These saclike cavities contain synovial fluid at joint sites where friction occurs, or where muscles and tendons pass over bony prominences. Bursitis most commonly occurs in the shoulder (subacromial or subdeltoid), hip (trochanteric or iliopsoas), knee (prepatellar), heel (achilles), or elbow (olecranon). The bursa may eventually develop scar tissue adhesions, villus formations, and/or calcific deposits causing pain, swelling, or muscle atrophy, limiting range of motion. Bursitis is often caused by overloading the affected joint via repetitive motions. Symptoms often are described as dull achy pains, throbbing in nature, exacerbated with specific repetitive motions, weakness, numbness, or tingling in the extremities may also be present with the involvement of peripheral nerve entrapment syndrome. These symptoms are often the result of soft tissue hypoxia.
Common treatment methods include initially rest or immobilization, physical therapy, anti-inflammatory medications or NSAIDs, aspiration of fluid within the bursa, corticosteroid injections, and/or removal of affected bursa.
Considerations and exam focus towards the diagnosis of acute vs. chronic bursitis is vital. Chronic or progressive bursitis may lead to calcific deposits of tendons, with or without partial or complete tears, adhesive capsulitis to joint capsules, or associated arthropathies to affected joints. Less chronic conditions, if well managed through proper diagnosis, have a good prognosis. Special imaging studies and clinical exam findings may provide valuable information. Early diagnosis and treatment is crucial in preventing long term disability.
Here at Active Family Care Chiropractic in Summerville SC our clinical focus is to reduce the cycle of inflammation through a combination of anti-inflammatory pharmaceuticals, local site injections, or through ice, rest, and bracing. The clinical focus is to reduce the mechanical dysfunction by reducing myotendinous friction. The biomechanical, myotendinous friction, must be a clinical focus or this chronic inflammatory condition will likely progress.
Passive modalities such as electrical muscle stimulation (EMS), heat/ice, and passive stretching may initially be used. As range of motion increases and inflammation decreases, a specific manual therapy technique called active release technique (A.R.T.) is implemented to reduce tissue hypoxia, reduce scar tissue formation, and break up soft tissue adhesions.
Active Release Technique's basic premise is simple. Using precisely directed tension and very specific patient movements, the doctor manually shortens the affected tissue, applies a contact tension with the thumb or finger to the affected muscle, tendon or nerves. This lengthens the shortened and contracted tissue to make it slide relative to the adjacent tissues, by breaking the scar tissue that is binding up the tissues that need to move freely and independently. As this scar tissue builds up, muscles become shorter and weakened, causing tension on their tendons, causing tendonitis, and peripheral nerve entrapments.
A progressive, active care rehabilitation plan is also designed to promote long term success. A series of concentric, eccentric, and isometric exercises are designed to develop muscle strength, endurance, and flexibility. The affected joint is an obvious focus for rehab, but often the joints above and below need to be addressed to correct any biomechanical compensation. With progress, patients are released to supportive care. Some patients require flare-up visits 1-2 times per month while others report full resolution with continued use of prescribed rehab programs at home, prevents regression. A focus on posture, technique, and determining a threshold of over-use becomes key in prevention of future recurrent flare-ups.