What is Bursitis?

Our bodies were constructed to withstand a certain level of pressure; however, with repetitive stress or excessive pressure, inflammation can occur.

Bursitis refers to inflammation of the fluid-filled sacs (bursa) that function as a cushioning surface to reduce friction between tissues of the body. In all, there are more than 150 bursae in the body which help joints move with ease(Figure 1). Bursitis (Figure 2) usually affects the joints in the shoulders, elbows, hips, and knees, although it can also occur in heels and at the base of big toes. Roughly 8.7 million people in the United States have bursitis.


Figure 3

There are several causes of bursitis, including overuse, stress or direct trauma to a joint such as repeated bumping or prolonged pressure. Bursitis can also be the result of arthritis, infection or gout.


Different parts of the body can develop bursitis in different ways. Bursitis of the shoulder (Figure 3) is often the result of injuries to the rotator cuff which connects the upper arm to the shoulder blade. Here, causes include falling, repetitive overhead activities and lifting.

Bursitis of the elbow (Figure 4) is associated with actions which require repeated bending and extending of the elbow, such as throwing a ball or Frisbee®.

Figure 4

Hip bursitis (Figure 5) is usually associated with arthritis or a hip injury and results from falls or standing or sitting for prolonged periods.

Figure 5



Knee bursitis (Figure 2) is usually caused by repetitive pressure, such as kneeling, or a sharp blow. Knee bursitis is often the result of impact sustained during athletic activities. It is usually characterized by an egg shaped bump on the front of the knee.

There is a risk that an inflamed bursa can become infected. This is often a major concern for patients with elbow bursitis because the inflamed bursa is close to the skin. For patients with hip or shoulder bursitis, the chance of infection is less of a concern because inflammation occurs much deeper in the body. Signs of infection include open wounds around the area of bursitis, fever, chills and redness or increasing warmth around the skin. If infection is suspected, fluid from the swollen bursa will be obtained using a needle and syringe.

While an infected bursa may require surgery, it can often be treated with antibiotics.

Patients with bursitis will likely experience stiffness or an ache in the inflamed area. Pain is usually intensified with movement or pressure. Other symptoms include swelling and redness in the area of inflammation.

Bursitis of the hip, however, may be more difficult to identify because the hip is not as close to the surface as other joints, thus there may be no visible swelling or skin redness. Doctors are typically able to diagnose bursitis with a combination of physical examination and x-ray imaging. By feeling the painful joint and surrounding area, doctors are able to identify points of tenderness. While x ray imaging is not tantamount in identifying bursitis, it can help exclude other possible causes of inflammation.

Figure 6

Bursitis is usually treated conservatively (Figure 6) with rest, immobilization, ice application, or anti-inflammatory medications. Physical therapy and injections into the bursa are also commonly used to relieve inflammation. Occasionally, bursitis requires aspiration of the bursa fluid. This involves removing the fluid with a needle and syringe. Of course, there are precautions that can be taken to lessen the chance of developing bursitis. First, proper stretching and strengthening of muscles will help prevent bursitis. Strengthening is an important factor in helping protect joints. Providing cushioning for joints is also an essential method for protecting joints from bursitis. Finally, taking breaks from repetitive tasks will lessen the chance of developing bursitis.


Sacroiliac Joint Pain and its Causes

The sacroiliac joint (Figure1) is the joint that connects the spine to the pelvis. It can be found between the sacrum, (the triangular-shaped bone in the lower portion of the spine) and the ilium of the pelvis. Joining these bones together are strong ligaments.

Unlike other joints in the body, the sacroiliac joint does not have much movement. However, it is essential in transferring the load of your upper body to your lower body. In other words, weight bearing forces go through the sacroiliac joint and acetabulum. Injury to this area affects the weight bearing ability of the joints. Its motion is a combination of rotation, tilting and sliding.

Figure 1


However, the sacroiliac joint may only slide a couple of millimeters and may tilt and rotate only three or four degrees.

Sacroiliac joint pain is a very common problem and one of the more common causes of low back pain. This type of pain is focused in the lower portion of the back and hip and may radiate out to the buttocks and lower back. In addition, it may radiate down the legs or around to the front, in the groin area. Pain is often worse withstanding and walking and improves with lying down.

When depending on the history and the clinical examination alone, it may be difficult to differentiate between sacroiliac joint pain and other sources of low back pain.

Examination of the sacroiliac joint usually begins with a physician conducting a Faber test. During this test, a physician forces external rotation of the affected hip in the supine position which causes pain in the sacroiliac joint. In addition, there would be tenderness over the sacroiliac joint.

