Podcast
Questions and Answers
What is the main purpose of a bursa in the body?
What is the main purpose of a bursa in the body?
Which type of bursitis is most commonly associated with overuse of the shoulder in overhead movements?
Which type of bursitis is most commonly associated with overuse of the shoulder in overhead movements?
Where is the subscapular bursa located?
Where is the subscapular bursa located?
Which term best describes a bursa?
Which term best describes a bursa?
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What causes bursitis in the knee region between the patella and tibia?
What causes bursitis in the knee region between the patella and tibia?
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Which bursa is not independent of the joint capsule?
Which bursa is not independent of the joint capsule?
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Bursitis is inflammation of the ______
Bursitis is inflammation of the ______
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A ______ is a small flat sac lined with synovium
A ______ is a small flat sac lined with synovium
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The purpose of having a bursa is to decrease ______ usually between tendons and bones
The purpose of having a bursa is to decrease ______ usually between tendons and bones
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The subacromial / subdeltoid bursitis occurs between supraspinatus, ______, and coracoacromial ligament
The subacromial / subdeltoid bursitis occurs between supraspinatus, ______, and coracoacromial ligament
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The ______ bursa communicates with the shoulder capsule
The ______ bursa communicates with the shoulder capsule
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The ______ infrapatellar bursa is a common site of bursitis
The ______ infrapatellar bursa is a common site of bursitis
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Where is the ischial bursa located?
Where is the ischial bursa located?
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What is a common cause of trochanteric bursitis?
What is a common cause of trochanteric bursitis?
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Which bursa is known as 'clergyman’s knee'?
Which bursa is known as 'clergyman’s knee'?
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How is the iliopectineal bursa typically palpated?
How is the iliopectineal bursa typically palpated?
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Which activity can irritate the olecranon bursa?
Which activity can irritate the olecranon bursa?
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What is a potential cause of pes anserine bursitis?
What is a potential cause of pes anserine bursitis?
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The ______ bursa lies between the iliopsoas muscle and the iliofemoral ligament.
The ______ bursa lies between the iliopsoas muscle and the iliofemoral ligament.
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The ______ bursa lies between the gluteus maximus tendon and the greater trochanter.
The ______ bursa lies between the gluteus maximus tendon and the greater trochanter.
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The ______ bursa lies between the tendons of the pes anserine muscles and the medial tibia.
The ______ bursa lies between the tendons of the pes anserine muscles and the medial tibia.
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The ______ bursa lies between the skin and the patellar ligament/tibial tuberosity.
The ______ bursa lies between the skin and the patellar ligament/tibial tuberosity.
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The ______ bursa lies between the Achilles tendon and the calcaneus.
The ______ bursa lies between the Achilles tendon and the calcaneus.
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The ______ bursa lies between the lower half of the patella, the patellar ligament and the skin.
The ______ bursa lies between the lower half of the patella, the patellar ligament and the skin.
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What is the common cause of Baker's Cyst?
What is the common cause of Baker's Cyst?
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Which condition can interfere with knee movement?
Which condition can interfere with knee movement?
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What can lead to the formation of a Bunion?
What can lead to the formation of a Bunion?
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Which condition can be associated with enlarged lymph nodes and fever?
Which condition can be associated with enlarged lymph nodes and fever?
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What type of dysfunction is commonly linked to trochanteric bursitis?
What type of dysfunction is commonly linked to trochanteric bursitis?
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What might lead to muscle imbalances causing bursitis?
What might lead to muscle imbalances causing bursitis?
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Baker's Cyst is a synovial cyst that usually appears on the medial side of the ______ space.
Baker's Cyst is a synovial cyst that usually appears on the medial side of the ______ space.
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Bunion is formed by excessive bone growth, a callus and an inflamed, thickened ______ developing over the joint.
Bunion is formed by excessive bone growth, a callus and an inflamed, thickened ______ developing over the joint.
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Muscle imbalances, poor biomechanics and postural dysfunction such as ______, hyperkyphosis, and lack of flexibility can lead to bursitis.
Muscle imbalances, poor biomechanics and postural dysfunction such as ______, hyperkyphosis, and lack of flexibility can lead to bursitis.
