Bursitis
OVERVIEW OF Bursitis :
Bursae are fluid-filled sacs found about your joints. They surround the areas where tendons, skin, and muscle tissues meet bones. The lubrication they add helps reduce friction during movement of the joint.Bursitis is an inflammation of your bursae. Inflamed bursae cause pain and discomfort in the affected location. They also limit the ways you can move your joints.
STRUCTURE of Bursitis :
It is an small pouch/sac found in muscles ,tendons and bone. It is also known as the bursa or plural bura or bursae. The bursa might be classified into adventitious,suncutaneous,synovial or submuscular
Adventitious bursa arises due to the continuous or repetative exposure to unusual shearing stresses particularly over bony prominences. They are temporary and does not cause much problems and it most commonly found in the foot regions due to the chronic friction. Subcutaneous bursa is found in the subcutaneous tissue and they are ill defined clefts and they are mainly present in between the subcutaneous tissue and deep fascia.
Synovial bursa are thin walled sacs and they are mainly present in between the bones ,joints and muscles and tendons. They are present in the large joints of the hand and leg and cenclose the synovial fluid.
Submuscular bursa are present underneath the muscles.
A bunion is an adventitious bursa that develops beneath the base of the big toe in association with the hallux vulgaris (deviation of the first toe such that it lies on top of or below the other toes).
Any type of inflammation of the bursae is called bursitis. The cause of most cases of bursitis appears to be local mechanical irritation, although bursas may also be involved along with the joints and tendon sheaths in rheumatoid arthritis and gout. Diseases of the bursa also occur in domestic animals. Capped elbow and capped hock are examples of chronic bursitis in horses, resulting from lying on hard floors
EPIDEMIOLOGY :
bursitis is common among the people who has crossed more than 40 years of age
CAUSES :
Injury to the joints
Arthritis
Tendonitis
Thyroid disorders
Diabetes mellitus
Kneeling for more than a hour
PATHOPHYSIOLOGY :
The role of the bursa is to act as a cushion and allow the tendon to move over bone as it contracts and relaxes. It's a fibrous sac lined with synovial fluid. The bursa itself is a synovial lining that represents a potential space, insofar as it is collapsed upon itself until a resulting trigger causes the bursa to become irritated and fill with synovial fluid. The patient experiences pain when the inflamed bursa is then compressed against bone, muscle, tendon, ligaments, or skin.
COMMON CLINICAL SIGNS AND SYMPTOMS :
Pain
Swelling
Tenderness
Limited motions
Localized tenderness
DIAGNOSTIC :
- X-ray. A diagnostic test that uses invisible electromagnetic energy beams to make pictures of internal tissues, bones, and organs on film.
- Magnetic resonance imaging (MRI). An imaging test that uses a combination of large magnets, radiofrequencies, and a computer to make detailed pictures of organs and structures within the body.
- Ultrasound. An imaging test that uses high-frequency sound waves to look at the internal organs and tissues.
- Aspiration. A procedure that involves using a thin needle to remove fluid from the swollen bursa to check for infection or gout as causes of bursitis.
- Blood tests. Lab tests may be done to confirm or rule out other conditions
TREATMENT AND PROGNOSIS :
Physical therapy:
Physical exercises provides greater releif from pain in bursitis and it also increases the flexibility of the joints to certain degrees.
Patients suffering from bursitis can benefit from both physical as well as occupational therapy. In bursitsis the joints become stiff and swollen and the range of movement are limited to the extent.. Physical therapy has been shown to significantly improve function, decrease pain, and delay need for surgical intervention in advanced cases. Exercise prescribed by a physical therapist has been shown to be more effective than medications in treating bursitis of the knee. Exercises mostly focuses on the flexibility and strength of the joints. Occupational therapy can provide assistance with activities.
Injections:
A corticosteroid drug injected into the bursa can relieve pain and inflammation in your shoulder or hip. This treatment generally works quickly and, in many cases, one injection is all you need.
Surgery:
A surgery is done to take away the fluid and the inflammation reduces.
Pain killer:
They are various treatment options available for the treatment of bursitis and medications which has lower side effects are selected as the first choice of treatment in bursitis.
Depending on the type of arthritis, the medications that are given may be different. For example, the first-line treatment is acetaminophen (paracetamol) and also it involves non steroidal anti inflammatory driugs (NSAIDs) like ibuprofen. opioids and NSAIDs may be less well tolerated. However, topical NSAIDs may have better safety profiles than oral NSAIDs. For more severe cases of bursitis, intra-articular corticosteroid injections may also be considered.
The drugs to bursitis range from corticosteroids to monoclonal antibodies given intravenously. Due to the autoimmune nature of RA, treatments may include not only pain medications and anti-inflammatory drugs. Treatment with DMARDs is designed to slow down the progression of RA by initiating an adaptive immune responses, in part by CD4+ T helper (Th) cells, specifically Th17 cells. Th17 cells are present in higher quantities at the site of bone destruction in joints and produce inflammatory cytokines associated with inflammation, such as interleukin-17 (IL-17).
Adaptive Aids:
People with hand bursitis that is in the shoulder and elbow joint can have trouble with simple activities daily doing tasks (ADLs), such as turning a key in a lock or opening jars, as these activities can be cumbersome and painful. Adaptive aids or assistanve aids are available in the market to assist the patient and simplyfing those task to them. but they are generally more costly than conventional products with the same function. It is now possible to 3D print adaptive aids, which have been released as open source hardware to reduce patient costs. Adaptive aids can significantly help the patients with bursitis and who feel difficult to carryout the day to day activities.
PROGNOSIS :
The prognosis of bursitis id really very good
PREVENTION :
Do stretch exercises
Avoid repetative injuries
Using kneeling pads
Lifting the load cautiously
Reduce the body weight
Eat fish or twice a week-since fish contains omega 3 fatty acids which can reduce inflammation in the bone.
Exercise regularly and also do warm up and stretches.
Protect the joints and avoid joint injuries.
Recovery period:
It is a chronic condition.It might takes months to years to go away.
When you find any swollen or mild inflammation seek the physician as soon as possible
Recovery Period :
Acute bursitis usually flares over hours or days. Chronic bursitis can last from a few days to several weeks
Medicines used in the Treatment :
acetaminophen (paracetamol)
ibuprofen
injection with corticosteroid