According to Dreyfuss et al, however, sacroiliac joint pain was resistant to identification by 12 clinical examination tests that were standardized against a confirmatory test of intra articular injection.

There are many causes of sacroiliac joint pain including dislocation, sacroiliitis, sacroiliac joint dysfunction, and conditions that alter normal walking patterns. First, sacroiliac pain may be caused by subluxation of the joint. A slightly causes displaced sacroiliac joint places excess stress on the ligaments that hold it together.

Second, sacroiliac joint pain may be caused by sacroiliitis. This is an inflammation of one or both of the sacroiliac joints. It is characterized by pain or stiffness in the lower back, pain that radiates down the leg, decreased range of motion, or pain that worsens when walking or standing.

Another cause of sacroiliac joint pain may be sacroiliac joint dysfunction. This type of sacroiliac joint pain differs from sacroiliitis because its origin is a disruption in the normal movement of the joint. This could either be the result of either too much or too little movement in the joint. When the cartilage is damaged or worn away, bones begin to rub on each other and degenerative arthritis occurs. This is typically the most common cause of sacroiliac joint dysfunction. However, pregnancy may be a cause of sacroiliac joint dysfunction in women. During pregnancy, hormones are released that allow the ligaments to relax. This relaxation of the ligaments holding the SI joints together allows for increased motion of the joints and can lead to increased and abnormal wear on the sacroiliac joint.

Lastly, sacroiliac joint pain may be caused by conditions that alter your normal walking pattern. These conditions include: leg length discrepancy; pain in the hip, knee, ankle or foot; and pregnancy.

While there are a number of ways to determine SI joint pain, the most accurate way is to perform a diagnostic injection of the joint. This type of injection may be done in the office or more accurately using x-ray guidance with a fluoroscope. Once the doctor places a needle in the joint, an anesthetic is injected into the joint to numb the joint. If your pain goes away with the anesthetic, it can be gathered the pain you are experiencing is coming from the SI joint. In a study conducted here, 90 percent of patients that had a CT guided sacroiliac joint injection had sacroiliac joint pain confirmed by the injection.

Treatment for SI joint pain can range from conservative to surgical. First, doctors may suggest conservative measures such as rest, anti-inflammatory medication, phy

Figure 2

sical therapy, and a sacroiliac belt to hold the SI joint together to ease the pain. If these conservative measures are unsuccessful, a series of cortisone injections may be used to reduce the inflammation in and around the joint. If these tactics are unsuccessful, doctors may use one of two surgical approaches: radiofrequency ablation or fusion. Sacroiliac joint pain does remain a diagnostic and therapeutic challenge. In a study conducted here, CT scans were negative in 42 percent of symptomatic sacroiliac joints with a positive sacroiliac joint injection test (Figure2).


Once it has been determined the pain is originating from the SI joint, doctors may perform a procedure called radiofrequency ablation. During this procedure, the nerves that provide sensation to the joint are burned with a needle called a radiofrequency probe. This eliminates sensation from the joint, making it essentially numb. This procedure is a temporary solution, although it can be repeated. The other surgical option available for sacroiliac joint pain is fusion (Figure3).

Figure 3


During this procedure, the articular cartilage from both ends of the Sacroiliac’s bone is removed. The two bones are held together with plates and screws until they fuse into one bone. This will stop the motion between the bones, thus eliminating pain from the joint.

Why My Shoulders Hurt?


If you think about it, there are few daily tasks that don’t involve the use of your shoulders. Because the shoulder is the most movable joint in the body, it is somewhat unstable. Overuse and shoulder instability can lead to several different varieties of shoulder pain.

The shoulder is composed of three bones: the clavicle (collarbone), the scapula

(Shoulder blade), and the humerus (upper arm bone)(Figure 1).

Figure 1

Motion is controlled by two joints:

The acromioclavicular joint (AC joint) and the glenohumeral joint (Figure 2).

The AC joint is located between the acromion and the clavicle while the glenohumeral joint is the ball-and-socket joint that allows the arm to rotate in a circular motion. Supported by muscles, tendons and ligaments, the rotator cuff holds the ball at the top of the humerus in the socket and provides strength and mobility to the shoulder joint. Injuries often arise from the shoulder’s soft tissue being over- or underused. In addition, the shoulder’s anatomy can also play a role in shoulder pain. Common shoulder pain causes include tendonitis, bursitis, injury/instability, arthritis, rotator cuff tears and fractures.