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A ______ is a small flat sac lined with synovium.
A ______ is a small flat sac lined with synovium.
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The ______ bursa lies between the skin and the patellar ligament/tibial tuberosity.
The ______ bursa lies between the skin and the patellar ligament/tibial tuberosity.
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The ______ bursa lies between the tendons of the pes anserine muscles and the medial tibia.
The ______ bursa lies between the tendons of the pes anserine muscles and the medial tibia.
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What is the primary symptom of acute bursitis?
What is the primary symptom of acute bursitis?
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How does the range of motion (ROM) of the affected joint differ between acute and chronic bursitis?
How does the range of motion (ROM) of the affected joint differ between acute and chronic bursitis?
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Which of the following is NOT a common symptom of chronic bursitis?
Which of the following is NOT a common symptom of chronic bursitis?
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What is the main purpose of a bursa in the body?
What is the main purpose of a bursa in the body?
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What is a potential cause of pes anserine bursitis?
What is a potential cause of pes anserine bursitis?
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Which type of bursitis is most commonly associated with overuse of the shoulder in overhead movements?
Which type of bursitis is most commonly associated with overuse of the shoulder in overhead movements?
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Which of the following is NOT a characteristic of bursitis caused by the bursa being pinched?
Which of the following is NOT a characteristic of bursitis caused by the bursa being pinched?
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What is a contraindication for treating acute bursitis?
What is a contraindication for treating acute bursitis?
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Which of the following special orthopedic tests is used to diagnose bursitis?
Which of the following special orthopedic tests is used to diagnose bursitis?
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In which stage of bursitis is it important to avoid compressing the bursa?
In which stage of bursitis is it important to avoid compressing the bursa?
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What should be done if a patient presents with infective bursitis?
What should be done if a patient presents with infective bursitis?
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Which of the following is a characteristic of bursitis caused by the bursa being completely surrounded by other structures?
Which of the following is a characteristic of bursitis caused by the bursa being completely surrounded by other structures?
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The ______ is compressed and irritated by surrounding structures
The ______ is compressed and irritated by surrounding structures
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Acute bursitis may refer pain some distance from the ______
Acute bursitis may refer pain some distance from the ______
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Chronic bursitis is characterized by pain that is more localized to the ______
Chronic bursitis is characterized by pain that is more localized to the ______
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Joints proximal and distal may have reduced range if crossed by a muscle or fascia that also crosses the affected ______
Joints proximal and distal may have reduced range if crossed by a muscle or fascia that also crosses the affected ______
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Other conditions, such as tendonitis, may be present alongside ______
Other conditions, such as tendonitis, may be present alongside ______
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Assessment of range of motion in acute bursitis may be restricted due to pain when an antagonist muscle is lengthening over the ______
Assessment of range of motion in acute bursitis may be restricted due to pain when an antagonist muscle is lengthening over the ______
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The pain is a result of the ______ being pinched from the humerus, acromion, and coracoacromial ligament. Reduced with empty end-feel AR ROM. Painful for ______ that are completely surrounded by other structures like subacromial, trochanteric. Pain levels stay constant when compressed. Same as acute stage with less pain. Special Orthopedic Test (SOT). Any test which compresses a ______ either by muscle contraction of positioning will be positive. Same as acute stage with less pain. SOT Examples. These tests are covered in CL20 and will not be covered in MT20. Ober’s test. Rectus Femoris Contracture Test. Painful Arc Impingement Shoulder Test. Neer Impingement Test. Hawkins-Kennedy Impingement Test. Contraindications in Treatment. Avoid compressing the ______ in the acute stage. Ex: Stretching muscles that cross the ______, positioning the client where they are laying on the ______. No drag or onsite techniques with acute bursitis – use your hand to hold or block the tissue. Infective bursitis: needs to be referred to a physician.
