Category: Uncategorized

“At Georgia pain and wellness we have a special work comp coordinator who works with adjusters to help facilitate patient care” — Dr. Patel

Electrical nerve stimulation is a procedure that uses an electrical current to treat chronic pain. Peripheral nerve stimulation (PNS) and spinal cord stimulation (SCS) are two types of electrical nerve stimulation. In either, a small pulse generator sends electrical pulses to the nerves (in peripheral nerve stimulation) or to the spinal cord (in spinal cord stimulation). These pulses interfere with the nerve impulses that make you feel pain.

Nerve stimulation is done in two steps. To see if it will help your pain, your doctor will first insert a temporary electrode through the skin (percutaneously) to give the treatment a trial run. The electrode is connected to a stimulator that the patient can control. If the trial is successful, your doctor can implant a permanent stimulator under your skin. This is typically done using a local anesthetic and a sedative. The stimulator itself is implanted under the skin and the small coated wires (leads) are inserted under the skin to the point where they are either connected to nerves or inserted into the spinal canal.

After this outpatient procedure is complete, you and your doctor determine the best pulse strength. You are then told how to use the stimulator at home. A typical schedule for spinal cord stimulation is to use it for 1 or 2 hours, 3 or 4 times a day.

When in use, electrical nerve stimulation creates a tingling feeling.

What To Expect After Treatment

You will have a small incision that you should keep clean and dry until it heals.

Why It Is Done

This treatment may be done for people with severe, chronic pain who have:

• Failed back surgery syndrome.
• Severe nerve-related pain or numbness.
• Chronic pain syndromes, such as complex regional pain syndrome.

Electrical nerve stimulation is typically considered investigational for various other conditions, including multiple sclerosis, paraplegia, and intractable angina.

How Well It Works

There isn’t a lot of evidence to show how well spinal cord stimulation works. It seems to help certain types of chronic pain, such as failed back surgery syndrome and complex regional pain syndrome.¹ Spinal cord stimulation may also help chronic low back pain.

Some researchers have reported that more than half of people receiving spinal cord stimulation for chronic low back and leg pain, ischemic leg pain, or complex regional pain syndrome have pain reduction or relief.

There is some evidence that peripheral nerve stimulation helps certain types of chronic pain, such as peripheral nerve pain and pain after surgery. Studies so far have been small.

Initial pain relief is often followed by a gradual decline in effectiveness. Apparently, this is caused by the body’s increasing tolerance to the treatment.

Risks

Possible risks related to electrical nerve stimulation include:

• Scar tissue (fibrosis) developing around the electrode.
• Pain gradually moving beyond the reach of the nerve stimulator.
• Breakage of an electrode or hardware failure.
• Infection.
• Leakage of spinal fluid during spinal cord stimulation.
• Headache from spinal cord stimulation.
• Bladder problems in spinal cord stimulation.
• Getting used to the stimulation, making it less effective.

People with an implanted stimulator can’t have MRI tests.

What To Think About

There is still not strong proof that electrical nerve stimulation works. Better research is needed. Treatment success varies widely and is influenced by the cause of pain.

Electrical nerve stimulation may be recommended for some people who have certain types of chronic pain.

A spinal fracture is a serious injury.

The most common fractures of the spine occur in the thoracic (midback) and lumbar spine (lower back) or at the connection of the two (thoracolumbar junction). These fractures are typically caused by high-velocity accidents, such as a car crash or fall from height.

Men experience fractures of the thoracic or lumbar spine four times more often than women. Seniors are also at risk for these fractures, due to a weakened bone from osteoporosis.

Because of the energy required to cause these spinal fractures, patients often have additional injuries that require treatment. The spinal cord may be injured, depending on the severity of the spinal fracture.

Cause
Fractures of the thoracic and lumbar spine are usually caused by high-energy trauma, such as:

• Car crash
• Fall from height
• Sports accident
• A violent act, such as a gunshot wound

Spinal fractures are not always caused by trauma. For example, people with osteoporosis, tumors, or other underlying conditions that weaken bone can fracture a vertebra during normal, daily activities.

