Entries by Tobias Hall

Four Foods To Reduce Inflammation and Pain In The Body

November 12, 2024 /0 Comments/in , , /by

Four Foods To Reduce Inflammation and Pain In The Body

Inflammation is the body’s natural defence mechanism, activated by the immune system in response to foreign substances—such as harmful microbes, irritants, or chemical exposures. When triggered appropriately, inflammation isolates and addresses these threats, supporting the body’s healing processes. However, inflammation isn’t always beneficial. Even without an actual threat, persistent inflammation can become detrimental, resulting in chronic inflammation that contributes to numerous health issues.

Inflammation and pain are directly linked, as inflammation signals the immune system and sensitizes nerves, leading to the perception of pain. Chronic inflammation often manifests with enduring pain symptoms, a hallmark of conditions like arthritis and other inflammatory diseases. This sustained inflammatory response is associated with severe health risks, including cardiovascular disease, diabetes, and neurodegenerative disorders.

An anti-inflammatory diet can be a powerful tool for managing chronic inflammation. Research indicates that specific foods and nutrients have measurable anti-inflammatory properties. Selecting foods that naturally reduce inflammation—like fruits, vegetables, whole grains, and healthy fats—may lower your risk of chronic inflammatory diseases. Conversely, a diet high in processed foods, sugars, and trans fats may exacerbate inflammation, accelerating the onset of inflammation-related diseases. In essence, what you eat is critical in managing inflammation and, in turn, chronic pain and long-term health. Here are some common foods to fight inflammation and the pain that comes with it. 

Fatty Fish

Fatty fish are a potent source of protein and contain high concentrations of the omega-3 fatty acids EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid). These specific omega-3s are crucial for reducing inflammation in the body, which, if left unchecked, can contribute to conditions such as metabolic syndrome, cardiovascular disease, diabetes, and kidney disease.

Omega-3s in fatty fish like salmon, sardines, herring, mackerel, and anchovies are uniquely effective because they are metabolised into anti-inflammatory compounds known as resolvins and protectins. These compounds counter inflammation, helping to mitigate pain and prevent the escalation of inflammatory diseases. Research consistently shows that individuals who consume fatty fish or take EPA and DHA supplements demonstrate reduced C-reactive protein (CRP) levels, a key marker of inflammation.

However, results can vary based on individual health conditions. For instance, in one study, participants with arrhythmias who took daily EPA and DHA supplements did not show significant changes in inflammatory markers compared to a placebo group. Despite such variances, the general evidence supports the anti-inflammatory and pain-relieving benefits of omega-3-rich fish in many inflammatory and metabolic conditions.

Extra-Virgin Olive Oil

Extra-virgin olive oil stands out as one of the most beneficial fats available. It is rich in monounsaturated fats and a foundational element of the Mediterranean diet, renowned for its health-protective effects. Extra-virgin olive oil reduces risks of significant health issues, including heart disease, certain cancers like brain cancer, obesity, and more.

The anti-inflammatory properties of extra-virgin olive oil are critical to its health benefits. Studies show that incorporating extra-virgin olive oil as part of a Mediterranean-style diet can significantly lower inflammatory markers, reducing overall inflammation within the body. One of its unique components, oleocanthal, exhibits powerful anti-inflammatory effects, with actions comparable to those of anti-inflammatory drugs such as ibuprofen. This compound targets the same inflammatory pathways, helping mitigate pain and reduce chronic inflammation.

It is important to note that extra-virgin olive oil provides superior anti-inflammatory benefits compared to refined olive oils, as its natural compounds remain intact through minimal processing. Regular consumption of extra-virgin olive oil may be a valuable dietary strategy for reducing inflammation and managing pain effectively.

Cherries

Cherries are flavorful and packed with potent antioxidants, including anthocyanins and catechins, which are known to help reduce inflammation. Tart cherries, in particular, have been extensively studied for their health benefits, though sweet cherries offer similar anti-inflammatory effects.

In a 2019 study involving 37 older adults, daily consumption of 16 ounces (480 mL) of tart cherry juice for 12 weeks led to a significant decrease in C-reactive protein (CRP), a key marker of inflammation. This suggests that cherries can effectively aid in lowering chronic inflammation levels in some populations.

However, effects may vary depending on age and health status. Another study found no significant reduction in inflammation in younger, healthy adults consuming tart cherry juice daily over 30 days. While further research is needed to clarify how and for whom cherries reduce inflammation, current evidence suggests that regular cherry intake, especially tart varieties, may support managing inflammation and related pain in susceptible individuals.

Avocados

Avocados are a nutrient-dense fruit, rich in potassium, magnesium, fibre, and monounsaturated fats, which are beneficial for heart health. Additionally, they contain bioactive compounds like carotenoids and tocopherols, which are linked to reduced risks of chronic diseases, including cancer and heart disease.

One unique compound in avocados has shown promise in reducing inflammation, specifically within newly forming skin cells, supporting tissue health and repair. In a rigorous study of 51 adults with excess weight, those who consumed avocado regularly over 12 weeks experienced a significant reduction in inflammatory markers, including interleukin-1 beta (IL-1β) and C-reactive protein (CRP), both indicators of systemic inflammation.

Conclusion

A diet rich in anti-inflammatory foods can be a powerful strategy for reducing chronic inflammation and the pain it drives. Inflammation, while essential for protecting the body from infection and injury, becomes harmful when persistent, leading to a range of chronic health conditions—from arthritis to cardiovascular disease and neurodegenerative disorders.

Several foods have been shown to modulate inflammation and offer relief from associated pain. Fatty fish, such as salmon and sardines, deliver omega-3s converted into compounds directly targeting inflammatory pathways. Extra-virgin olive oil, a staple of the Mediterranean diet, provides both healthy fats and oleocanthal, a natural anti-inflammatory with effects comparable to ibuprofen. Cherries, particularly tart varieties, supply antioxidants like anthocyanins that lower inflammatory markers, such as CRP and avocados contribute an array of nutrients, including bioactive compounds that reduce systemic inflammation.

