea5JVAAAAAElFTkSuQmCC","orcid":"","institution":"Sir Sayajirao General Hospital Medical College","correspondingAuthor":true,"prefix":"","firstName":"Malvik","middleName":"","lastName":"Patel","suffix":""}],"badges":[],"createdAt":"2026-04-25 08:23:37","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9523683/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9523683/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108409973,"identity":"cfc8140a-0968-4116-a456-d2ac3d925a2a","added_by":"auto","created_at":"2026-05-04 10:04:34","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":647693,"visible":true,"origin":"","legend":"\u003cp\u003eAP radiograph of the right shoulder showing acromioclavicular joint space narrowing and osteophyte formation.\u003c/p\u003e","description":"","filename":"image1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-9523683/v1/c2e2e201d592cfd58c1cca8c.jpeg"},{"id":108492613,"identity":"094f4b01-5bf5-4707-8464-8786f023dabb","added_by":"auto","created_at":"2026-05-05 09:58:10","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":774179,"visible":true,"origin":"","legend":"\u003cp\u003eMRI sagittal view demonstrating supraspinatus tendinosis and subacromial-subdeltoid bursitis.\u003c/p\u003e","description":"","filename":"image2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9523683/v1/1d234633da0e90ff2af28c32.jpg"},{"id":108409975,"identity":"a6ad2000-9111-4e0c-b1f5-b0b614933242","added_by":"auto","created_at":"2026-05-04 10:04:34","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":1000027,"visible":true,"origin":"","legend":"\u003cp\u003eMRI axial view showing degenerative changes of the acromioclavicular joint.\u003c/p\u003e","description":"","filename":"image3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-9523683/v1/48a760948a96591b8b2e361e.jpg"},{"id":108803895,"identity":"d1edb63c-48c0-4c9d-b5b4-319e19321422","added_by":"auto","created_at":"2026-05-08 15:10:10","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2513400,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9523683/v1/f2708eb6-64e9-4131-9931-b50e1c100b41.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Subacromial-subdeltoid bursitis and acromioclavicular arthrosis presenting as a palpable shoulder mass","fulltext":[{"header":"Case","content":"\u003cp\u003ePalpable shoulder masses are uncommon and often raise concern for neoplastic or cystic lesions. Common causes include lipoma, ganglion cyst, and osteochondroma. Subacromial-subdeltoid bursitis is a frequent cause of shoulder pain, but rarely presents as a discrete mass (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). In contrast, acromioclavicular joint osteoarthritis is highly prevalent with aging and may produce a palpable bony prominence (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). We report a case where combined bursitis and AC joint arthrosis presented as a painless shoulder lump, emphasizing the importance of imaging in diagnosis.\u003c/p\u003e \u003cp\u003eA 56-year-old male presented with a 3-month history of a right shoulder lump. He was otherwise healthy, with no history of trauma, systemic disease, or substance use. The mass was firm, approximately 2 \u0026times; 2 cm, located over the superior aspect of the shoulder, and initially asymptomatic. There was no associated redness, warmth, or limitation of motion.\u003c/p\u003e \u003cp\u003eOn examination, the mass was hard and fixed at the AC joint region. The shoulder demonstrated a full active and passive range of motion without pain. There was mild tenderness over the AC joint on direct palpation, while the cross-body adduction test was negative. No rotator cuff weakness or impingement signs were noted.\u003c/p\u003e \u003cp\u003ePlain radiographs revealed severe AC joint arthrosis with joint space narrowing and osteophyte formation. Magnetic resonance imaging showed supraspinatus tendinosis with intact fibers, mild subacromial-subdeltoid bursitis, minimal glenohumeral effusion, and advanced degenerative changes of the AC joint. No rotator cuff tear, labral injury, or neoplastic lesion was identified.\u003c/p\u003e \u003cp\u003eThe patient was treated conservatively with non-steroidal anti-inflammatory drugs and physiotherapy focusing on rotator cuff strengthening and range-of-motion exercises. Symptoms improved over a 4-week period, and no invasive intervention was required.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis case demonstrates an unusual presentation of common shoulder pathologies as a palpable mass. The differential diagnosis of a palpable shoulder mass includes lipoma, ganglion cyst, osteochondroma, and soft tissue tumors. In such cases, clinical examination alone may be insufficient, and imaging plays a crucial role in distinguishing benign degenerative conditions from potentially malignant lesions. Subacromial-subdeltoid bursitis typically presents with pain and impingement symptoms rather than a discrete swelling (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Similarly, acromioclavicular joint osteoarthritis is frequently asymptomatic despite its high prevalence in older individuals (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). However, osteophyte formation at the AC joint can produce a visible and palpable prominence. This presentation is clinically important as it can closely mimic a neoplastic lesion, potentially leading to unnecessary biopsy or surgical intervention if not correctly identified.\u003c/p\u003e \u003cp\u003eIn this patient, the combination of AC joint osteophytes and associated bursitis contributed to the clinical presentation. Imaging played a crucial role in excluding sinister causes and confirming a benign etiology. Interestingly, despite advanced acromioclavicular joint arthrosis on imaging, the cross-body adduction test was negative, underscoring the potential discordance between clinical examination and radiological findings. Radiographs are useful for identifying bony changes, while magnetic resonance imaging provides a detailed assessment of soft tissue structures (3).