The pain is a result of the ______ being pinched from the humerus, acromion, and coracoacromial ligament. Reduced with empty end-feel AR ROM. Painful for ______ that are completely surrounded by other structures like subacromial, trochanteric. Pain levels stay constant when compressed. Same as acute stage with less pain. Special Orthopedic Test (SOT). Any test which compresses a ______ either by muscle contraction of positioning will be positive. Same as acute stage with less pain. SOT Examples. These tests are covered in CL20 and will not be covered in MT20. Ober’s test. Rectus Femoris Contracture Test. Painful Arc Impingement Shoulder Test. Neer Impingement Test. Hawkins-Kennedy Impingement Test. Contraindications in Treatment. Avoid compressing the ______ in the acute stage. Ex: Stretching muscles that cross the ______, positioning the client where they are laying on the ______. No drag or onsite techniques with acute bursitis – use your hand to hold or block the tissue. Infective bursitis: needs to be referred to a physician.
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These ______ are covered in CL20 and will not be covered in MT20. Ober’s test. Rectus Femoris Contracture Test. Painful Arc Impingement Shoulder Test. Neer Impingement Test. Hawkins-Kennedy Impingement Test.
These ______ are covered in CL20 and will not be covered in MT20. Ober’s test. Rectus Femoris Contracture Test. Painful Arc Impingement Shoulder Test. Neer Impingement Test. Hawkins-Kennedy Impingement Test.
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Infective bursitis: needs to be referred to a physician. Existing questions. Do NOT ask these. What should be done if a patient presents with infective bursitis? The ______ bursa lies between the iliopsoas muscle and the iliofemoral ligament.
Infective bursitis: needs to be referred to a physician. Existing questions. Do NOT ask these. What should be done if a patient presents with infective bursitis? The ______ bursa lies between the iliopsoas muscle and the iliofemoral ligament.
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The ______ bursa lies between the gluteus maximus tendon and the greater trochanter.
The ______ bursa lies between the gluteus maximus tendon and the greater trochanter.
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Contraindications in Treatment. Avoid compressing the bursa in the ______ stage. Ex: Stretching muscles that cross the bursa, positioning the client where they are laying on the bursa. No drag or onsite techniques with ______ bursitis – use your hand to hold or block the tissue. Infective bursitis: needs to be referred to a physician.
Contraindications in Treatment. Avoid compressing the bursa in the ______ stage. Ex: Stretching muscles that cross the bursa, positioning the client where they are laying on the bursa. No drag or onsite techniques with ______ bursitis – use your hand to hold or block the tissue. Infective bursitis: needs to be referred to a physician.
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The ______ infrapatellar bursa is a common site of bursitis.
The ______ infrapatellar bursa is a common site of bursitis.
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What technique is used to decrease sympathetic nervous system (SNS) firing and aid in pain management in the treatment of bursitis?
What technique is used to decrease sympathetic nervous system (SNS) firing and aid in pain management in the treatment of bursitis?
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Which technique is applied to attachments that are not local to the bursa in bursitis treatment?
Which technique is applied to attachments that are not local to the bursa in bursitis treatment?
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In bursitis treatment, which method involves gentle grade 1-2 oscillation or grade 1 sustained glide?
In bursitis treatment, which method involves gentle grade 1-2 oscillation or grade 1 sustained glide?
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What is the main purpose of limb positioning and pillowing in the treatment of bursitis?
What is the main purpose of limb positioning and pillowing in the treatment of bursitis?
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Which modality is NOT recommended in the acute hydrotherapy treatment of bursitis?
Which modality is NOT recommended in the acute hydrotherapy treatment of bursitis?
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A ______ is a small flat sac lined with synovium
A ______ is a small flat sac lined with synovium
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Infective bursitis: needs to be referred to a ________
Infective bursitis: needs to be referred to a ________
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The ______ bursa lies between the iliopsoas muscle and the iliofemoral ligament.
The ______ bursa lies between the iliopsoas muscle and the iliofemoral ligament.
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The ______ bursa lies between the tendons of the pes anserine muscles and the medial tibia.
The ______ bursa lies between the tendons of the pes anserine muscles and the medial tibia.
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The ______ bursa communicates with the shoulder capsule
The ______ bursa communicates with the shoulder capsule
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Acute bursitis should be treated with heavy cold therapy, such as a frozen towel.