Types of Spinal Fractures

There are different types of spinal fractures. Doctors classify fractures of the thoracic and lumbar spine based upon a pattern of injury and whether there is a spinal cord injury. Classifying the fracture patterns can help to determine the proper treatment. The three major types of spine fracture patterns are flexion, extension, and rotation.

Flexion Fracture Pattern

Compression fracture. While the front (anterior) of the vertebra breaks and loses height, the back (posterior) part of it does not. This type of fracture is usually stable and rarely associated with neurologic problems.

Axial burst fracture. The vertebra loses height on both the front and back sides. It is often caused by a fall from a height and landing on the feet.

Extension Fracture Pattern

Flexion/distraction (Chance) fracture. The vertebra is literally pulled apart (distraction). This can happen in accidents such as a head-on car crash, in which the upper body is thrown forward while the pelvis is stabilized by a lap seat belt.

Rotation Fracture Pattern

Transverse process fracture. This fracture is uncommon and results from rotation or extreme sideways (lateral) bending, and usually does not affect stability.

Fracture-dislocation. This is an unstable injury involving bone and/or soft tissue in which a vertebra may move off an adjacent vertebra (displaced). These injuries frequently cause serious spinal cord compression.

Symptoms

The primary symptom is moderate to severe back pain that is made worse by movement.

When the spinal cord is also involved, numbness, tingling, weakness, or bowel/bladder dysfunction may occur.

In the case of high-energy trauma, the patient may have a brain injury and may have lost consciousness, or “blacked-out.” There may also be other injuries — called distracting injuries — which cause pain that overwhelms the back pain. In these cases, it has to be assumed that the patient has a fracture of the spine, especially after a high-energy injury (motor vehicle crash).

Medications for Back Pain and Neck Pain (part 1)

There are multiple over-the-counter (non-prescription) and prescription medications that can be helpful in relieving pain and addressing related symptoms while an episode of back pain is getting better. Careful attention to pain management is a critical component of a patient’s recovery, as acute or chronic low back pain can lead to depression, difficulty sleeping and difficulty exercising and stretching, all of which in turn can exacerbate and prolong a painful back condition.

Pain relievers are generally available in three forms: oral, topical, and injection.

• Oral pain medications. There are many forms of pain medications that are taken by mouth – pill or liquid form – and they each work differently and have unique benefits and potential risks. Some are available only by prescription.
• Topical pain medications. These products are applied to the skin and are intended to reduce localized pain, such as pain from a sore muscle or from an arthritic joint. Most are available without a prescription. Brands of several popular topical pain relievers include Icy Hot, Arthricare, Zostrix (capsaicin), Aspercreme, Ben Gay, and many store brands.
• Injections. Pain relieving medication and/or anti-inflammatory medications can be injected directly to the source of the pain.

Nonprescription Pain Medications

While there are many over-the-counter pain medications used to address back pain, the two most common types are acetaminophen (for example, brand name Tylenol) and non-steroidal anti-inflammatory drugs or NSAIDs (for example, brand name Advil). Because acetaminophen and NSAIDs work differently to address the pain, they may be taken at the same time. For example, a patient in severe pain may take the recommended dose of acetaminophen, and then two to three hours later take the recommended dose of ibuprofen, and repeat this pattern as appropriate.

Prescription Pain Medications

For short periods of time, prescription medications (such as narcotic pain medications or muscle relaxants) may be helpful to alleviate pain or related complications. Other classes of drugs (such as antidepressants or anti-seizure medications) can also help modulate the sensation of pain and can be taken on a prolonged basis.

There are risks, side effects, and drug interactions with any medication, so a medical professional should always be consulted prior to taking medications. Patients should be especially cautious with medications if they are on other medications or have any significant medical conditions (e.g. diabetes).

While a few major risks and side effects are outlined for some medications on this site, patients should always read the label and package inserts and consult with a physician for a complete understanding of risks, side effects, and drug interactions.

This article provides a thorough overview of the most common prescription and nonprescription medications used to relieve back pain and neck pain.

Muscle relaxants are not really a class of drugs, but rather a group of different drugs that each has an overall sedative effect on the body. These drugs do not act directly on the muscles; rather they act centrally (in the brain) and are more of a total body relaxant.