Incorporating these foods into a regular diet while avoiding processed and inflammatory foods provides a natural approach to managing inflammation. This holistic approach addresses pain and supports long-term health by reducing the risk of inflammation-driven diseases. The cumulative effect of these foods can help sustain a lower inflammatory state, providing a foundation for healthier, pain-free living.

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Olecranon Bursitis – What You Need To Know

November 12, 2024 /0 Comments/in , , , /by

Olecranon Bursitis – What You Need To Know

Introduction To Olecranon Bursitis

Olecranon bursitis occurs when the bursa, a fluid-filled sac located over the olecranon process (the bony tip of the elbow), becomes inflamed. The olecranon bursa acts as a cushion, allowing the skin to move smoothly over the bony structure of the elbow. However, due to its position right beneath the skin, this bursa is highly vulnerable to inflammation from various causes, particularly trauma.

This trauma can be acute, caused by a single impact like a blow to the elbow or repetitive, stemming from activities that involve prolonged pressure or friction on the elbow, such as leaning on hard surfaces for extended periods. Another significant cause is infection; when bacteria infiltrate the bursa, it can lead to septic bursitis. Around one-third of olecranon bursitis cases are septic, meaning they involve infection. At the same time, the other two-thirds are classified as non-septic or aseptic bursitis, where inflammation occurs without infection.

Non-septic bursitis is generally more common and often less concerning medically. However, it can still lead to considerable pain and swelling. Prompt medical intervention is crucial in cases of septic bursitis, as infections can spread and become severe if not properly treated.

Anatomy of The Bursae Around The Olecranon

The olecranon is the bony prominence at the tip of the elbow, an extension of the ulna—the longer of the two bones in the forearm. Structurally, the olecranon functions as a lever arm for muscles, facilitating the powerful extension and flexion of the elbow joint, which is critical for lifting, pushing, and supporting body weight. Overlying the olecranon is the olecranon bursa, a small, fluid-filled sac that plays a crucial role in reducing friction as the skin and other soft tissues move across the bone beneath.

A bursa, by definition, is a thin, slippery sac lined with synovial tissue and filled with a minimal amount of lubricating fluid positioned between tissues to facilitate smooth, low-friction movement. Bursae are found throughout the body, especially where tendons, muscles, or skin frequently move over bones. The olecranon bursa cushions the skin from the hard, underlying bone at the elbow tip, allowing the joint to bend and extend without irritation.

When the olecranon bursa becomes irritated, often from direct trauma or prolonged pressure, it can become inflamed and filled with excess fluid. This swelling results in what is clinically recognised as olecranon bursitis, a visible and sometimes painful condition at the elbow’s point. The buildup of fluid leads to swelling, tenderness, and restricted movement as the increased friction interferes with the otherwise smooth gliding action of the bursa over the olecranon.

How Common Is Olecranon Bursitis?

Olecranon bursitis is a relatively common condition, particularly affecting the back of the elbow. It can cause pain, swelling, and discomfort, impacting daily activities like writing, lifting, or even bending the elbow. The olecranon and prepatellar bursae (located at the elbow and knee, respectively) are the most frequently affected superficial bursae due to their exposure to trauma and pressure, making them more susceptible to inflammation and infection.

The true prevalence of olecranon bursitis is likely underestimated, as many individuals with mild or chronic cases don’t seek medical care, opting to manage symptoms on their own. However, in hospital settings, cases of olecranon bursitis are estimated to account for approximately 0.01% to 0.1% of admissions. While the exact incidence rate in the general population is not fully established, this condition is most commonly observed in men between 30 and 60 years of age but can also affect children and adults across a wide age range.

What Causes Olecranon Bursitis?

Olecranon bursitis typically arises from two primary causes: non-infectious inflammation (non-septic bursitis) and infection (septic bursitis). In non-septic cases, trauma or repetitive minor injuries to the elbow cause irritation and inflammation of the bursa. These injuries can lead to bleeding within the bursa or release inflammatory mediators, prompting fluid buildup and noticeable swelling at the elbow tip. Here are some common causes:

  • Acute trauma, such as a fall onto a hard surface or direct impact during sports, can quickly trigger inflammation. For individuals undergoing long-term hemodialysis, mechanical factors like resting the back of the elbow against surfaces during treatment can also contribute to irritation and inflammation in the bursa. Repetitive microtrauma from regular activities—like leaning the elbow against a hard surface when writing or typing—can also cause chronic irritation.
  • Certain occupations present a heightened risk for olecranon bursitis. For example, plumbers and heat pump technicians often work in positions where they lean heavily on their elbows, leading to repeated pressure and increasing the likelihood of bursitis. Additionally, specific medications, such as sunitinib used in treating renal cell carcinoma, have been linked to olecranon bursitis as a side effect.
  • Underlying inflammatory diseases, such as rheumatoid arthritis, gout, or pseudogout, can also predispose individuals to bursitis. In these cases, systemic inflammation or crystal deposition within the bursa exacerbates irritation, leading to more persistent swelling and discomfort.

What Are The Symptoms of Olecranon Bursitis?

Olecranon bursitis often presents as a noticeable swelling at the back of the elbow, ranging from painless to mildly tender. Patients frequently report that leaning on the elbow or pressing it against surfaces, like a table while writing, can worsen the discomfort. The degree of pain varies—acute cases from infection or trauma may bring sudden and pronounced pain. In contrast, more chronic cases of repeated irritation are often less tender but can still limit movement and comfort.

The hallmark sign of olecranon bursitis is the protruding appearance of the swollen elbow, making it easy to bump accidentally, given its enlarged profile. This repeated bumping can be frustrating and even painful, especially as the swelling makes the elbow more susceptible to impact.

