Bursitis and Bursal Treatment posted by : Dr. Barnetton: 23 September, 2019
Often cited as inflammation or infection or failure of a Bursa, bursitis is seen as often as 1 in 200 primary care office visits.  In my pain center it is most often involving the Subdeltoid bursa in the shoulder, Trocanteric bursa on the side of the hip, Psoas bursitis ( the largest), in the groin, or the Knee bursa. We have approximately 150 of these small fluid filled sacs that cushion or lubricate areas likely to produce friction.  Think of them as a small sac with thick WD40.
imaThe subdeltoid bursa is the most common bursa I inject in the upper body. 20 to 30 milligrams of a longer acting steroid with local anesthesia may increase range of motion and decrease deconditioning and disability. Because of the local anesthetic the procedure is very diagnostic as only the bursa is affected. The benefit may be prolonged. I am often asked to perform a “shoulder injection”. The most common diagnosis listed seems to be a “rotator cuff tear” or “tendon injury in the shoulder” but often a simple bursal injection isolates the pain.
ima1Prior to injection, care should be the “PRICEM” plan, as practiced in the UK. Protect, Rest, Ice, Compression, Elevation, Medication. I typically, teach about proper use of anti-inflammatory medications, proper diagnosis, and injections for both diagnosis and treatment. If the patient fails to get immediate changes I suspect other problems in the area and refer to an Orthopedic Surgeon.Trocanteric bursitis is by far the most common bursitis condition that I treat. It occurs between the Iliotibial band and trochanter as seen on the right. It inflames the ITBand and progresses down the side of the leg to the tibia. This linear pattern is often confused as a nerve pathway. The simple “finger test” can diagnose it. If I touch it and it hurts, its that tissue under my finger that is causing the problem. Patients often have a very difficult time sleeping in the presence of bursitis conditions. Often caused by gait and leg length issues, Physical therapy and understanding mechanical pain is key.
ima2Knee bursitis is common, the treatment plan is the same as other forms. The Pes Anserine bursa (lower left of picture) is probably the most difficult to recognize. Quite easy to treat, it is so often missed that the level of disability that I see is often dramatic, with the patients describing years of pain, without diagnosis or treatment, unlike more common and easily diagnosed cases of bursitis. Contrary to myth, Cortisone injections don’t heal these issues. Their use with other modalities can increase function, decrease use of other medications and allow healing to occur.
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