Typically, muscle relaxants are prescribed early in a course of back pain, on a short-term basis, to relieve low back pain associated with muscle spasms. There are several types of muscle relaxant medications that are commonly used to treat low back pain.

Muscle Relaxant Medications List

• Carisoprodol (Soma). This drug’s dosage is 350mg every eight hours as needed for muscle spasm. Soma is typically prescribed on a short-term basis and may be habit-forming, especially if used in conjunction with alcohol or other drugs that have a sedative effect.
• Cyclobenzaprine (Flexeril). This medication can be used on a longer-term basis and actually has a chemical structure related to some antidepressant medications, although it is not an antidepressant. Usually, it is prescribed as 10mg every six hours as needed to relieve low back pain associated with muscle spasm, or it can also be prescribed as 10mg at night as needed to help with difficulty sleeping. Flexeril can impair mental and physical function and may lead to urinary retention in males with large prostates.
• Diazepam (Valium). Valium is usually limited to one to two weeks of use, and the typical dosage is 5-10 mg every six hours as needed to relieve low back pain associated with muscle spasm. Because of its habit-forming potential, and because it changes sleep cycles and makes it very difficult to sleep after stopping the drug, Valium should not be used long term. Patients should also note that Valium is a depressant and can worsen depression associated with chronic pain.

ORAL STEROIDS

Oral steroids, a non-narcotic type of prescription medication, are very powerful anti-inflammatory medications that are sometimes effective treatment for low back pain. Like narcotics agents, oral steroids are intended for use for short periods of time (one to two weeks). Oral steroids come in many forms, but are usually ordered as a Medrol Dose Pack in which patients starts with a high dose for initial low back pain relief and then taper down to a lower dose over five or six days.

When used on a short-term basis, there are generally few complications associated with oral steroids. There are, however, a number of potential complications associated with long-term usage of oral steroids. Adverse side effects can include weight gain, stomach ulcers, osteoporosis, the collapse of the hip joint, as well as other complications.

It is important to note that diabetics should not use oral steroids since the medication increases blood sugar. Steroids should also not be taken by patients with an active infection (e.g. sinus infection, urinary tract infection) because they can make the infection worse.

ULTRAM PAIN RELIEVER

Ultram is a type of narcotic-like oral pain reliever that is often prescribed to treat lower back pain, neck pain, sciatica, and related conditions. Ultram, also known as tramadol, was approved by the FDA in 1998 and acts centrally (in the brain) to modulate the sensation of pain.

It is not an NSAID nor does it have the anti-inflammatory effect of an NSAID. Its mechanism of action is similar to acetaminophen (e.g. Tylenol), but Ultram is a stronger pain reliever than acetaminophen and has a weak narcotic effect.

While Ultram is technically a narcotic or opioid pain medication, it is different from typical narcotics in that patients do not build up a tolerance with extended usage and there is a very low incidence of addiction. With other narcotics, there is a general tendency to escalate the dosage of the medicine with time and a chance of addiction. The narcotic effect of Ultram is not as strong as the narcotic agents in other common pain medications, such as Vicodin (hydrocodone) and Oxycontin and Percocet (Oxycodone).

NSAIDS: NON-STEROIDAL ANTI-INFLAMMATORY DRUGS

Because most episodes of back pain have inflammation as a contributing factor, anti-inflammatory medication such as non-steroidal anti-inflammatory drugs (NSAIDs) is often an effective pain medication treatment option.

The types of NSAIDs reviewed on this page work like aspirin by limiting the formation of inflammation, but have fewer gastrointestinal side effects (such as gastritis or ulcers) than aspirin.

Most Common Types of NSAIDs

NSAIDs comprise a large class of drugs with many different options. In addition to aspirin, there are currently several types of both non-prescription (over-the-counter) NSAIDs and prescription brands of NSAIDs. The three types of NSAIDs most commonly used to treat many types of back pain and neck pain include:

• Ibuprofen (e.g. brand names Advil, Motrin, Nuprin)
• Naproxen (e.g. brand names Aleve, Naprosyn)
• COX-2 inhibitors (e.g. brand name Celebrex)

The type of NSAID recommended will usually depend on a number of factors, including the patient’s diagnosis, clinical situation, level of pain, individual risk factors, and the patient’s past experience with particular medications.

