125 Questions
What is the main purpose of a bursa in the body?
To decrease friction between tendons and bones
Which type of bursitis is most commonly associated with overuse of the shoulder in overhead movements?
Subacromial bursitis
Where is the subscapular bursa located?
Between capsule and subscapularis
Which term best describes a bursa?
Flat sac lined with synovium
What causes bursitis in the knee region between the patella and tibia?
Overuse of the knee in squatting exercises
Which bursa is not independent of the joint capsule?
Subacromial bursa
Bursitis is inflammation of the ______
bursa
A ______ is a small flat sac lined with synovium
bursa
The purpose of having a bursa is to decrease ______ usually between tendons and bones
friction
The subacromial / subdeltoid bursitis occurs between supraspinatus, ______, and coracoacromial ligament
acromion
The ______ bursa communicates with the shoulder capsule
subscapular
The ______ infrapatellar bursa is a common site of bursitis
deep
Where is the ischial bursa located?
Between the gluteus maximus and the ischial tuberosity
What is a common cause of trochanteric bursitis?
Altered hip biomechanics
Which bursa is known as 'clergyman’s knee'?
Patellar Superficial Infrapatellar Bursa
How is the iliopectineal bursa typically palpated?
Located 1-2cm inferior to the inguinal ligament
Which activity can irritate the olecranon bursa?
Repeatedly dragging the elbow on the ground when wrestling
What is a potential cause of pes anserine bursitis?
Occupations involving frequent kneeling
The ______ bursa lies between the iliopsoas muscle and the iliofemoral ligament.
iliopectineal
The ______ bursa lies between the gluteus maximus tendon and the greater trochanter.
trochanteric
The ______ bursa lies between the tendons of the pes anserine muscles and the medial tibia.
pes anserine
The ______ bursa lies between the skin and the patellar ligament/tibial tuberosity.
prepatellar
The ______ bursa lies between the Achilles tendon and the calcaneus.
retrocalcaneal
The ______ bursa lies between the lower half of the patella, the patellar ligament and the skin.
prepatellar
What is the common cause of Baker's Cyst?
Synovial cavity link with the knee
Which condition can interfere with knee movement?
Baker's Cyst
What can lead to the formation of a Bunion?
Muscle imbalances and poor biomechanics
Which condition can be associated with enlarged lymph nodes and fever?
Rheumatoid Arthritis
What type of dysfunction is commonly linked to trochanteric bursitis?
Lack of flexibility
What might lead to muscle imbalances causing bursitis?
'Other Causes'
Baker's Cyst is a synovial cyst that usually appears on the medial side of the ______ space.
popliteal
Bunion is formed by excessive bone growth, a callus and an inflamed, thickened ______ developing over the joint.
bursa
Muscle imbalances, poor biomechanics and postural dysfunction such as ______, hyperkyphosis, and lack of flexibility can lead to bursitis.
scoliosis
A ______ is a small flat sac lined with synovium.
bursa
The ______ bursa lies between the skin and the patellar ligament/tibial tuberosity.
superficial infrapatellar
The ______ bursa lies between the tendons of the pes anserine muscles and the medial tibia.
pes anserine
What is the primary symptom of acute bursitis?
Deep, burning pain that disturbs sleep
How does the range of motion (ROM) of the affected joint differ between acute and chronic bursitis?
ROM is less restricted in the chronic stage compared to the acute stage
Which of the following is NOT a common symptom of chronic bursitis?
Swelling and redness around the bursa
What is the main purpose of a bursa in the body?
To decrease friction usually between tendons and bones
What is a potential cause of pes anserine bursitis?
Compression of the bursa by surrounding structures
Which type of bursitis is most commonly associated with overuse of the shoulder in overhead movements?
Subacromial/subdeltoid bursitis
Which of the following is NOT a characteristic of bursitis caused by the bursa being pinched?
Pain levels increase with compression
What is a contraindication for treating acute bursitis?
All of the above
Which of the following special orthopedic tests is used to diagnose bursitis?
Any test that compresses the bursa
In which stage of bursitis is it important to avoid compressing the bursa?
Acute stage
What should be done if a patient presents with infective bursitis?
Refer the patient to a physician
Which of the following is a characteristic of bursitis caused by the bursa being completely surrounded by other structures?
Pain is constant when compressed
The ______ is compressed and irritated by surrounding structures
bursa
Acute bursitis may refer pain some distance from the ______
bursa
Chronic bursitis is characterized by pain that is more localized to the ______
bursa
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 alongside ______
bursitis
Assessment of range of motion in acute bursitis may be restricted due to pain when an antagonist muscle is lengthening over the ______
bursa
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.
bursa
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.
tests
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.
iliopsoas
The ______ bursa lies between the gluteus maximus tendon and the greater trochanter.
gluteus
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.
acute
The ______ infrapatellar bursa is a common site of bursitis.
infrapatellar
What technique is used to decrease sympathetic nervous system (SNS) firing and aid in pain management in the treatment of bursitis?
Petrissage
Which technique is applied to attachments that are not local to the bursa in bursitis treatment?
Trigger Point (TrP) Release
In bursitis treatment, which method involves gentle grade 1-2 oscillation or grade 1 sustained glide?
Joint Play
What is the main purpose of limb positioning and pillowing in the treatment of bursitis?
To maintain comfort and avoid bursa compression
Which modality is NOT recommended in the acute hydrotherapy treatment of bursitis?
