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Bursitis

Bursitis

Inflammation of a bursa

Cause
Overuse of structures surrounding the bursa, leading to excessive friction and inflammation of the bursa walls
Usually secondary to other conditions such as tendinitis
Contributing factors are mxl imbalances, poor biomechanics, postural dysFCN such as scoliosis or hyperkyphosis and a lack of flexibility
Overuse of the shoulder, especially with the arm in an overhead position is the most common cause

Common location
Types of bursitis

More details on individual bursa (page 449-452)

Acute

SXS
Inflammation, heat, swelling
Pain is deep and burning, at rest or on activity
ROM is restricted

Contraindication: Acute bursitis: Avoid compressing the bursa or applying tech that place a drag on the surrounding tissues
On-site tech are contraindicated with acute bursitis
If infective (or Septic) bursitis is suspected,the client is referred for medical attention

Assessment
Observation and palpation
Swelling and redness can be present
Antalgic posture or gait is present
Warm to touch
Spasm, hypertonicity and TrP are present

Massage
Hydrotherapy cold to the affected bursa
Lymphatic drainage to the affected limb starting with nodal pumping, distal limb is treated
NM tech are applied to the trunk and proximal limbs to treat the compensating structures and to decrease sympathetic nervous system firing and pain
TrP in proximal mxl with stripping and gentle ischemic compression could be applied
GTO
Grade 1-2 Jt play
Pain free PROM

Self care
RICE
Pain free sub maximal isometric exercise as soon as the client can tolerate them

Chronic

SXS
Pain or ashiness with activity or upon direct compression
Pain is more localized to the bursa
 Chronic inflammation, fibrosis and adhesions are present
ROM are still present 

Contraindication: Acute bursitis: Avoid compressing the bursa or applying tech that place a drag on the surrounding tissues
On-site tech are contraindicated with acute bursitis
If infective (or Septic) bursitis is suspected,the client is referred for medical attention

Assessment
Postural assessment
Adhesions are palpated (Bogginess)
Hypertonicity and TrP
ARROM, PROM, Isometric testing is painful for bursa that are completely surrounded by the other structures
Bursitis differentiation test
Tendinitis differentiation test

Massage
Hydrotherapy of deep moist heat before stretching
Fascial technique
Compensating structures in the trunk and proximal limb are treated with NM tech
TrP, Fractioning, Pain free PROM
Fingertip kneading and scooping motion towards the bursa

Self care
Rest from aggravating activities
Return to activity is guradual
If flare-ups is experienced, Ice is apprlied after activity
Self massage is performed to the mxl surrounding the bursa
Stretching also is ncouraged
Gradual progression from pain-free isometrics to isotonic exercise
Referral to physiotherapist for U/S or Podiatrist referral for orthotics if necessary

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