Acute bursitis should be treated with heavy cold therapy, such as a frozen towel.
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Petrissage massage techniques can be used to decrease sympathetic nervous system firing and aid in pain management for bursitis.
Petrissage massage techniques can be used to decrease sympathetic nervous system firing and aid in pain management for bursitis.
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Joint play techniques involving gentle grade 1-2 oscillation or grade 1 sustained glide are contraindicated in the treatment of bursitis.
Joint play techniques involving gentle grade 1-2 oscillation or grade 1 sustained glide are contraindicated in the treatment of bursitis.
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Muscle imbalances, poor biomechanics, and postural dysfunction like scoliosis can lead to the development of bursitis.
Muscle imbalances, poor biomechanics, and postural dysfunction like scoliosis can lead to the development of bursitis.
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Infective bursitis should be treated with the same techniques as non-infective bursitis.
Infective bursitis should be treated with the same techniques as non-infective bursitis.
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The ______ bursa lies between the tendons of the pes anserine muscles and the medial tibia.
The ______ bursa lies between the tendons of the pes anserine muscles and the medial tibia.
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The subacromial / subdeltoid bursitis occurs between supraspinatus, ______, and coracoacromial ligament.
The subacromial / subdeltoid bursitis occurs between supraspinatus, ______, and coracoacromial ligament.
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The pain is a result of the ______ being pinched from the humerus, acromion, and coracoacromial ligament.
The pain is a result of the ______ being pinched from the humerus, acromion, and coracoacromial ligament.
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Contraindications in Treatment. Avoid compressing the ______ in the acute stage.
Contraindications in Treatment. Avoid compressing the ______ in the acute stage.
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The ______ infrapatellar bursa is a common site of bursitis.
The ______ infrapatellar bursa is a common site of bursitis.
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Baker's Cyst is a synovial cyst that usually appears on the medial side of the ______ space.
Baker's Cyst is a synovial cyst that usually appears on the medial side of the ______ space.
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In bursitis treatment, which method involves gentle grade 1-2 oscillation or grade 1 sustained glide?
In bursitis treatment, which method involves gentle grade 1-2 oscillation or grade 1 sustained glide?
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The ______ infrapatellar bursa is a common site of bursitis.
The ______ infrapatellar bursa is a common site of bursitis.
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The ______ bursa lies between the lower half of the patella, the patellar ligament and the skin.
The ______ bursa lies between the lower half of the patella, the patellar ligament and the skin.
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The pain is a result of the ______ being pinched from the humerus, acromion, and coracoacromial ligament.
The pain is a result of the ______ being pinched from the humerus, acromion, and coracoacromial ligament.
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Which bursa is located between the supraspinatus tendon, the acromion, and the coracoacromial ligament?
Which bursa is located between the supraspinatus tendon, the acromion, and the coracoacromial ligament?
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What technique should be avoided in the acute stage of bursitis treatment?
What technique should be avoided in the acute stage of bursitis treatment?
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Which of the following is a potential cause of pes anserine bursitis?
Which of the following is a potential cause of pes anserine bursitis?
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Which technique should be used with caution in the treatment of bursitis?
Which technique should be used with caution in the treatment of bursitis?
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In the treatment of bursitis, what is the main purpose of positioning and pillowing?
In the treatment of bursitis, what is the main purpose of positioning and pillowing?
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In the treatment of bursitis, it is recommended to introduce massage techniques to the inflamed site during the early stage.
In the treatment of bursitis, it is recommended to introduce massage techniques to the inflamed site during the early stage.
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Contrast towels are used in the late stage of bursitis treatment.
Contrast towels are used in the late stage of bursitis treatment.
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It is important to compress the bursa directly during massage techniques in the treatment of bursitis.
It is important to compress the bursa directly during massage techniques in the treatment of bursitis.
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The main purpose of limb positioning and pillowing in bursitis treatment is to promote compression on the affected bursa.
The main purpose of limb positioning and pillowing in bursitis treatment is to promote compression on the affected bursa.
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The subacromial bursa communicates with the shoulder capsule.
The subacromial bursa communicates with the shoulder capsule.