Ibuprofen (e.g. Advil, Motrin, Nuprin)

Ibuprofen was one of the original non-steroidal anti-inflammatory drugs and is available without a prescription.

For patients with back problems, ibuprofen is most commonly recommended to relieve mild or moderate back pain, tenderness, inflammation, and stiffness.

Common situations in which ibuprofen may be recommended include:

• Activity-related pain or discomfort (e.g. pain that follows sports, housework, shoveling snow, or other exertion)
• Pain related to a muscle strain in the lower back
• Neck stiffness related to muscle, ligament or tendon strains or damage

Ibuprofen does have some aspirin-like effects on the stomach, so people with active ulcers or sensitive stomachs should avoid ibuprofen. It is best to take ibuprofen with food to minimize the chance of stomach upset.

Ibuprofen also has a mild blood thinning effect that lasts a few hours and can reduce the effectiveness of some blood pressure medications and diuretics (water pills).

The typical recommended dose for ibuprofen is 400mg taken every eight hours. Prescription doses can be as high as 800mg of ibuprofen every eight hours.

Naproxen (e.g. Aleve, Naprosyn, Anaprox, Naprelan)

Naproxen is available in both non-prescription strength (e.g. brand name Aleve) and prescription strength (e.g. brand name Naprosyn).

For patients with back pain, it works by reducing proteins that cause inflammation and pain in the body and is commonly recommended for treatment of back pain.

Naproxen thins the blood, so individuals taking oral blood thinners or anticoagulants should avoid naproxen, as excessive blood thinning may lead to bleeding.

Naproxen also can have some adverse gastrointestinal side effects, so people with active ulcers or sensitive stomachs should avoid it. It is best to take naproxen with food to reduce the chance of an upset stomach.

The usual adult dose is 250 to 500 mg twice daily using regular naproxen tablets.

COX-2 Inhibitors (e.g. Prescription Brand Celebrex)

This is a newer class of NSAID, which includes the brand name Celebrex.

It works by stopping the chemical reaction that leads to inflammation in the body, but (unlike other NSAIDs) does not harm the chemical production of the protective stomach lining.

Therefore, COX-2 inhibitors lead to a lower gastrointestinal complication rate than other NSAIDs and do not tend to produce ulcers.

Also unlike other NSAIDs, COX-2 inhibitors do not impair blood clotting, so they are considered safer for patients taking blood thinning medications, such as warfarin (e.g. Coumadin), and they may be used before or after surgery without an increased risk of bleeding.

Important new information from recent studies shows a potentially increased risk for cardiovascular events (such as heart attack and stroke) for COX-2 inhibitors, and the FDA has called for further research.

Patients taking COX-2 inhibitors should meet with their physician to determine their individual risk factors for side effects and appropriate treatment options.

Other Forms of NSAIDs

In addition to the above, NSAIDs come in forms other than taking it orally. For example:

• Toradol can be given as an intravenous drug, so it is useful after surgery or if the patient cannot eat.
• Flector can be given as a transcutaneous form of Diclofenac. An NSAID administered through an adhesive patch applied to the skin can be useful because it does not give the patient a large dose of the drug systematically, which can reduce gastrointestinal and other potential side effects of NSAIDs.

Effective Use of NSAIDs

It is better to use NSAIDs continuously to build up an anti-inflammatory blood level, and the efficacy is markedly lower if taken only when experiencing pain.

Taking the drug regularly in the prescribed/recommended dose lets the drug build up over time in order to have an anti-inflammatory effect and allowing the area a better healing environment.

NSAIDs and the pain relief medication acetaminophen (e.g. brand name Tylenol) work differently, so sometimes doctors recommend taking the two medications at the same time. Some people report feeling better pain relief when they take both an NSAID and acetaminophen for their pain.

What is Radiofrequency Ablation?

