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Dr Rod Pearce
HEALTH
Bursitis? Can I still play sport? L
ike most medical things, the word bursitis implies that the bursa is inflamed, infected or swollen. A bursa is a closed, fluid-filled sac that works as a cushion and gliding surface to reduce friction between tissues of the body. So many moving parts of the body are separated by tissue designed to help movement, reduce friction and lessen the wear and tear on the moving part. We see versions of that in machines with their bearings and lubrication with grease or oil. In humans, we have joints and a viscous, slippery, lubricating fluid (called synovial fluid). Often compared to an egg white in appearance and texture, it allows ligaments, joints and muscles to slide over each other without hurting or rubbing so much that they cause pain or inflammation. When something goes wrong, we feel pain or hear clicking or crunching. If that is happening in ligaments and muscles, it causes inflammation, tendonitis or muscle strain but, when it happens between the muscles, tendons or bones, it causes bursitis. The more complex the machinery, and the more it is used, the more likely there is to be wear and tear. Same with the human body. The major bursae are located next to the tendons near the large joints, such as the shoulders, elbows, hips and knees. The shoulder joint can rotate in multiple directions with complex muscle and tendon attachments crossing over each other, twisting, and putting pressure across each other and the joint. The most common movement to cause problems with the shoulder is the jumping jack (star jump) exercise.
Surgery is rarely needed to treat bursitis. Injections are usually with antiinflammatory medication (steroids) and often done under ultrasound guidance, identifying the bursitis.
Four muscles and their tendons pull through a small gap between the bony process on the shoulder blade which joins the collarbone (clavicle) and the shoulder joint, rotating the arm (humerus) bone. When strained, the tendons become swollen and rub against bone (acromion) and the lubricated cushion can’t take the strain and becomes inflamed. This sub acromial bursa is the common problem causing pain when rotating the shoulder. Depending on the type of shoulder bursitis, treatment might include activity modification, immobilization with a splint, icing, injections, aspiration of the bursa (removing fluid with a syringe) and anti-inflammatory pain medication. Surgery is rarely needed to treat bursitis. Injections are usually with antiinflammatory medication (steroids) and often done under ultrasound guidance, identifying the bursitis. The elbow contains a large, curved, pointy bone at the back called the olecranon, which is covered by the olecranon bursa. Bursitis will occur here owing to: • Trauma or a hard blow. • Excessive leaning on the elbow. • Infection through puncture wounds. • Insect bites. • Conditions such as gout and rheumatoid arthritis. People highly prone to this condition work in occupations such as plumbing or are air conditioning technicians. Their work involves a lot of crawling on the elbows. A similar knee bursitis (prepatellar bursitis) used to be known as “housemaid’s knee” because cleaning floors on one’s knees irritated the bursa and caused swelling and pain.
Some hip pain can be from a bursa on the outside of the leg bone (femur) which can become sore if you sleep on your side on a hard surface. Trochanteric bursitis (bursa over the greater trochanter of the femur) can also result from: • Falling onto the hip. • Bumping the hip into an object. • Play or work activities – such as running upstairs, climbing, or standing for long periods – which cause overuse or injury to the joint areas. This will present as a pain in the hip region but has nothing at all to do with the hip, but rather the ligament running over the femur, with the bursa swelling and causing pain. What usually fixes this is altered activity and understanding what is aggravating the pain. But, again, the best fix can be injections directly into the bursa.
Continued page 40 February 2022
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