Professional Documents
Culture Documents
Bursitis
Bursitis
Bhoomi Rathod
Guided by: Dr. Camy Bhura, PT
Types
Irritative Infective
bursitis bursitis
IRRITATIVE Excessive
pressure /
BURSITIS friction
Sac gets
thickened causing Inflammation
pressure erosion of bursa
on adjacent bone.
Effusion of
Prolonged clear fluid
inflammation within the
bursal sac
Common
bursitis
• Supra patellar bursitis
• Pre patellar bursitis
• Infrapatellar bursitis
• Olecranon bursitis
• Ischial bursitis
• On lateral malleolus
• On great toe
Treatment
Removal of
Analgesics Rest causative
factor
Sac Infiltered Rarely
with excision of
hydrocortisone bursa
INFECTIVE BURSITIS
RX BY SURGICAL
INFECTED BY TROCHANTERIC
DRAINAGE/
PYOGENIC/ BURSITIS/PREPATELL
TUBERCULAR BURSITIS AR BURSA ANTIBACTERIAL
DRUGS
SUPRAPATELLAR BURSITIS
Located b/w the quadriceps tendons and the femur.
It is an extension of the synovial membrane of knee joint capsule.
Bursa facilitates movement of synovial fluid in the anterior and
posterior compartments of the capsule during flexion and extension
of the knee joint.
Eg : during flexion of knee joint , the anteriorly located supra patellar
bursa is compressed and the fluid is moved posteriorly.
SUPRA PATELLAR BURSITIS contd..
Not a separate clinical entity rather a manifestation of synovitis of
knee (signs & symptoms are similar ) therefore, RX is focused on
resolution of synovitis of knee joint.
Bursa is inflamed secondary to secretion of excessive synovial fluid
due to trauma, infection, or autoimmune disorder affecting the knee
joint.
PRE PATELLAR BURSITIS
Located blw the patella and subcutaneous tissue layer covering
anterior knee.
Can occur in all age groups due to superficial location and very thin
synovial layer of bursa.
Cause – direct trauma to anterior knee such as fall on knees / blunt
trauma to anterior knee.
Seen in Housemaid + carpenters. Hence the name.
PRE PATELLAR BURSITIS contd..
DIAGNOSIS:
H/o blunt trauma or repetitive micro trauma over the front of the knee .
Visible localized swelling over bursa and pain when bending the knee.
D/D : Synovitis, Fracture of patella , Injury to Extensor Retinaculum.
PHYSICAL EXAMINATION:
Palpation of patella
Knee ROM, MMT
Knee ligaments, menisci testing to exclude other causes of anterior knee
pain.
PRE PATELLAR BURSITIS contd..
Due to superficial location , septic bursitis occurs in children
following an open injury to anterior knee/ immunocompromised
population.
Septic pre patellar bursitis – erythema, increase in temperature over
the knee.
Blood cell investigations, Aspiration of burial fluid for culture
examination.
Rx :
Rest, cold compression, NSAIDS
EXCELLENT prognosis for non septic bursitis.
INFRA PATELLAR BURSITIS
Superficial bursa Located blw subcutaneous tissue and patellar
tendon
Deep bursa located blw patellar tendon and tibial tuberosity.
Superficial infrapatellar bursa :
Functions: to provide smooth gliding of patellar tendon and tibial
tuberosity over the skin during flexion and extension.
Prolonged compression during kneeling might lead to inflammation of
this bursa – k/a clergyman’s knee
Patients often present with painful and tender, small, localized area
over anterioroinferior knee.
INFRA PATELLAR BURSITIS contd..
Pain is not affected by movement of knee, the only problem is
increased pressure sensitivity in the affected area.
This inflammation frequently becomes chronic---> thickening of this
burs. Once the bursa is thickened the symptoms subside and no
longer produce any difficulty in activities of daily living (ADL).
INFRAPATELLAR BURSITIS contd..
Deep infra patellar bursa functions to provide smooth gliding of
patellar tendon over tibial tuberosity during knee movements.
Bursa along with patellar tendon may get inflamed by repetitive
knee movements such as squatting, lifting heaving weights ,
prolonged cross legged sitting or prolonged stair activities.
Repetitive lengthening of patellar tendon and tensioning of the
bursa without adequate rest periods frequently lead to inflammation
of both patellar tendon and deep infrapatellar bursa together.
INFRAPATELLAR BURSITIS contd..
History of knee joint overuse
Constant pain around inferior knee which is aggravated by knee
movements
Pain on walking and prolonged standing
Tenderness – inferior pole of patella and patellar tendon.
Passive knee flexion is painful + restricted, while active terminal knee
extension is also painful.
Resisted isometric testing of knee might be painful + strong/weak,
indicative of accompanying patellar tendon pathology.
INFRAPATELLAR BURSITIS contd..
D/D: Osgood Schlatter’s disease in adolescents and patellar tendon
rupture.
Presence of extensor lag indicates possibility of patellar tendon
rupture/ Osgood Schlatter’s disease.
• RX: SIB: Rest, cold compression, NSAID’s
DIP: Rest, activity modification, NSAID’s,
occasionally, corticosteriod injections
TROCHANTERIC BURSITIS
Cause- lateral hip pain, all groups, >>> obese females and elderly
Has many surrounding bursae due to multiple muscle attachments
and close proximity of various tendons.
The bursae act as a lubricating medium for surrounding gluteus
tendons to smoothly slide over the bone and each other during the
physiologic ROM.
Trochanteric bursa is located on lateral aspect of hip, superficial to
gluteal musculature and deep to ITB
Bursa separating the gluteal medius from GT is frequently inflamed -
lateral hip pain. Accompained with tendinopathy of hip abductor
muscles.
CAUSES OF TROCHANTERIC BURSITIS
RUNNING, JUMPING ACTIVITIES without adequate warm up/ rest
periods.
Direct fall on side of hip
Age related weakness / tendinopathy of deep hip abductor muscles
can lead to increased compression of bursa on prolonged standing,
walking/stair climbing.
Alterations in spine alignment and mechanism of pelvis, lumbar and
distal lower limbs overuse of hip abductor muscles. LLD, Scoliosis,
Genu varum, Degenerative OA.
DIAGNOSIS OF TROCHANTERIC
BURSITIS
OTHER CAUSES OF LATERAL HIP PAIN ARE NECESSARY:
Fracture of neck of femur
Acetabular labral tear
AVN of head of femur
Acetabulo femoral impingement syndrome
Hip OA
Infective arthritis
Referred pain from lumbar disc/ facet
Detailed history
Palpation of painful area
Standing posture
Analysis of gait
PROM, AROM
Hip muscle strength testing
They have significant tenderness over the bursa
Pain on standing on affected limb, lying on that side, positive
tredelenberg sign, restricted ROM ADDuction , decreased strength in
GMED, GMINI
Slightly restricted isometric testing, hip abductor – painful+ weak
GMED, GMINI Tendinopathy
Full and pain free lumbar spine and Hip ROM excludes possibility of
other causes.
Rx
• Rest
• Weight loss
• NSAID’s
• Occasionally corticosteroid injection for chronic recurrent cases
• Crossed leg sitting, passive ITB to be avoided.
• Sleep with pillows b/w legs