Radiofrequency waves are electromagnetic waves which travel at the speed of light, or 186,000 miles per second (300,000 km/s). Radiofrequency Energy is a type of heat energy that is created by a special generator at very high or super high frequencies. With the use of this specialized generator, heat energy is created and delivered with precision to target nerves that carry pain impulses. The resulting “lesion” involves a spherical area of tissue destruction at the tip of the RF needle that can include pain-carrying nerves.

Why is this procedure done?

Radiofrequency ablation/lesioning is a procedure used to provide longer term pain relief than that provided by simple injections or nerve blocks. Many patients who are being considered for this procedure have already undergone simple injection techniques like Epidural Steroid Injection, Facet Joint Injection, Sympathetic Nerve Blocks, or other nerve blocks with pain relief that is less prolonged than desired. By selectively destroying nerves that carry pain impulses, the painful structure can be effectively denervated and the pain reduced or eliminated for anywhere from a few months to up to 12 months.

How is this procedure done?

Once a structure has been determined to be a pain generator, its nerve supply is targeted for interruption. A small insulated needle or RF cannula is positioned next to these nerves with fluoroscopic guidance (live video X-Ray). Your doctor knows where to place the RF cannula because he is an expert in anatomy. The shaft of this cannula except for the last 5 to 10 mm is covered with a protective insulation so that the electric current only passes into the surrounding tissues from the very tip of the cannula. When the cannula appears to be in good position, the doctor may perform a test and release a small amount of electric current through the needle tip at two different frequencies. This test helps to confirm that the cannula tip is in close proximity to the target nerve and that it is not near any other nerve. After a successful test confirms good cannula tip position, a local anesthetic is injected to numb the area. The RF generator is then used to heat the cannula tip for up to 90 seconds, and thus the target nerve is destroyed.

What types of conditions will respond to Radiofrequency Lesioning?

Radiofrequency treatments for chronic pain.

There are a multitude of chronic pain conditions that respond well to this treatment. Chronic spinal pain, including spinal arthritis (spondylosis), post-traumatic pain (whiplash), pain after spine surgery, and other spinal pain conditions are those most commonly treated with RFL. Other conditions that are known to respond well to RFL include some neuropathic pain conditions like Complex Regional Pain Syndrome (CRPS or RSD), peripheral nerve entrapment syndromes, and other assorted chronic pain conditions. A patient’s candidacy for RFL is usually determined by the performance of a Diagnostic Nerve Block. This procedure will help to confirm whether a patient’s pain improves just for the duration of the local anesthetic (or not). Patients who have little to no pain relief after a diagnostic nerve block are not candidates for a neurodestructive procedure like RF Lesioning.

Does the procedure hurt?

This procedure is no more painful than any other injection procedure that is performed in interventional pain management. Patients are often given mild intravenous sedation during the procedure, but sedation is not absolutely required. Deep sedation is not a safe alternative and is therefore not offered for my RF procedures. It is quite common for neck or back pain to increase for a few days or longer after the RFL procedure before it starts to improve.

What should I do to prepare for my procedure?

On the day of your injection, you should not have anything to eat or drink for at least eight (8) hours before your scheduled procedure. If you are scheduled to receive sedation during the procedure, you must have someone available to drive you home. If you usually take medication for high blood pressure or any kind of heart condition, it is very important that you take this medication at the usual time with a sip of water before your procedure.

If you are taking any type of medication that can thin the blood and cause excessive bleeding, you should discuss with your doctors whether to discontinue this medication prior to the procedure. These anticoagulant meds are usually prescribed to protect a patient against stroke, heart attack, or other vascular occlusion event. Therefore the decision to discontinue one of these medications is not made by the pain management physician but rather by the primary care or specialty physician (cardiologist) who prescribes and manages that medication. Examples of medications that could promote surgical bleeding include Coumadin, Plavix, Aggrenox, Pletal, Ticlid, and Lovenox.

What should I do after my procedure?

Discharge suggestions following procedures.

Following discharge home, you should plan on simple rest and relaxation. If you have pain at the needle puncture sites, application of an ice pack to this area should be helpful. If you receive intravenous sedation, you should not drive a car until the next day. Patients are generally advised to go home and not return to work after this type of procedure. Some patients do return to work the next day.