In cases where bursitis arises from a singular trauma, symptoms typically start abruptly, with more intense swelling and discomfort. By contrast, when the cause is repetitive microtrauma or chronic irritation, the onset is gradual, with symptoms developing over time.

How Is Olecranon Bursitis Diagnosed?

The diagnosis of olecranon bursitis primarily relies on a clinical assessment, with physicians basing their conclusions on the patient’s history and a physical examination of the affected elbow. Key indicators include the presence of localised swelling, tenderness, and whether there’s any redness or warmth that could signal an infection.

If there’s any doubt about whether the bursitis is septic (infected) or non-septic (non-infected), fluid aspiration from the bursa is the diagnostic gold standard. During this procedure, a sample of the bursal fluid is drawn and analysed in a lab. Important factors examined include the colour of the fluid, cell counts, glucose concentration, presence of crystals, and any signs of bacteria under a gram stain. This analysis provides crucial information, enabling the clinician to rule out infection or other underlying causes like crystal-induced inflammation.

While blood tests are generally not helpful in diagnosing olecranon bursitis directly, they can sometimes be ordered to support findings, especially if there’s a high suspicion of infection. In cases where the diagnosis is unclear, treatment for septic bursitis may be initiated as a precaution until the culture results from the aspirated fluid are available.

The Best Way To Treat Olecranon Bursitis

Treatment for olecranon bursitis typically involves a combination of lifestyle adjustments, anti-inflammatory medications, physical therapy, and, in more severe cases, minimally invasive procedures.

For chronic, non-infectious olecranon bursitis, the first line of treatment is activity modification—reducing or avoiding movements that place pressure on the elbow, such as leaning or frequent use during repetitive tasks. Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, naproxen, or celecoxib are often prescribed for a few weeks to manage pain and reduce inflammation. However, these don’t resolve the underlying issue. Ice application, 2-3 times daily for 20-30 minutes, helps control swelling effectively. However, it’s essential to avoid heat, as it can worsen inflammation.

In persistent cases, a corticosteroid injection into the bursa may be considered to reduce swelling. However, these injections carry potential side effects, including infection risk, skin atrophy, and chronic pain. They are generally reserved for cases unresponsive to other treatments. If infection is suspected, corticosteroid injections should be avoided.

For septic (infected) olecranon bursitis, prompt medical intervention is crucial. Aspiration of the bursa by drawing out the fluid with a needle can help relieve pressure and allow the fluid to be tested to identify the infection’s cause. Antibiotics are then prescribed based on lab findings to treat the infection and prevent bacteria from spreading to the bloodstream. 

In cases resulting from acute trauma, aspiration may also be needed to drain excess fluid or blood from the bursa, and a regimen of ice and NSAIDs will aid in reducing inflammation. Physical therapy may benefit patients who experience muscle tightness or impaired movement, helping to restore normal range and function.

Newer adjunct therapies have shown promise in managing chronic bursitis. High Power Laser (HPL) Therapy, for instance, uses focused light energy to penetrate deeply into tissues, increasing blood flow, accelerating inflammatory waste removal, and enhancing cellular energy production (ATP). This promotes tissue repair, with some studies on similar conditions indicating up to a 40-60% improvement in pain and function after consistent sessions over several weeks.

Extracorporeal Shockwave Therapy (ESWT) is another emerging option. Originally used to treat chronic tendinopathies, ESWT involves applying acoustic waves to stimulate tissue repair, reduce inflammation, and improve blood flow. Studies on chronic musculoskeletal conditions suggest a 60-80% success rate in reducing pain and improving function, with patients who haven’t responded to standard care often experiencing significant improvement after several treatments.

These newer, non-invasive therapies offer additional options for cases where traditional measures alone may not be fully effective, enhancing outcomes for patients with challenging or recurrent olecranon bursitis.

Conclusion

In summary, olecranon bursitis is an inflammatory condition impacting the bursa at the elbow’s tip, which functions as a cushion, allowing smooth movement between skin and bone. Due to its exposed location, the olecranon bursa is particularly vulnerable to trauma—whether from direct injury or repetitive, prolonged pressure on the elbow. This irritation can lead to fluid buildup within the bursa, resulting in visible swelling, discomfort, and restricted movement.

Olecranon bursitis cases may be non-septic, with no infection, or septic, where bacterial infection infiltrates the bursa and warrants immediate intervention. Diagnosis typically relies on clinical examination, while aspiration and lab analysis of bursal fluid confirm whether 

infection is present. Treatment approaches vary based on the severity and cause, with non-septic bursitis often managed conservatively through NSAIDs, activity modification, and ice application. For septic cases, antibiotics are essential, often combined with aspiration to clear the infected fluid. Emerging therapies, including High Power Laser and Extracorporeal Shockwave Therapy, show potential for chronic cases, offering additional relief and function improvement. Patients with olecranon bursitis can recover significantly and regain comfort and mobility through tailored treatments.

Proactively addressing olecranon bursitis improves comfort and enhances

overall mobility and quality of life. If you have any questions regarding olecranon bursitis or are experiencing elbow pain, don’t hesitate to contact Severn Clinics at 04 385 6446. Our dedicated team is here to assist you in navigating your path to recovery and restoring your well-being.

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Ischial Bursitis – What You Need To Know

October 22, 2024 /0 Comments/in , , , /by

Ischial Bursitis – What You Need To Know

Introduction To Ischial Bursitis

Ischial bursitis, also known as ischiogluteal bursitis, Weaver’s bottom, or Tailor’s bottom, is a relatively uncommon yet clinically significant inflammation of the ischial bursa located in the buttock region. As one of the four types of hip bursitis, it often goes underdiagnosed due to its subtle presentation and the tendency to attribute symptoms to other conditions. The bursa, a fluid-filled sac that reduces friction between tissues, becomes inflamed primarily due to chronic pressure or mechanical stress. 

