Common Shoulder Pathologies Bursitis

Question 1

Bursitis (p.449 Clinical Massage Therapy - Rattray and Ludwig, p.308 - Management of Common Musculoskeletal Disorders -Kessler and Randolph)

Answer 1

This is the inflammation of the bursa. In the shoulder there are 8 to 9 present but only 2 have clinical significance.

Question 2

Subacromial (aka subdeltoid) –

Answer 2

this bursa is situated on top of the supraspinatus muscle (tendon and belly) and underneath the acromion and deltoid muscle. As a result of this positioning, this bursa is susceptible to impingement by the acromial arch especially when inflamed or affected by a calcified supraspinatus tendon.

Question 3

Subscapular –

Answer 3

this bursa lies over the anterior joint capsule and under the subscapularis tendon. As a result of lying atop the articular joint capsule, joint effusion may be apparent because of inflammation of the bursa.

Question 4

Etiology: bursitis

Answer 4

Usually secondary to other conditions like calcific tendinitis
The overuse of the structures surrounding the bursa excessive friction upon bursa inflammation of bursa.
Contributing factors include: repetitive movements, poor biomechanics/technique in sport, muscle imbalance, postural changes and a lack of flexibility
Trauma (blunt force or FOOSH), infection (from a needle) and other joint pathologies (arthritis) may also cause bursitis

Question 5

Bursitis Signs and symptoms:

Answer 5

Pain over the lateral brachial region and referred below elbow
Pain may affect sleep especially if bursa is compressed
Acute = inflammation, heat and swelling, pain is deep, constant, intense, burning and present at rest and with activity; onset is sudden over 12 –72 hours and builds severe debilitation lasting for 2 weeks
Chronic = pain is more localized and expressed with activity or direct compression
Other conditions may be present i.e. – tendonitis
Protected positioning and guarded movements
Pain with AROM, PROM, and RROM – varying degrees depending if it’s acute or chronic
AROM = all ROM restricted especially elevation (60˚), a painful arc may be present
PROM = non-capsular pattern, empty end-feel (with pain or anticipation of it)
RROM = most hesitation with abduction because of pain and the squeezing of the inflamed bursa. Other movements may yield strong and painless contractions if performed carefully
With chronic inflammation = fibrosis and adhesions

Question 6

Bursitis Special tests:

Answer 6

1. Painful Arc -present
2. PROM, AROM, RROM of the muscles affecting the subacromial or subscapular bursas = pain
3. Neer Impingement
4. Bursitis Differentiation Test

Question 7

Bursitis Treatment planning:

Answer 7

Treating bursitis is similar to tendonitis in the acute, subacute and chronic stages. Manage inflammation first then address the structures contributing to the bursitis i.e.- tendonitis

Question 8

Bursitis Precautions and Contraindications:

Answer 8

Avoid compressing an inflamed bursa therefore techniques should work around the affected area until inflammation subsides Onsite work with acute bursitis If infected, refer to MD for medical attention

Question 9

Bursitis REMEX and homecare:

Answer 9

o Educate guest of noxious activities or factors
o Stretch shortened muscles
o Strengthen any muscles that have disuse atrophy