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What is the main purpose of a bursa in the body?
What is the main purpose of a bursa in the body?
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Which of the following is a potential cause of pes anserine bursitis?
Which of the following is a potential cause of pes anserine bursitis?
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In which stage of bursitis is it important to avoid compressing the bursa?
In which stage of bursitis is it important to avoid compressing the bursa?
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What technique should be used with caution in the treatment of bursitis?
What technique should be used with caution in the treatment of bursitis?
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Which of the following special orthopedic tests is used to diagnose bursitis?
Which of the following special orthopedic tests is used to diagnose bursitis?
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The ______ bursa lies between the skin and the patellar ligament/tibial tuberosity.
The ______ bursa lies between the skin and the patellar ligament/tibial tuberosity.
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The subacromial / subdeltoid bursitis occurs between supraspinatus, ______, and coracoacromial ligament.
The subacromial / subdeltoid bursitis occurs between supraspinatus, ______, and coracoacromial ligament.
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Contraindications in Treatment. Avoid compressing the bursa in the ______ stage.
Contraindications in Treatment. Avoid compressing the bursa in the ______ stage.
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Infective bursitis: needs to be referred to a ______.
Infective bursitis: needs to be referred to a ______.
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A ______ is a small flat sac lined with synovium.
A ______ is a small flat sac lined with synovium.
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Contrast application is used post-treatment for bursitis to increase circulation and drainage.
Contrast application is used post-treatment for bursitis to increase circulation and drainage.
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In the treatment of bursitis, it is recommended to introduce massage techniques to the inflamed site during the early stage.
In the treatment of bursitis, it is recommended to introduce massage techniques to the inflamed site during the early stage.
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Stretching of muscles that cross the bursa is a recommended technique for chronic bursitis treatment.
Stretching of muscles that cross the bursa is a recommended technique for chronic bursitis treatment.
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Infective bursitis should be treated with the same techniques as non-infective bursitis.
Infective bursitis should be treated with the same techniques as non-infective bursitis.
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The main purpose of limb positioning and pillowing in bursitis treatment is to promote compression on the affected bursa.
The main purpose of limb positioning and pillowing in bursitis treatment is to promote compression on the affected bursa.
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The ______ infrapatellar bursa is a common site of bursitis.
The ______ infrapatellar bursa is a common site of bursitis.
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The ______ bursa lies between the tendons of the pes anserine muscles and the medial tibia.
The ______ bursa lies between the tendons of the pes anserine muscles and the medial tibia.
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The ______ bursa lies between the iliopsoas muscle and the iliofemoral ligament.
The ______ bursa lies between the iliopsoas muscle and the iliofemoral ligament.
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The ______ bursa communicates with the shoulder capsule
The ______ bursa communicates with the shoulder capsule
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The ______ bursa lies between the skin and the patellar ligament/tibial tuberosity.
The ______ bursa lies between the skin and the patellar ligament/tibial tuberosity.
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The ______ bursa lies between the lower half of the patella, the patellar ligament and the skin.
The ______ bursa lies between the lower half of the patella, the patellar ligament and the skin.
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The subacromial / subdeltoid bursitis occurs between supraspinatus, ______, and coracoacromial ligament.
The subacromial / subdeltoid bursitis occurs between supraspinatus, ______, and coracoacromial ligament.
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Muscle imbalances, poor biomechanics and postural dysfunction such as ______, hyperkyphosis, and lack of flexibility can lead to bursitis.
Muscle imbalances, poor biomechanics and postural dysfunction such as ______, hyperkyphosis, and lack of flexibility can lead to bursitis.
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The ______ bursa communicates with the shoulder capsule.
The ______ bursa communicates with the shoulder capsule.
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The purpose of having a bursa is to decrease ______ usually between tendons and bones.
The purpose of having a bursa is to decrease ______ usually between tendons and bones.
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Infective bursitis requires referral to a physician.
Infective bursitis requires referral to a physician.
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The purpose of a bursa is to increase friction between tendons and bones.
The purpose of a bursa is to increase friction between tendons and bones.
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Chronic bursitis is characterized by localized pain, while acute bursitis often refers pain to a wider area.
