Bursitis

This presentation is on bursitis specially focused on Baker's cyst and housemaid knee with Physiotherapeutic management

1. Bursitis By Simran Shaw

2. What is Bursa? Bursa are flat sacs of synovial membrane in which the inner sides of the sacs are separated by a fluid film. Bursa are found where moving structures are in tight approximation that is between tendon and bone, bone and skin, muscle and bone or ligament and bone. Bursa

3. Bursa around the knee joint... Subcutaneous bursa Subtendinous bursa Submuscular bursa Prepatellar Bursa Subpopliteal Bursa Suprapatellar Bursa Infrapatellar Bursa (Clergyman’s Knee)

4. Bursa around the knee joint...

5. Bursa around the knee joint... Suprapatellar bursa Subpopliteal Bursa Gastrocnemius Bursa

6. Bursitis Baker’s cyst Also known as Popliteal cyst . Named after Dr. William Morrant Baker. Housemaid’s knee Also known as Prepatellar Bursitis , Miner’s knee .

7. Baker’s Cyst... Definition :- A  Baker's cyst  is a is a fluid-filled swelling that is developed at the back of the knee in the popliteal fossa region. The pain can get worse when you fully flex or extend your knee or when you're active. Pathology :- Osteoarthritis Trauma or cartilage injury(athletes) Herniation of synovial membrane – through the posterior part of the capsule of the knee joint. (30%) Escape of fluid through normal communication of bursa with the knee. (semimembranosus /medial gastrocnemius) Secondary to Rheumatoid Arthritis.

8. Baker’s Cyst... Observation Posterior View- Clinical Picture

9. Baker’s Cyst... Clinical Features :- Usually asymptomatic Pain (worst at ext & full flexion) Stiffness Swelling Giving way Restriction of movement Investigations :- MRI Ultrasound Arthrography Plain radiographs (OA)

10. Baker’s cyst... Investigations :- MRI Arthrography of Ruptured Baker’s Cyst

11. Baker’s cyst... Physiotherapeutic Treatment RICE Protocol Rest – Taping the knee in semi flexed position or braces in severe case. Ice massage - 15 minutes every 4-7 hours Compression Limb elevation After pain reduces – Mid range Knee mobilisation. Joint ROM exercises Calf stretch Hamstring stretch Quadriceps strengthening

12. Taping Technique

13. Compression with exercise

14. Compression with exercise

15. Quads isometrics

16. Stretching and strengthening

17. Baker’s cyst... Surgical Treatment :- Baker’s cyst – Needle aspiration Excision of bursa and closure of the capsular orifice. Giant cyst – 1-2 days of non-surgical treatment Later arthrography and cyst is excised. Synovectomy is done later to prevent recurrence.

18. Housemaid’s Knee… Definition :- Prepatellar Bursa, which occupies a position just over the patella gets inflamed. Cause :- Sustained pressure of body weight due to frequent kneeling – occupational or in handicapped persons who depend on knee walking. Direct blow on knee. Clinical Features :- Large rounded swelling Red skin, rise in temperature Tenderness Quads activity may be painful

19. Housemaid’s Knee… Observation An terior View- Clinical Picture

20. Housemaid’s Knee… Investigations :- MRI Ultrasound Arthrography Plain radiographs (OA) MRI

21. Housemaid’s Knee… Treatment Conservative Analgesic ant inflammatory drugs. Rest – crepe or pressure bandage Avoid – kneeling, pressure positions & movements at knee Limb elevation Isometric quadriceps contraction – pain free range Relaxed knee swinging – available pain free range Electrical stimulation – avoid disuse atrophy (Quads) Assisted SLR

22. Housemaid’s Knee… Treatment Surgery :- If becomes chronic and painful , then bursa is excised surgically. Post operative management Limb elevation Strong movements to toes, ankle & hip End of 1 week- small range isometrics to quadriceps within pain free range. Self assisted relaxed passive knee swinging Gentle passive movements – start to improve patellar mobility

23. Housemaid’s Knee… Re-education in walking( tendency to walk with flexed knee) Body resistive quadriceps exercise (self-resistive) – excellent means of Quadriceps strengthening and mobilising knee. Guided functional positions Back to normal activities by 4-6 weeks.

24. Patella mobilisation

25. Quads isometrics

26. Other strengthening

27. Body resistive quads strengthening

28. Easy to Advanced Quads strengthening

29. Bibliography Joint structure and function by Pamela K. Levangie & Cynthia C. Norkin Essential Orthopaedics by Maheshwari & Mhaskar Essentials of Orthopedics for Physiotherapists by John Ebnezer & Rakesh John Essentials of Orthopaedics and Applied Physiotherapy by Jayant Joshi & Prakash Kotwal Orthopedic Physical Assessment by David J. Magee Pictures by these books only Physiopedia Videos from Youtube and my friend Basudev Barman

30. Thank You