Could there be side effects or complications?

Our physicians will discuss these issues with you, and you will be asked to carefully read and sign a consent form before any procedure is performed.

Can this procedure be repeated if my pain returns?

It is possible for the treated nerve(s) to regenerate, which could lead to recurrent pain. However, RF Lesioning is repeatable for nerve regeneration if it worked the first time around.

adapted from Interventional Spine and Pain, Dallas, TX

During life’s busy times it important to take care of yourself. That is why Georgia Pain and Wellness Center has expanded our number of convenient locations throughout Atlanta. We now have 6 pain center locations. They are in Lawrenceville, Lilburn, John’s Creek, Cumming, Decatur, and Braselton. Also, beginning in September, our seventh location will be added in Lithonia. We want to be easily accessible to your needs and assist you with your chronic pain concerns.

Our doctors are highly trained and board certified Interventional Pain Management physicians. They take the time to listen to your concerns and then provide you with an individualized plan to help you feel your best. We treat all types of chronic pain from herniated discs, complex regional pain syndrome, post laminectomy, facet joint syndrome, and many more painful chronic conditions.

Our treatments for chronic pain include radio frequency ablation, spine cord stimulation, sympathetic blocks, epidural steriod injections, kyphoplasty, and platelet rich plasma (prp) injection treatments.

If you have chronic pain, we are the pain management experts! You don’t need a referral, call us today (770)962-3642.

The facet joints, found on both sides of the back of the spine, can become painfully irritated or inflamed. A facet joint injection may help diagnose the source of a patient’s pain. It can also relieve pain and inflammation.

Skin Numbed

In preparation for the procedure, the physician numbs the skin and tissue above the facet joint with an injection of local anesthetic.

Placement Confirmed

With the aid of an x-ray device called a fluoroscope, the physician guides a needle through the numbed tissue and into the facet joint. Contrast dye is injected into the joint to confirm the needle’s placement.

Medication Injected

Once the needle is positioned properly, the physician injects a soothing mixture of numbing anesthetic and anti-inflammatory steroid medication. One or more facet joints may be treated. If this causes the pain to subside, it suggests that the facet joint (or joints) injected were the cause of pain.

End of Procedure

Back or neck pain may disappear immediately after a successful injection because of the anesthetic that is administered. As this anesthetic wears off, pain may return. The steroid will begin to take effect in the days after the injection. The steroid will reduce inflammation and pain. The injection can provide relief for a span ranging from several days to several months. Up to three injections may be given per year.

georgiapainandwellnesscenter.com/

Any bursa may become inflamed, though the bursae near certain joints are particularly prone to do so. Here is an overview of how bursitis commonly affects some of the larger joints of the body.

Bursitis symptoms depend on which bursa is affected and how much inflammation there is. People with bursitis often experience the following in the area of the affected bursa:

-Swelling
-Tenderness
-Pain
-Stiffness
-Redness
-Warmth

The inflammation may also make the area sensitive to pressure. For example, lying on your side with your knees one on top of the other may be painful if you have bursitis in your knee. If you have bursitis in your hip, it may hurt to lie on that side of the body.

You should see your doctor if you have pain lasting more than two weeks; joint pain severe enough to keep you from moving the joint; sharp or shooting pain, particularly during exertion or exercise; or a rash near the affected joint or severe bruising, swelling, or redness.

If you have a fever in addition to these symptoms, see your doctor immediately. If the bursitis is caused by an infection, it could spread throughout your body or into your blood.

Elbow bursitis

Olecranon bursitis is inflammation in the bursa that sits at the tip of the elbow, near the olecranon, a hard point at the end of the ulna (one of the two primary bones of the forearm). Although normally flat, if inflamed or irritated, the olecranon bursa may fill with extra fluid and expand.

Hitting the elbow on something; repeated, long-term pressure on the tip of the elbow from, say, leaning on a counter, desk, or table; and frequently crawling on the elbows may all cause elbow bursitis. Rheumatoid arthritis and gout have also been linked to bursitis of the elbow.

The treatment of elbow bursitis usually follows the strategies outlined above, including the use of an elbow pad. People with bursitis of the elbow are also generally advised to avoid putting pressure on the elbow.