This condition is most prevalent among individuals with sedentary lifestyles or those engaging in activities that place repetitive strain on the ischium, such as prolonged running or cycling. It is important to note that ischial bursitis rarely occurs in isolation; it is typically secondary to underlying pathologies, including hamstring injuries, trauma, or overuse syndromes. Proper identification and management of the root cause are essential for effective treatment and prevention of recurrence.

Anatomy of The Bursae Around The Ischium

The ischial bursa is a small, fluid-filled sac located deep in the buttock area, right over a bony part of the pelvis called the ischial tuberosity. It cushions between the large gluteus maximus muscle and the bone to prevent friction when you move.

The bursa is positioned below the gluteus maximus muscle and just behind the ischial tuberosity. On one side, it’s close to where the hamstring muscles attach to the bone. If the bursa gets irritated or swollen, it can sometimes spread into the nearby fatty tissue in the buttock area, especially if it gets swollen or inflamed. This inflammation often happens when there’s too much pressure or stress on that part of the body, like sitting for long periods or overworking the hamstrings.

How Common Is Ischial Bursitis?

Ischial bursitis is a relatively uncommon condition, often overlooked in clinical settings. It can affect individuals of any age, though it accounts for less than 1% of primary care visits related to bursitis. Historically referred to as “weaver’s bottom,” the condition has been associated with sedentary occupations, particularly prolonged sitting on hard surfaces. This has been a recognised issue since weaving became a common vocation, dating back to around 6000 BCE. Despite its long history, ischial bursitis remains underdiagnosed due to its subtle presentation and overlap with other musculoskeletal conditions.

What Causes Ischial Bursitis?

The origin of ischial bursitis is reflected in its historical name, “weaver’s bottom,” referring to workers who spent prolonged periods sitting on hard surfaces, leading to inflammation of the ischial bursa. Similarly, “tailor’s bottom” describes another common cause related to extended sitting. While pressure from prolonged sitting remains a primary cause, other factors contribute to ischial bursitis development. Here are some common causes: 

  • Trauma, such as direct impact or injury, can lead to hemorrhagic bursitis. 
  • Inflammatory conditions like rheumatoid arthritis and spondyloarthropathies can also trigger bursitis, as the body’s immune response targets the bursa. 
  • Though rare, infection can result in septic bursitis, often following septicemia or septic arthritis. 
  • Additionally, crystal deposition diseases, including gout and pseudogout, can provoke inflammation in the bursa.
  • Activities involving repetitive gluteus maximus motion, such as cycling, can aggravate the ischial bursa due to the continuous stress on the muscle, further contributing to bursitis development.

What Are The Symptoms of Ischial Bursitis?

The symptoms of ischial bursitis are primarily characterised by localised pain and discomfort, often worsening with specific activities or prolonged pressure on the affected area. The presentation can vary in severity, but common symptoms include:

  • Pain localised to the ischial tuberosity may radiate down the lower leg.
  • Increased pain with prolonged sitting, particularly on hard surfaces.
  • Pain with passive hip flexion and inability to extend the hip fully, especially when stretching.
  • Tenderness upon palpation over the ischial tuberosity.
  • Difficulty sleeping on the affected side due to pressure on the inflamed bursa.
  • Regional muscle dysfunction, often resulting in limited mobility and swelling.
  • Overlying erythema (skin redness) in more severe cases may indicate underlying cellulitis or septic joint, particularly if redness is a prominent feature.

How Is Ischial Bursitis Diagnosed?

Diagnosing ischial bursitis involves checking for certain signs and symptoms and some imaging tests to confirm inflammation in the bursa when needed.

One important test is the straight leg raise, which often causes pain if ischial bursitis is present. Another way to check is by having the patient resist leg movements; if extending the affected hip reproduces the pain, it further suggests bursitis. In rare circumstances, using X-rays to look for any calcification in the bursa and nearby areas can indicate long-term inflammation.

During the physical exam, patients often have a noticeable soft tissue lump in the buttock area of the affected hip. This lump is usually well-defined, doesn’t move around much, and feels tender when touched. Together, these signs and tests help our practitioners accurately diagnose ischial bursitis.

Not All Hip Pains Are Caused By Ischial Bursitis

The symptoms of ischial bursitis can sometimes look like other conditions, such as myxoid tumours, which are rare growths that can occur in the body. These include types like neurofibromas, schwannomas, and myxomas. Suppose one of our practitioners suspects a tumour. In that case, they might do a referral for a biopsy, which involves taking a small sample of tissue from the area to examine under a microscope. This helps tell the difference between the swelling from bursitis and the cells from a tumour.

In rare circumstances, one of our practitioners may also use X-rays to rule out other causes of pain, like stress fractures or wear and tear on the cartilage in the hip joint. A careful physical examination is essential to distinguish the pain of ischial bursitis from muscle-related issues. This examination typically involves checking specific movements and pressing on the area over the ischial tuberosity (the bony part of the pelvis). This thorough approach helps ensure a correct diagnosis and the right treatment plan.

How Is Ischial Bursitis Bursitis Treated

Chronic ischial bursitis is typically managed by reducing activities that exacerbate the condition, alongside using anti-inflammatory medications such as ibuprofen, Naprosyn, or Celebrex for a few weeks. While these medications help alleviate pain and inflammation, they do not address the underlying issue. Icing the affected area 2-3 times daily for 20-30 minutes can effectively control swelling; however, heat should be avoided, as it can worsen inflammation. 

Corticosteroid injections into the bursa may help reduce swelling but carry risks of side effects, including infection, skin atrophy, or chronic pain. These injections are generally reserved for cases that do not respond to other treatments, and they should be avoided if infection is suspected.