\u003c/p\u003e \u003cp\u003eManagement of both conditions is primarily conservative, including rest, non-steroidal anti-inflammatory drugs, and physiotherapy (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Corticosteroid injections may be considered for persistent symptoms, while surgical intervention is reserved for refractory cases.\u003c/p\u003e \u003cp\u003eTo our knowledge, presentation of combined subacromial bursitis and acromioclavicular arthrosis as a discrete palpable mass in a patient without systemic disease is rarely reported (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). This case highlights the importance of correlating clinical findings with imaging to accurately diagnose benign degenerative conditions presenting as a palpable shoulder mass and to avoid unnecessary invasive procedures.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003eAuthor contributions\u003c/p\u003e\n\u003cp\u003eMP: Concept, data collection, manuscript drafting, and revision.\u003c/p\u003e\n\u003cp\u003eData sharing statement\u003c/p\u003e\n\u003cp\u003eNo additional data available.\u003c/p\u003e\n\u003cp\u003eFunding: None\u003c/p\u003e\n\u003cp\u003eConflict of interest: None declared\u003c/p\u003e\n\u003cp\u003eEthical approval: Not required for a single case report as per institutional policy\u003c/p\u003e\n\u003cp\u003ePatient consent: Written informed consent was obtained\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eJain NB, Khazzam MS. Degenerative Rotator-Cuff Disorders. N Engl J Med. 2024;391(21):2027\u0026ndash;34. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1056/NEJMcp1909797\u003c/span\u003e\u003cspan address=\"10.1056/NEJMcp1909797\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRossano A, Manohar N, Veenendaal WJ, Van Den Bekerom MPJ, Ring D, Fatehi A. Prevalence of acromioclavicular joint osteoarthritis in people not seeking care: A systematic review. J Orthop. 2022;32:85\u0026ndash;91. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jor.2022.05.009\u003c/span\u003e\u003cspan address=\"10.1016/j.jor.2022.05.009\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDraghi F, Scudeller L, Draghi AG, Bortolotto C. Prevalence of subacromial-subdeltoid bursitis in shoulder pain: an ultrasonographic study. J Ultrasound. 2015;18(2):151\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s40477-015-0167-0\u003c/span\u003e\u003cspan address=\"10.1007/s40477-015-0167-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDiercks R, Bron C, Dorrestijn O, Meskers C, Naber R, de Ruiter T, et al. Guideline for diagnosis and treatment of subacromial pain syndrome: a multidisciplinary review by the Dutch Orthopaedic Association. Acta Orthop. 2014;85(3):314\u0026ndash;22. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3109/17453674.2014.920991\u003c/span\u003e\u003cspan address=\"10.3109/17453674.2014.920991\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKashid M, Rai SK, Chakrabarty B. Rare Presentation of Subacromial Bursitis Mimics Neoplasm in a Case of Rheumatoid Arthritis. J Orthop Case Rep. 2020;9(6):23\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.13107/jocr.2019.v09.i06.1572\u003c/span\u003e\u003cspan address=\"10.13107/jocr.2019.v09.i06.1572\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-musculoskeletal-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmsd","sideBox":"Learn more about [BMC Musculoskeletal Disorders](http://bmcmusculoskeletdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12891","title":"BMC Musculoskeletal Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Shoulder, Subacromial-subdeltoid bursitis, Acromioclavicular joint osteoarthritis, Shoulder mass, Magnetic resonance imaging, Rotator cuff","lastPublishedDoi":"10.21203/rs.3.rs-9523683/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9523683/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eA 56-year-old man presented with a firm, non-tender 2 \u0026times; 2 cm mass over the superior aspect of the right shoulder without restriction of motion. Plain radiographs demonstrated severe acromioclavicular (AC) joint osteoarthritis with joint space narrowing and osteophyte formation. Magnetic resonance imaging revealed supraspinatus tendinosis, mild subacromial-subdeltoid bursitis, and advanced AC joint arthrosis without rotator cuff tear or labral injury. The imaging findings explained the palpable prominence at the AC joint. The patient was managed conservatively with non-steroidal anti-inflammatory drugs and physiotherapy, resulting in symptomatic improvement. This case highlights that common degenerative shoulder conditions can present as a palpable mass, potentially mimicking neoplastic lesions. Careful clinical and radiological correlation is essential to avoid unnecessary invasive procedures.\u003c/p\u003e","manuscriptTitle":"Subacromial-subdeltoid bursitis and acromioclavicular arthrosis presenting as a palpable shoulder mass","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-04 10:04:30","doi":"10.21203/rs.3.rs-9523683/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorAssigned","content":"","date":"2026-05-04T05:22:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-05-04T05:21:52+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Musculoskeletal Disorders","date":"2026-04-25T08:18:08+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-musculoskeletal-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmsd","sideBox":"Learn more about [BMC Musculoskeletal Disorders](http://bmcmusculoskeletdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12891","title":"BMC Musculoskeletal Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a88581b0-5190-4414-ada8-f8673f027cca","owner":[],"postedDate":"May 4th, 2026","published":true,"recentEditorialEvents":[{"type":"editorAssigned","content":"","date":"2026-05-04T05:22:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-05-04T05:21:52+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-07T00:54:22+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-04 10:04:30","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9523683","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9523683","identity":"rs-9523683","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}