Hot pack
A ______ is a small flat sac lined with synovium
bursa
Infective bursitis: needs to be referred to a ________
physician
The ______ bursa lies between the iliopsoas muscle and the iliofemoral ligament.
iliopsoas
The ______ bursa lies between the tendons of the pes anserine muscles and the medial tibia.
pes anserine
The ______ bursa communicates with the shoulder capsule
subacromial
Acute bursitis should be treated with heavy cold therapy, such as a frozen towel.
False
Petrissage massage techniques can be used to decrease sympathetic nervous system firing and aid in pain management for bursitis.
True
Joint play techniques involving gentle grade 1-2 oscillation or grade 1 sustained glide are contraindicated in the treatment of bursitis.
False
Muscle imbalances, poor biomechanics, and postural dysfunction like scoliosis can lead to the development of bursitis.
True
Infective bursitis should be treated with the same techniques as non-infective bursitis.
False
The ______ bursa lies between the tendons of the pes anserine muscles and the medial tibia.
anserine
The subacromial / subdeltoid bursitis occurs between supraspinatus, ______, and coracoacromial ligament.
infraspinatus
The pain is a result of the ______ being pinched from the humerus, acromion, and coracoacromial ligament.
bursa
Contraindications in Treatment. Avoid compressing the ______ in the acute stage.
bursa
The ______ infrapatellar bursa is a common site of bursitis.
prepatellar
Baker's Cyst is a synovial cyst that usually appears on the medial side of the ______ space.
popliteal
In bursitis treatment, which method involves gentle grade 1-2 oscillation or grade 1 sustained glide?
joint
The ______ infrapatellar bursa is a common site of bursitis.
subcutaneous
The ______ bursa lies between the lower half of the patella, the patellar ligament and the skin.
prepatellar
The pain is a result of the ______ being pinched from the humerus, acromion, and coracoacromial ligament.
rotator
Which bursa is located between the supraspinatus tendon, the acromion, and the coracoacromial ligament?
Subdeltoid bursa
What technique should be avoided in the acute stage of bursitis treatment?
Techniques that compress or stretch muscles crossing the bursa
Which of the following is a potential cause of pes anserine bursitis?
Poor biomechanics or muscle imbalances
Which technique should be used with caution in the treatment of bursitis?
Fingertip kneading toward the bursa
In the treatment of bursitis, what is the main purpose of positioning and pillowing?
To comfortably elevate the limb and avoid compression on the bursa
In the treatment of bursitis, it is recommended to introduce massage techniques to the inflamed site during the early stage.
True
Contrast towels are used in the late stage of bursitis treatment.
False
It is important to compress the bursa directly during massage techniques in the treatment of bursitis.
False
The main purpose of limb positioning and pillowing in bursitis treatment is to promote compression on the affected bursa.
False
The subacromial bursa communicates with the shoulder capsule.
False
What is the main purpose of a bursa in the body?
To provide a cushion and reduce friction between moving parts
Which of the following is a potential cause of pes anserine bursitis?
Repetitive stress on the medial knee area
In which stage of bursitis is it important to avoid compressing the bursa?
Acute stage
What technique should be used with caution in the treatment of bursitis?
Stretching
Which of the following special orthopedic tests is used to diagnose bursitis?
Neer Impingement Test
The ______ bursa lies between the skin and the patellar ligament/tibial tuberosity.
prepatellar
The subacromial / subdeltoid bursitis occurs between supraspinatus, ______, and coracoacromial ligament.
infraspinatus
Contraindications in Treatment. Avoid compressing the bursa in the ______ stage.
acute
Infective bursitis: needs to be referred to a ______.
physician
A ______ is a small flat sac lined with synovium.
bursa
Contrast application is used post-treatment for bursitis to increase circulation and drainage.
True
In the treatment of bursitis, it is recommended to introduce massage techniques to the inflamed site during the early stage.
False
Stretching of muscles that cross the bursa is a recommended technique for chronic bursitis treatment.
True
Infective bursitis should be treated with the same techniques as non-infective bursitis.
False
The main purpose of limb positioning and pillowing in bursitis treatment is to promote compression on the affected bursa.
False
The ______ infrapatellar bursa is a common site of bursitis.
Prepatellar
The ______ bursa lies between the tendons of the pes anserine muscles and the medial tibia.
Pes anserine
The ______ bursa lies between the iliopsoas muscle and the iliofemoral ligament.
Iliopsoas
The ______ bursa communicates with the shoulder capsule
Subacromial/subdeltoid
The ______ bursa lies between the skin and the patellar ligament/tibial tuberosity.
Superficial infrapatellar
The ______ bursa lies between the lower half of the patella, the patellar ligament and the skin.
prepatellar
The subacromial / subdeltoid bursitis occurs between supraspinatus, ______, and coracoacromial ligament.
subscapularis
Muscle imbalances, poor biomechanics and postural dysfunction such as ______, hyperkyphosis, and lack of flexibility can lead to bursitis.
lordosis
The ______ bursa communicates with the shoulder capsule.
subscapular
The purpose of having a bursa is to decrease ______ usually between tendons and bones.
friction
Infective bursitis requires referral to a physician.
True
The purpose of a bursa is to increase friction between tendons and bones.
False
Chronic bursitis is characterized by localized pain, while acute bursitis often refers pain to a wider area.
True
Petrissage massage techniques should be avoided in the treatment of bursitis, as they can increase sympathetic nervous system firing and worsen pain.
False
Joint play techniques involving gentle grade 1-2 oscillation or grade 1 sustained glide are recommended in the treatment of bursitis.
True
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.
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.
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