Chronic bursitis is characterized by localized pain, while acute bursitis often refers pain to a wider area.
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Petrissage massage techniques should be avoided in the treatment of bursitis, as they can increase sympathetic nervous system firing and worsen pain.
Petrissage massage techniques should be avoided in the treatment of bursitis, as they can increase sympathetic nervous system firing and worsen pain.
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Joint play techniques involving gentle grade 1-2 oscillation or grade 1 sustained glide are recommended in the treatment of bursitis.
Joint play techniques involving gentle grade 1-2 oscillation or grade 1 sustained glide are recommended in the treatment of bursitis.
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Study Notes
Types of Bursitis
- Olecranon bursitis:
- Located between the olecranon and subcutaneous fascia
- AKA "student elbow"
- Irritated by repetitive weight bearing or trauma
- Iliopectineal bursitis:
- Located between the iliopsoas muscle and the iliofemoral ligament
- Palpated with client seated, hip flexed to 90 degrees, and located 1-2cm inferior to the inguinal ligament
- Caused by hip flexor tightness and repetitive activity
- Trochanteric bursitis:
- One between gluteus maximus tendon and greater trochanter
- Another between gluteus medius and greater trochanter
- Palpated through the gluteal tendons at the lateral hip
- Pain is local to the lateral thigh and can also radiate down to the IT band
- Caused by altered hip biomechanics, leg length discrepancy, low back pain, OA, surgery, RSI, and ITB contracture
- Ischial bursitis:
- Located between the gluteus maximus and the ischial tuberosity
- Palpated through gluteus maximus
- AKA "bench warmers bursitis"
- Caused by sitting on hard surfaces for long periods of time and hamstring contractures associated with sprinting
- Pes Anserine bursitis:
- Located between the tendons of the pes anserine muscles (sartorius, gracilis, and semitendinosus) and the medial tibia
- Palpated through the pes anserine tendons
- Associated with knee bursitis
- Caused by occupations involving frequent kneeling
- Patellar bursitis:
- Supperificial (Subcutaneous) Infrapatellar Bursa:
- Located between the skin and patellar ligament/tibial tuberosity
- AKA "clergyman's knee"
- Deep Infrapatellar Bursa:
- Located between the patellar ligament and the tibia
- Palpated through overlying tendons
- Prepatellar Bursa:
- Located between the lower half of the patella, the patellar ligament, and the skin
- AKA "housemaids knee"
- Suprapatellar Bursa:
- Located superficial to the femur and deep to quadriceps tendon
- AKA "quadriceps bursa"
- Can infect the knee joint
- Supperificial (Subcutaneous) Infrapatellar Bursa:
- Retrocalcaneal bursitis:
- Located between the Achilles tendon and the calcaneus
- Can be palpated on either side of the tendon
- Caused by overuse and tight gastric-soleus complex
Other Types of Bursitis
- Baker's Cyst:
- Synovial cyst that usually appears on the medial side of the popliteal space
- Caused by herniation of the knee joint capsule or distention of the bursa between the gastrocnemius and semimembranosus
- Fluid escapes into the knee joint or bursa and is collected in the popliteal fossa
- Can interfere with knee movement
- Can disappear in less than 2 years if left untreated
- Bunion:
- Occurs at the first metatarsophalangeal joint capsule
- Formed by excessive bone growth, a callus, and an inflamed, thickened bursa developing over the joint
Causes of Bursitis
- Infection due to an open wound or through the bloodstream
- Muscle imbalances
- Poor biomechanics
- Postural dysfunction
- Overuse of structures surrounding the bursa
- Acute trauma
- Infection
- Pathologies (e.g. Gout, Rheumatoid Arthritis)
Signs and Symptoms of Bursitis
- Acute:
- Pain is deep and burning, at rest or on activity
- Pain may refer some distance from the bursa
- Pain may disturb sleep, especially if the bursa is compressed
- ROM of the affected joint is restricted
- Joints proximal and distal may have reduced range if crossed by a muscle or fascia that also crosses the affected bursa