If signs of infection accompany ischial bursitis, immediate medical attention is crucial. Aspiration of the bursa may be necessary to relieve swelling and obtain samples for biopsy, with antibiotics prescribed to eliminate the infection. A significant concern with infected bursitis is the potential for bacteria to spread into the bloodstream. As with other forms of bursitis, rest, ice, and nonsteroidal anti-inflammatory drugs (NSAIDs) are employed to manage inflammation.

In cases of traumatic bursitis, aspiration with a small needle may be required to remove excess fluid or blood from the affected bursa. Icing the area and using NSAIDs can also help reduce swelling. Physical therapy may be beneficial, particularly if the condition is accompanied by muscle tightness or dysfunction.

HPL Therapy (High Power Laser Therapy): HPL therapy is a non-invasive treatment that utilises focused light energy to penetrate tissues deeply. While research specifically targeting ischial bursitis is limited, studies on other musculoskeletal conditions show promising results. HPL therapy enhances blood flow, accelerates the removal of inflammatory substances, and boosts cellular energy production (ATP), promoting tissue repair. In chronic or severe cases of ischial bursitis, it can serve as an effective adjunctive treatment, with some clinical studies reporting a significant reduction in pain, with patients experiencing up to a 40-60% improvement in pain and function after consistent use over several weeks.

ESWT (Extracorporeal Shockwave Therapy): ESWT is well-known for treating chronic tendinopathies but has also shown promise for ischial bursitis. The acoustic waves produced in ESWT stimulate tissue repair by enhancing blood flow and reducing inflammation. Some clinical studies indicate a success rate of 60%-80% in decreasing pain and improving function in patients with musculoskeletal conditions. Additionally, data shows that patients with chronic hip pain who do not respond to conservative measures experience significant improvements after several ESWT sessions.

Conclusion

In summary, ischial bursitis is an often overlooked yet significant condition that can adversely affect individuals’ quality of life, particularly those who lead sedentary lifestyles or participate in activities that impose repetitive strain on the ischial bursa. This inflammation of the bursa can lead to localised pain, discomfort, and restricted mobility, making it essential for individuals to recognise the symptoms and seek proper evaluation.

Understanding the potential causes—such as prolonged sitting, trauma, inflammatory conditions, and repetitive motion—is crucial for effective management. An accurate diagnosis, often achieved through physical examination and imaging is vital in differentiating ischial bursitis from other conditions that may present similarly.

Treatment options vary and may include conservative measures like activity modification, anti-inflammatory medications, and ice application to reduce swelling. In cases where traditional treatments are insufficient, advanced therapies such as High Power Laser Therapy (HPL) and Extracorporeal Shockwave Therapy (ESWT) have shown promise in promoting healing and alleviating pain.

Proactively addressing ischial bursitis improves comfort and enhances overall mobility and quality of life. If you have any questions regarding ischial bursitis or are experiencing hip pain, don’t hesitate to contact Severn Clinics at 04 385 6446. Our dedicated team is here to assist you in navigating your path to recovery and restoring your well-being.

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Shoulder Bursitis – What You Need To Know

October 8, 2024 /0 Comments/in , , , /by

Shoulder Bursitis – What You Need To Know

Introduction To Shoulder Bursitis

Shoulder bursae are synovial fluid-filled sacs located around the shoulder joint. Their role in life is to reduce friction at tendon-bone and tendon-tendon interfaces, promoting smoother movement. 

When glenohumeral bursae become inflamed, known as shoulder bursitis, we find a leading cause of shoulder pain. It can contribute to lost workdays and, in severe cases, disability. Symptoms of shoulder bursitis can vary depending on the severity and type but typically include swelling, localised warmth, tenderness, pain, and sometimes fever, indicating possible infection. Clinical signs often mimic other shoulder pathologies, necessitating a precise diagnosis.

Treatment approaches depend on the severity and underlying cause of the bursitis. Initial strategies may involve activity modification, immobilisation, icing, and anti-inflammatory medications. For persistent cases, options like corticosteroid injections or aspiration of the bursa may be required. However, emerging evidence highlights the efficacy of innovative treatments such as Extracorporeal Shockwave Therapy (ESWT) and High-Powered Laser (HPL), which are shown to be equally or more effective than traditional interventions, with fewer risks and complications.

Anatomy of The Bursae Around The Shoulder

The shoulder contains five primary bursae, which are crucial in reducing friction between tendons and bones and facilitating smooth movement. These include:

  • Subacromial-Subdeltoid (SASD) Bursa: The largest and most clinically significant, often implicated in shoulder impingement and bursitis.
  • Subscapular Recess: Located beneath the scapula, this bursa helps protect the subscapularis tendon.
  • Subcoracoid Bursa: Found near the coracoid process, it reduces friction during shoulder flexion and internal rotation.
  • Coracoclavicular Bursa: Situated between the coracoid process and the clavicle, this bursa helps ease movement in the acromioclavicular joint.
  • Supra-acromial Bursa: Located above the acromion, its role is less clinically prominent but still assists in movement.

Some authors include a sixth bursal space:

  • Medial Extension of The Subacromial-Subdeltoid Bursa: This can communicate with the SASD bursa and is considered by some to be a distinct space.

Shoulder bursae are innervated, with the subacromial bursa receiving sensory input from the suprascapular and axillary nerves. Nociceptors, such as free nerve endings, detect painful stimuli and inflammatory changes, transmitting these signals to the brain. Additionally, mechanoreceptors within the bursae provide proprioceptive feedback on joint position. This suggests that bursae contribute to lubrication and play a role in sensory and motor control of shoulder movement, adding another layer of complexity to their function in joint health and inflammation management.

How Common Is Shoulder Bursitis?

Shoulder bursitis is relatively common, accounting for about 0.4% of all primary care visits, with no significant gender differences. It frequently affects individuals engaged in repetitive overhead activities, such as athletes, factory workers, and manual labourers. Older adults are more susceptible, likely due to accumulated wear over time, contributing to subacromial impingement.

What Causes Shoulder Bursitis?

