Bursitis and Bursal Treatment
posted by : Dr. Barnetton: 15 October, 2018
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.
The 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.
Knee 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.