Figure 2

Tendonitis often causes pain which is the result of the tendon being overused. A tendon connects the muscle to bone or other tissue.

Tendonitisis usually the result of degenerative changes that take place over several years.

This can be car characterized either as an acute (following an overuse problem) Injury or a chronic (degenerative disease due to age) injury.


Bursitis is another overuse disease that affects the shoulder. Excessive use often leads to inflammation of the bursa–the fluid filled sac around the joints–which may limit the use of the shoulder. The bursa is responsible for lessening the friction caused by shoulder movement.

Shoulder instability is a common problem that results in shoulder pain. Because the ball of the upper arm is larger than the socket that holds it, it is often subject to injury. This anatomical anomaly causes instability if muscles, and tendons or ligaments are disrupted.

Another common shoulder problem is a dislocated shoulder

The shoulder joint it the most commonly dislocated joint in the body and is usually has a high recurrence rate in young patients. Shoulder dislocation is usually caused by a strong force that pulls the shoulder outward, popping the ball of the humerus out of the shoulder socket. Often, this motion overwhelms the muscles because they are unprepared to resist the excessive force. Putting the shoulder back into position is accomplished through a process called reduction. This procedure is usually done while the patient is sedated or relaxed. Dislocations may be associated with nerve injuries such as the axillary nerve and brachial plexus. If a young patient is unable to lift his or her arms following reduction of a shoulder dislocation, there is usually an axillary nerve injury. However, if an elderly patient is unable to lift his or her arms following reduction of a shoulder dislocation, there is usually a rotator cuff tear. An MRI may be necessary to determine the injury.

Another shoulder injury patients often experience is a separated shoulder. A separated shoulder results when a force separates the collarbone from the shoulder blade. The shoulder blade moves downward from the weight of the arm and creates a bump or bulge above the shoulder.

Arthritis and rotator cuff tears can also occur. Arthritis involves wear-and-tear changes with inflammation of the joint causing swelling, stiffness and pain. Rotator cuff tears refer to a tear in one of the four tendons that blend together to attach to the humerus. These tendons transfer forces from the shoulder blade to the arm, providing motion and stability.

Fractures are also a shoulder injury concern. A shoulder fracture refers to a partial or total crack through one of the three bones of the shoulder. Fractures are usually the result of an impact injury. Clavicle (collarbone) fractures are usually treated conservatively, although there is a high incidence of non-union in distal third fractures. Patients with scapula (shoulder blade) fractures should be admitted and observed. Here, there is a concern of pulmonary complications. Fractures of the humerus are usually treated conservatively. Stiffness is often a concern for elderly patients. Therefore, early rehabilitation is usually necessary.

Certain signs indicate that patients should seek medical attention, including an inability to carry objects or use an arm; deformity of the shoulder joint; pain that occurs at night or while resting; pain that persists beyond a few days; an inability to raise the arm; or severe bruising or swelling around the joint.

Figure 3

Doctors often use a variety of methods to determine shoulder pain, including x-rays, MRIs (Figure 3), injections (Figure 4) and arthrograms. While shoulder pain can be treated conservatively, surgical intervention is sometimes required to alleviate shoulder pain.


Figure 4

How To Develop Loyalty In Your Team

The head of the team is responsible for maintaining team morale and leadership. The head of the team is supposed to act as the “glue” that holds the rest of the team together.


It is important to acknowledge the work that is done by members of your team in order to boost morale. When leadership focuses on building team morale, it creates a positive environment within the office, department or university. It is important to mention the employee by name and show them appreciation for a job well done!

Often the employee does not feel appreciated in their work when they do not receive appreciation from their leaders. Appreciation has the greatest impact on team morale.

Recognition and Appreciation

Allow the employee to feel valued for their continued hard work. Give them praise and publish recognition. Giving recognition to the employee is a positive way to inspire them to use the full extent of their talents and “go the extra mile”. Morale will increase, as well as productivity.

Communication should always occur between the leaders and the employees! Be hands on! Correspondence should not occur simply through email or other non-personal methods. It is important to maintain face to face communication.

Allow the employees the opportunity to lead and receive credit for their accomplishments. As a leader, be there to help and coach others to take responsibility and think for themselves. During times of crisis, lead from the front! During times of comfort, lead from behind!

Engaged Team

An engaged team will be better equipped to achieve the mission and objective of their work. They will believe in what needs to be accomplished with passion and enthusiasm.