Bursitis typically develops from excessive stress placed on the bursa, leading to inflammation. The condition can be categorised into three main types based on the cause:

  • Chronic Bursitis: This is the most common form, resulting from repetitive irritation over time. Those with underlying conditions such as gout, pseudogout, diabetes, rheumatoid arthritis, or uremia are at a higher risk due to systemic inflammation or metabolic imbalances that affect joint health. But in most cases it is just caused by excessive movement of overuse. 
  • Infected Bursitis: In this type, bacterial infection infiltrates the bursa, causing inflammation. The infection can spread if left untreated, leading to more severe complications. This form requires prompt medical attention and often antibiotic treatment.
  • Traumatic bursitis (acute traumatic bursitis): This occurs following direct trauma to the bursa, such as a fall or impact, causing immediate irritation and swelling. Traumatic events may lead to rapid-onset inflammation, differing from the gradual progression in chronic cases.

Understanding the root cause is crucial for developing an effective treatment strategy, as management differs based on whether the bursitis is due to overuse, infection, or trauma.

What Are The Symptoms of Shoulder Bursitis?

Shoulder bursitis is typically marked by localised pain, swelling, and tenderness, with discomfort worsening during movement. Common symptoms include lateral or anterior shoulder pain, particularly aggravated by overhead lifting or reaching. Pain tends to intensify at night, often disrupting sleep.

Younger and middle-aged individuals are more likely to experience acute bursitis. At the same time, older patients with chronic rotator cuff issues may present differently. Tendonopathy in nearby tendons frequently accompanies shoulder bursitis, further complicating mobility. Daily activities, including household tasks and hygiene, can become difficult due to restricted and painful overhead movements. Contact sports or similar activities often exacerbate the pain.

How Is Shoulder Bursitis Diagnosed?

Bursitis is typically diagnosed through a combination of clinical examination and imaging studies. It is characterised by localised pain, swelling, tenderness, and discomfort with movement in the affected area. Healthcare providers often observe signs such as redness, warmth, and joint stiffness during a physical exam, particularly when inflammation is pronounced.

For subacromial bursitis, a physical examination usually reveals a reduced active range of motion, particularly in shoulder elevation, internal rotation, and abduction due to pain. The most significant discomfort often occurs during the arc of motion between 70 and 120 degrees of abduction, associated with subacromial pain syndrome.

Imaging studies can also aid in diagnosis. X-rays may reveal calcifications in the bursa in chronic or recurrent bursitis cases. Magnetic Resonance Imaging (MRI) is particularly effective for assessing the extent of inflammation and fluid accumulation in the bursa, providing a more detailed view of the condition.

But Not All Shoulder Pains Are Cauaed By Bursitis. 

There are many other issues that can occur within the shoulder region that mimic bursitis and can also be found in combination with bursitis.

  • Subacromial Impingement: This condition occurs when the space between the acromion and the rotator cuff narrows, leading to friction and irritation of the subacromial bursa. This repetitive impingement can lead to bursitis, making it a common co-diagnosis.
  • Adhesive Capsulitis (Frozen Shoulder): Patients with adhesive capsulitis experience significant restriction in shoulder movement, which can increase pressure on the surrounding structures, including the bursa. The immobility and compensatory movements often contribute to inflammation of the bursa.
  • Rotator Cuff Tendinopathy: Degeneration or inflammation of the rotator cuff tendons, particularly the supraspinatus tendon, can lead to secondary bursa irritation. The close anatomical relationship between the rotator cuff and the subacromial bursa makes this a frequent co-existing condition.
  • Supraspinatus Tendinopathy: This specific type of tendinopathy affects the supraspinatus tendon, one of the main components of the rotator cuff. Inflammation or degeneration of this tendon can easily extend to the subacromial bursa due to their proximity, often resulting in bursitis.
  • Bicipital Tendinopathy: Inflammation of the biceps tendon, mainly where it runs through the bicipital groove of the humerus, can cause pain and swelling that radiates into the shoulder joint and bursa, contributing to the development of bursitis.

Given the overlap in symptoms—such as pain with overhead movements, tenderness, and restricted mobility—it is essential to assess for associated conditions when diagnosing shoulder bursitis thoroughly. Accurately identifying the primary cause will guide more effective treatment and management strategies.

How Is Shoulder Bursitis Treated

Chronic bursitis is typically managed by reducing aggravating activities alongside anti-inflammatory medications like ibuprofen, Naprosyn, or Celebrex for a few weeks; however, these medications don’t address the underlying problem. Icing the shoulder 2-3 times daily for 20-30 minutes helps control swelling. Heat should be avoided as it worsens inflammation. Steroid injections into the bursa can reduce swelling. Still, they may lead to side effects, such as infection, skin atrophy, or chronic pain. Cortisone injections are usually reserved for cases that do not respond to other treatments. However, these pose risks. If infection is suspected, cortisone should be avoided.

Infected bursitis requires immediate medical attention. Aspiration of the bursa may be necessary to reduce swelling and obtain samples for biopsy, with antibiotics prescribed to eliminate bacteria. The critical risk is the potential for bacteria to spread into the bloodstream. As with other bursitis types, ice, rest, and NSAIDs are used to manage inflammation.

For traumatic bursitis, aspiration using a small needle is often required to remove excess fluid or blood from the affected bursa. Ice and NSAIDs help in reducing swelling. Physical therapy is also beneficial, especially if the condition is accompanied by frozen shoulder.

HPL Therapy (High Power Laser Therapy): HPL therapy is a non-invasive treatment that utilises focused light energy to deeply penetrate tissues. While data targeting bursitis is limited, studies on other musculoskeletal conditions show promising results. HPL therapy works by enhancing blood flow, accelerating the clearance of inflammatory mediators, and boosting cellular energy production (ATP), ultimately promoting tissue repair. It can be an effective adjunctive treatment in chronic or severe cases of shoulder bursitis. Some clinical studies report a significant reduction in pain, with patients experiencing up to a 40-60% improvement in pain and function after consistent use over several weeks.

