Bursitis Flashcards
what is bursa
● A bursa is a small, flat sac lined with synovium
● The word bursa means purse
● Both membranous surfaces of the bursa are normally in contact, separated by only a thin film of lubricating fluid
● A bursa reduces friction, usually between tendons and bones
● Since it is flat, a bursa is not palpable unless it is inflamed
● A bursa can regrow in 6-24 months if surgically removed
Causes of Bursitis
● Overuse of structures surrounding the bursa, leading to excessive friction and inflammation of the bursal walls
● Bursitis is usually secondary to other conditions such as tendinitis
Contributing Factors:
● Muscle imbalances, poor biomechanics, postural dysfunctions such as scoliosis or hyperkyphosis and a lack of flexibility
● Less commonly acute trauma, infection and pathologies such as OA, gout and RA
Common Bursitis Locations & Causes
Shoulder Bursae
● There are several bursa at the shoulder:
○ The subacromial (subdeltoid) bursa
between the acromion and the
supraspinatus tendon, with a
portion of the bursa between the
deltoid muscle and the humerus
○ The subcoracoid portion is not
always present. It is palpated
through the anterior deltoid muscle
near the acromion
○ The subscapular bursa lies between
the scapula and subscapularis
muscle, but not easily palpable
Common Bursitis Locations & Causes
Olecranon Bursa
● Lies between the olecranon and the
subcutaneous fascia
● It is quite swollen and obvious when
inflamed
● It is irritated by repetitive weight bearing
or trauma such as dragging the elbow on
the ground when wrestling
Common Bursitis Locations & Causes
Trochanteric Bursa
● Two main bursae at the greater
trochanter
● Ones lies between the gluteus maximus
tendon and the trochanter
● The other lies between the gluteus
medius tendon and the trochanter
● The bursae are palpated through the
overlying gluteus maximus tendons
● Pain is local to the lateral hip and the
client will not be able to sleep on the
involved side
● Pain is worse on climbing stairs and
getting out of a car
● Causes include altered hip biomechanics,
low back pain causing antalgic gait, OA
Common Bursitis Locations & Causes
Iliopectineal Bursa
● Lies between the iliopsoas muscle and
the iliofemoral ligament
● To palpate, the supine client’s hip is
flexed to 90 degrees
● The bursa is located 1-2 cm inferior to
the middle third of the inguinal ligament
● Pain is at the anterior hip and may
radiate down the anterior leg due to
pressure on the femoral nerve
● Antalgic posture is usually hip flexion and
external rotation
● This bursitis is caused by hip flexor
tightness and repetitive activity
Common Bursitis Locations & Causes
Ischial Bursa
● Lies between gluteus maximus and the
ischial tuberosity
● Palpated through gluteus maximus
● With inflammation there is well-localized
pain over the ischial tuberosity
● May be referral down the posterior leg
that mimics sciatic pain
● When the client is driving, they may find
that pressing down on the brake or gas
pedal relieves the pain. This is due to
increased tone in muscles that cross the
knee which rotates the ischial tuberosity
away from the car seat
● Antalgic gait with the client leaning
towards the affected side and shortening
their stride
Common Bursitis Locations & Causes
Knee Bursa
● Numerous bursa are around the knee
● The pes anserine bursa lies between the
tendons of sartorius, semitendinosus &
gracilis muscles & the medial tibia
● The infrapatellar bursa lies between the
patellar ligament and the tibia
● Other bursae lie between the iliotibial
band and the lateral collateral ligament
and the tibia
● All of these bursa are palpated through
the overlying tendons
● Pain is worse on use
● The prepatellar bursa lies between the
lower half of the patella, the patellar
ligament and the skin
Common Bursitis Locations & Causes
Retrocalcaneal Bursa
● Lies between the Achilles tendon and the
calcaneus
● The bursa is palpated on either side of
the tendon
● It is locally painful when inflamed
● Overuse and a tight gastrocnemius soleus complex are causes of inflammation
Baker’s Cyst
Other Bursal Injuries
● A synovial cyst that usually appears at the
lateral side of the popliteal space
● It is thought to be an enlargement of the
extracapsular bursa between the
gastrocnemius and semimembranosus
muscles, or a herniation of the synovium
through the posterior joint capsule wall
● Can appear in children and adults
Bunion
Other Bursal Injuries
● Occurs at the first metatarsophalangeal joint capsule
● A bunion is formed by excessive bone growth (exostosis), a callus and an inflamed, thickened bursa developing over the joint
● This is in response to joint hypermobility as poor biomechanics allow the first metatarsal bone to deviate medially
● The phalanges deviate laterally, forming a
hallux valgus
● NSAIDS and corrective footwear are used to treat a bunion
● Surgery to straighten the toe and reduce the exostosis is an option
Medically
● Acute bursitis is treated with rest and NSAIDs, ultrasound and ice
● Superficial bursae such as the olecranon may be protected with a padded donut
● A superficial bursae may also be aspirated, especially if it is infected, then infiltrated with a corticosteroid
● Surgical excision is another option
● A program of stretching a gradual return to strengthening for the structures that
cross the bursa are recommended
Symptom Picture: Acute
● The bursa is compressed and irritated by surrounding structures
● Inflammation, heat and swelling are present
● Pain is deep and burning, at rest or on activity
● ROM of the affected joint is restricted
● Joints distal or proximal may have reduced range if crossed by a muscle or fascia that also crosses the affected bursa
Symptom Picture: 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
Contraindications
- With acute bursitis, the therapist should avoid compressing the bursa or applying techniques that place a drag on the surrounding tissues
- On-site techniques are CI’d with acute bursitis
- If infective bursitis is suspected, the client is referred for medical attention