- Other conditions, such as tendonitis, may be present
- Chronic:
- Pain or achiness is felt with activity or upon direct compression
- Pain is more localized to the bursa
- Chronic inflammation, fibrosis, and adhesions are present
- ROM of the affected joint is less restricted than in the acute stage
Assessment of Bursitis
- ROM:
- Acute:
- AF ROM: Restricted in most directions due to pain
- PR ROM: Severely reduced with empty end-feel
- AR ROM: Painful for bursa that are completely surrounded by other structures
- Chronic:
- AF ROM: Restricted in most directions due to pain
- PR ROM: Reduced with empty end-feel
- AR ROM: Painful for bursa that are completely surrounded by other structures
- Acute:
- Special Orthopedic Tests (SOTs):
- Any test that compresses a bursa either by muscle contraction or positioning will be positive
Contraindications in Treatment
- Avoid compressing the bursa in the acute stage
- No drag or onsite techniques with acute bursitis
- Infective bursitis: needs to be referred to a physician
Treatment of Bursitis
-
Acute:
- Hydrotherapy: Cold, not heavy, such as frozen towel or O-ring/donut cold towel
- Positioning and Pillowing: Limb is comfortably elevated, no compression on bursa
- Techniques:
- MLD/LD: Petrissage, decrease SNS firing and pain management, compensatory areas
- TrP Release: For muscles that refer to the area of the bursa, segmental stretch
- GTO Release and O+I: Applied only to attachments that are not local to the bursa
- Joint play: Gentle grade 1-2 oscillation or grade 1 sustained glide
- Stroking, Compressions, and Muscle Squeezing distally
- Pain-free PR-ROM and AA-ROM to proximal and distal joints
-
Subacute:
- Hydrotherapy: Early, same as acute; Late, contrast towels
- Positioning and Pillowing: Limb is comfortably elevated, no compression on bursa
- Techniques:
- Same as acute, with early stage
- Gradually introduce massage techniques to the inflamed site (P-C-P)
- Fingertip kneading toward the bursa
- Gentle friction (1-2 mins, 2-3 times, not all the time on 1 spot) around the bursa
- Always be careful not to compress the bursa### Treatment of Chronic Bursitis
-
Hydrotherapy involves deep moist heat before fascial work and contrast application post-treatment for increased circulation and drainage.
-
Positioning and pillowing: the limb is comfortably elevated with no compression on the bursa.
-
Techniques:
- Fascial techniques:
- To muscles crossing the bursa.
- Petrissage: same as acute/subacute work towards the bursa.
- Effleurage: around and through the bursa.
- C-Scoop or picking up techniques with the bursa in the center.
- Finger-tip kneading towards the bursa.
- Distal limb can be treated using circulatory techniques.
- TrP Release: same as acute.
- Frictions: 2-4 minutes, 2-3 times, for adhered structures surrounding the bursa.
- Stretching: for muscles that cross the bursa.
- Joint play: full PRROM and AFROM on any hypo-mobile joints.
- Fascial techniques:
Bursitis Overview
- Bursitis is inflammation of the bursa.
- A bursa is a small flat sac lined with synovium.
- The purpose of a bursa is to decrease friction, usually between tendons and bones.
- It is normally flat and only palpable when inflamed.
- Capsular relationship: bursas can be independent from the joint capsule or communicate with the joint capsule and be continuous with the synovial lining.
Common Sites of Bursitis and Causes
- Subacromial/Subdeltoid: between supraspinatus, acromion, and coracoacromial ligament, and between deltoid and humerus.
- Causes: overuse of the shoulder, especially in overhead movements or falling directly onto the shoulder.
- Subscapular: between capsule/scapula and subscapularis.
- Causes: similar to Subacromial/Subdeltoid.
- Other common sites: Prepatellar, Superficial infrapatellar, Deep infrapatellar, Pes Anserine, Suprapatellar, Popliteal, and Gastrocnemius/Semimembranosus.
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Description
Learn about bursitis, which is an inflammation of the bursa - a small flat sac lined with synovium. Understand the purpose of a bursa in decreasing friction between tendons and bones. Explore the relationship between bursas and joint capsules in the body.