ESWT: Extracorporeal Shockwave Therapy is widely recognised for treating chronic tendinopathies, but it has also shown promise for shoulder bursitis. The acoustic waves generated in ESWT stimulate tissue repair by promoting blood flow and reducing inflammation. Some clinical studies report a success rate of 60%–80% in reducing pain and improving function in patients with musculoskeletal conditions such as calcific shoulder tendinopathy. Data also shows that patients with chronic shoulder pain not responding to conservative measures saw significant improvements after several ESWT sessions.

Conclusion

Shoulder bursitis can be an extremely painful and frustrating condition to live with. And from a healthcare providers perspective it can be extremely tricky to diagnose. Yet the good news is that being diagnosed with bursitis is not a life sentence for shoulder pain. In fact there are many effective treatment options to be explored. Finding ways to reduce the pain whilst looking at the background to understand what the underlying cause of the bursitis is can be an extremely fruitful and satisfying way to find lasting freedom from the pain and limitation associated with shoulder bursitis.


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Bursitis: The Simple Facts

Bursitis: The Simple Facts What Is Bursitis? Bursitis is a condition characterised by the inflammation or swelling of a bursa.


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Tobias Hall

September 16, 2024

Five Foods That Decrease Testosterone Production

October 8, 2024 /0 Comments/in /by

Five Foods That Decrease Testosterone Production

Maintaining hormonal balance is critical for overall health and wellness. Testosterone, a key hormone in both men and women, plays a significant role in numerous bodily functions. Certain dietary choices can affect testosterone levels, and it’s important to understand how specific foods may contribute to this. Studies suggest that up to 8% of men may experience low testosterone levels, which can impact various aspects of health.

This overview highlights five foods shown by scientific research to lower testosterone levels and offers practical insights on how to manage hormonal balance more effectively.

Foods That May Lower Testosterone Levels

Certain foods can reduce testosterone levels, potentially impacting muscle mass, sexual function, and overall strength. Key categories include specific herbs, seeds, and beverages.

Testosterone is a crucial sex hormone that significantly influences various aspects of health. It’s estimated that 8% of males experience low testosterone levels, known as hypogonadism. Low testosterone can increase the risk of several health conditions, including:

  • Erectile Dysfunction
  • Obesity
  • Metabolic syndrome
  • Type 2 diabetes
  • Cardiovascular disease
  • Osteoporosis

While many factors regulate testosterone levels, maintaining a healthy diet can play a vital role in hormonal balance. Here are six foods that may contribute to lower testosterone levels.

Flaxseed and Its Impact on Testosterone Levels

Flaxseed is rich in heart-healthy fats, fibre, and essential vitamins and minerals. However, some research indicates that it may lead to a decrease in testosterone levels in specific populations. The primary reason for this effect is flaxseed’s high lignan content—plant compounds that can bind to testosterone, promoting its excretion from the body. Additionally, flaxseed is abundant in omega-3 fatty acids, which may also be linked to reduced testosterone levels.

In a 2001 study involving 25 men with prostate cancer, supplementation with flaxseed, combined with a reduction in overall fat intake, resulted in a significant decline in testosterone levels. Similarly, a case study noted that daily flaxseed supplements lowered testosterone levels in a 31-year-old woman with polycystic ovary syndrome (PCOS), a condition marked by elevated male hormones.

Despite these findings, more large-scale studies are needed to assess flaxseed’s impact on testosterone levels fully.

Trans Fats and Their Impact on Testosterone Levels

Trans fats are associated with an increased risk of heart disease, type 2 diabetes, and inflammation. Additionally, some studies suggest that regular consumption of trans fats from processed foods may lead to decreased testosterone levels. For instance, a study involving 209 men found that those with the highest trans fat intake had testosterone levels that were 15% lower than those with minimal consumption. Furthermore, these men exhibited a 37% decrease in sperm count and reduced testicular volume, which may indicate impaired testicular function. Animal studies corroborate these findings, showing that high trans fat intake can lower testosterone levels and negatively affect reproductive performance.

The type of fat consumed can also influence testosterone levels and function. A 2017 study examining dietary patterns in young, healthy men indicated that trans fats might lower testosterone levels. The research also found that excessive omega-6 fatty acids could diminish testicular size and function. Conversely, a diet rich in polyunsaturated omega-3 fatty acids may enhance testicle size and improve function. While more research is needed to confirm these results, individuals concerned about their testosterone levels might consider avoiding trans fats and limiting omega-6 fats.

Alcohol and Its Impact on Testosterone Levels

For those concerned about their testosterone levels, it may be worth considering a reduction or elimination of alcohol, particularly for men. Although some studies suggest that a small amount of alcohol might elevate testosterone levels in males, this is not the prevailing trend. A 2017 review indicates that heavy or chronic alcohol consumption typically leads to decreased testosterone levels in men. Interestingly, the same review notes that alcohol consumption can raise testosterone levels in females.

While the occasional glass of wine has been associated with health benefits, a small 2004 study involving 19 healthy adults found that consuming 30–40 grams of alcohol daily—about 2–3 standard drinks—resulted in a 6.8% decline in testosterone levels in men over three weeks. Additionally, a 2014 study reported that alcohol intake reduced semen quality and altered reproductive hormones in young Danish men.

However, the evidence is not entirely conclusive. Both older human and animal studies have yielded mixed results, with some research indicating that alcohol might increase testosterone levels in specific scenarios. Further investigation is necessary to fully understand how varying alcohol doses affect testosterone levels in the general population.