Hip bursitis

There are two areas of the hip that are particularly prone to bursitis. The first is the greater trochanter, a point that sticks out near the top of the femur (the thigh bone). If the large bursa between the greater trochanter and the skin becomes inflamed, the result is trochanteric bursitis.

Another form of bursitis associated with the hip occurs on the inside of the hip near the groin. This form of bursitis is called iliopsoas bursitis because it affects the iliopsoas bursa, the largest bursa in the body. When this bursa becomes inflamed, the nearby tendons generally also become inflamed (a condition called iliopsoas tendinitis), and vice versa.

Women and middle-aged and older men are at an increased risk of developing bursitis of the hip. Bursitis of the hip may develop as a result of an overuse injury, such as from running, stair climbing, or bicycling. It can also be a consequence of lying on one side or standing for long periods of time. As with elbow bursitis, a strong blow to the area, sometimes from a fall, may lead to bursitis of the hip. Certain spine conditions, rheumatoid arthritis, having one leg that is shorter than the other, and bone spurs (bony growths) or calcium deposits inside the tendons that connect to the greater trochanter, and having had surgery near the hip all increase a person’s risk of hip bursitis.

In addition to standard bursitis treatment, your doctor may suggest temporarily using a cane or crutches, especially if your bursitis requires surgery.

Knee bursitis

There are also two areas in the knee that are common sites of bursitis. Knee tendon bursitis occurs in a bursa that sits between the three tendons of the hamstring muscles and a ligament coming down from the femur, where all four make contact with the tibia (shin bone) on the inside of the knee. This form of bursitis—pes anserine bursitis—is often seen in athletes, especially runners.

Pes anserine bursitis may occur as a result of exercising without prior stretching, abruptly increasing the distance you run, and frequently running on hills. Obesity, osteoarthritis of the knee, damage to the meniscus on the inside of the knee, tight hamstrings, and a knee or lower leg that turns outward may all also increase the risk of developing pes anserine bursitis.

Another common form of bursitis that may affect the knee is called kneecap (or prepatellar) bursitis. In this case, the inflamed bursa sits between the front of the kneecap (the patella) and the skin.

Gout and RA both increase a person’s risk of developing bursitis of the kneecap. Other risk factors include kneeling often as part of your job; having been in a motor vehicle accident; and participating in a sport such as wrestling or football that includes landing on one’s knees or other frequent impacts to the knees.

The usual treatments for bursitis, as outlined above, are commonly effective for treating knee bursitis. If you are prone to bursitis of the knee, it may help to elevate and ice your knees after physical activity, stretch your legs often, and wear kneepads when you kneel or play sports that may involve impact to your knees.

Shoulder bursitis

Bursitis of the shoulder is usually related to inflammation in the bursa that lies above the tendons that connect to the top of your arm (the rotator cuff) and below a portion of the shoulder blade called the acromion, which extends forward toward the collarbone.

In shoulder bursitis, both the tendons and the bursa may swell. As they grow larger in the narrow space between the acromion and the humerus (the upper arm bone), the acromion may rub against them. This rubbing is called impingement and may cause pain and further irritation. Shoulder bursitis may lead to adhesive capsulitis, commonly referred to as “frozen shoulder,” in which the movement of the shoulder is severely limited.

As with other kinds of bursitis, shoulder bursitis may arise after a blow to the area. It is also common in people who frequently hold their arms over their shoulders during activities such as painting, swimming, playing tennis or baseball, hanging wallpaper, and doing construction.

Rest and NSAIDs are often prescribed as initial treatment options. Physical therapy can help to restore range of motion in the shoulder. An injection of cortisone may also help to reduce swelling.

Surgery to remove part of the bursa and possibly part of the acromion as well is sometimes recommended. This surgery is often performed arthroscopically, using several small instruments inserted into the shoulder joint through small incisions. During the surgery, the surgeon may also address other problems in the shoulder, such as bone spurs, arthritis, or a partial rotator cuff tear, if there is one. However, surgery for shoulder bursitis is not usually necessary.

Taken from Pain-Free Living