What are small sacs made of connective tissue; lined with synovial membrane and filled with synovial fluid?
Bursae
What is the inflammation of bursae?
Bursitis
What is the etiology?
- Overuse (constant friction), most common in physically active individuals
- Usually secondary to other conditions such as tendinopathy
- Less commonly due to acute trauma, infections
- Muscle imbalances / postural dysfunction
- Altered biomechanics
- Hypo / Hypermobility
What are the common locations?
- Olecranon - “Student’s Elbow”
- Prepatellar - “Housemaid’s knee”
- Subacromial
- Trochanteric
- Ischial - “Bench warmer’s bursitis”
- Popliteal - “Baker’s Cyst”
- Retrocalcaneal - “Achilles Bursitis”
What is the MOI of olecranon bursitis / “students elbow”?`
- Repeated pressure on the elbow
- Trauma
What is the MOI of prepatellar bursitis / “housemaid’s knee”?
- Repeated pressure on the knee
What is the MOI of subacromial?
- Tendinopathy (often calcific)
- Impingement
- FOOSH
What is the MOI of trochanteric bursitis?
- Repetitive actions
- Altered biomechanics
- ITB contracture
- Osteoarthritis
- Surgery
What is the MOI of ischial bursitis / “Bench Warmer’s Bursitis or Weaver’s Bottom”
- Sitting on hard surfaces for long periods
- Fall on the ischial tuberosity
- Excessive sprinting
What is the MOI of popliteal / “Baker’s Cyst”?
- Knee problems
- Arthritis, meniscus tear
What is the MOI of retrocalcaneal bursitis / “Achilles Bursitis”?
- Overuse
- Hypertonic, triceps surae
What are signs & symptoms of acute bursitis?
- Pain at rest & during activity
- Pain is constant pain
- Deep burning - Inflammation, especially apparent if the bursa is superficial
- The deeper the bursa, the harder it is to see - Limited ROM due to pain & protective spasm
- Ex. subacromial - anything past 90 degrees of abduction, flexion & external rotation
What are the signs & symptoms of chronic bursitis?
- Pain during activity or with compression
- more localized than in acute - Chronic inflammation
- Fibrosis & adhesions
- Limited ROM, less so than in acute
- Flare ups may occur
What are contraindications & precautions?
- In acute, do not compress the bursa or place drag nearby tissue
- Ex. myofascial release, put direction TOWARDS bursa - No local treatment in acute
- If infection is suspected, refer for medial attention
What are contraindications & precautions?
- In acute, do not compress the bursa or place drag on nearby tissue (MFR away from bursa)
- No local treatment in acute
- If infective, refer for medical attention
What are assessments in acute?
- Visible swelling and redness
- Antalgic gait and/or posture
- Heat local to bursa
- Spasm, HT & TPs in muscles that cross the bursa
- Possible pained facial expression
- AROM limited in most directions due to pain
- PROM marked limitation and empty end feels due to pain
- RROM painful; pain is constant when bursa is compressed
- Potential impact on ADLs
- Special tests : pain in any test that compresses the bursa
What are assessments in chronic?
- Postural assessment for muscle imbalances
- Palpation : adhesions, HT, TPs; possible bogginess from chronic inflammation or adh
- AROM pain typically experienced in a single movement at end range (ones that compress the bursa the most)
- PROM & RROM pain in movements(s) that compress the bursa
- Same as acutr
What are goals in acute?
- Reduce edema and pain (MLD won’t work for swelling in bursa)
- Prevent excess adhesion formation & reduce those that form
- Maintain function & mobility
- Normalize muscle tone to reduce stress on the bursa
What are goals in chronic?
- Reduce TPs
- Restore painless ROM
- Restore strength
What are techniques?
- Edema reduced via elevation, cold application or lymphatic drainage
- Positioning during treatment should never compress the bursa
- Kneading, Stripping
- Cross fibre kneading
5.
What are homecares?
- RICE in acute & in flare ups
- Pain free gentle isometrics as soon as tolerated in acute or subacute/post acute
- Breathing exercises for pain reduction in acute
- Stretching
- Strengthening progress to isotonic
- Self massage or foam rolling
- Heat or contrast applications
