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