Nuts and Their Impact on Testosterone Levels

Nuts are an excellent source of essential nutrients, including fibre, heart-healthy fats, and minerals such as folic acid, selenium, and magnesium. However, some studies indicate that certain nuts might reduce testosterone levels. For instance, a small study involving 31 women with polycystic ovary syndrome found that walnuts and almonds increased levels of sex hormone-binding globulin (SHBG) by 12.5% and 16%, respectively. SHBG is a protein that binds to testosterone, potentially leading to lower free testosterone levels in the body.

Additionally, nuts are typically high in polyunsaturated fatty acids, which some older studies have linked to decreased testosterone levels. Despite these findings, further research is necessary to clarify whether and how specific nuts influence testosterone levels. In the meantime, existing research supports nut consumption for cardiovascular and endocrine health, provided no allergies are involved.

Bread, Pastries, And Desserts Impact on Testosterone Levels

A 2018 study linked a diet rich in bread, pastries, and desserts to lower total testosterone levels in Taiwanese men. Other contributing factors included high dairy intake, frequent dining out, and insufficient consumption of dark green vegetables.

The research indicated that these participants also experienced decreased muscle mass and increased body fat, further highlighting the potential impact of such dietary choices on hormonal health.

Key Takeaways

  • Understanding the impact of specific foods on testosterone levels is crucial for maintaining hormonal balance. 
  • Key culprits that may reduce testosterone include soy-based products, dairy, alcohol, processed foods, refined grains like breads and pastries, added sugars, and trans fats.
  • Both men and women should evaluate their dietary habits and lifestyle choices to manage hormonal health more effectively. 
  • Persistent symptoms of low testosterone, such as fatigue, hair thinning, muscle loss, increased body fat, or erectile impotence should be discussed with a healthcare provider for a comprehensive approach to hormone management.

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The Relationship Between Low Testosterone and Erectile Dysfunction

September 24, 2024 /0 Comments/in /by

The Relationship Between Low Testosterone and Erectile Dysfunction

Testosterone is the principal androgen hormone in males, playing a critical role in male reproductive development, including the formation of tissues like the testicles and prostate. It promotes secondary sexual characteristics, such as muscle mass, bone density, and body hair growth. Additionally, it influences behaviour by enhancing aggression, libido, dominance, and various cognitive and social factors. 

Beyond sexual development, testosterone contributes to broader health, including metabolism, cardiovascular function, mood regulation, and bone density. Low testosterone levels, also known as Hypogonadism in men, can result in diminished muscle mass, increased body fat, anxiety, reduced sexual performance, weakened bones and erectile dysfunction. Additionally, testosterone therapy is used to address hypogonadism and breast cancer, and it can also counteract natural declines in testosterone as men age. However, it’s often misused in athletic settings to enhance physical performance, a practice banned by the World Anti-Doping Agency due to its anabolic effects.

What is Low Testosterone (Hypogonadism)?

Male Hypogonadism can arise from defects that disrupt the hypothalamic-pituitary-testicular axis, either congenitally or through acquired conditions. The condition can be classified into two types: primary Hypogonadism, where the defect lies in the testes, and secondary Hypogonadism, where the issue originates in the hypothalamus or pituitary gland. Understanding this distinction is essential for accurate diagnosis and treatment.

  • Primary Hypogonadism involves the testicles’ failure to produce adequate levels of testosterone, which is primarily synthesised in the Leydig cells of the testes. This condition can stem from a variety of factors, including trauma, infection (such as mumps orchitis), chemotherapy, radiation, or congenital abnormalities like Klinefelter syndrome. Symptoms typically include reduced spontaneous erections, diminished nocturnal penile tumescence, low libido, fatigue, and smaller testicular volume. Additionally, testicular failure leads to increased levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) due to a lack of negative feedback to the hypothalamus and pituitary. These elevated levels help differentiate primary Hypogonadism from secondary forms.
  • Secondary Hypogonadism, or hypogonadotropic Hypogonadism, involves dysfunction of the hypothalamus or pituitary gland, leading to insufficient secretion of gonadotropins (LH and FSH), which are crucial for stimulating testosterone production in the testes. Causes include pituitary tumours, genetic disorders such as Kallmann syndrome, head trauma, or chronic illnesses that impair the hypothalamus or pituitary. In this form of hypogonadism, LH and FSH levels are low or inappropriately normal.

Hypogonadism is significantly underreported and often misdiagnosed. The condition is prevalent, particularly in older men, with studies indicating that approximately 40% of men over the age of 45 and nearly 50% of men in their 80s are affected. Testosterone levels decline naturally with age at a rate of approximately 100 ng/dL every decade. Interestingly, Hypogonadism does not show significant variance across different racial or ethnic groups.

In diabetic populations, particularly non-obese males, 29% were found to be testosterone deficient. The visceral adiposity index (VAI), derived from waist circumference, BMI, serum triglycerides, and HDL levels, has emerged as a reliable predictor of testosterone deficiency in such patients, emphasizing the link between metabolic health and Hypogonadism. 

The overall underrecognition of hypogonadism calls for greater awareness, particularly in light of its profound impact on men’s health and quality of life. The ageing population is particularly susceptible, and metabolic factors like obesity and insulin resistance further increase the risk of testosterone deficiency. Early diagnosis and appropriate treatment are essential for improving outcomes in men affected by this hormonal disorder.

Diagnosing Hypogonadism typically involves measuring serum testosterone levels in the early morning (when testosterone levels peak). The standard reference range is usually between 300-1000 ng/dL, although values may vary depending on the laboratory. A diagnosis of Hypogonadism is generally confirmed when the serum testosterone falls below 300 ng/dL on two separate occasions, mainly when symptoms are present. 

What Is The Role of Testosterone?

Testosterone plays a vital role in male physiology, particularly in erectile function. It influences both the frequency and rigidity of erections, though the degree of testosterone required to maintain erectile function remains debated. It has always been assumed that testosterone and other androgens have played a role in erectile function. This is mainly due to:

  • Testosterone levels naturally decrease with age, coinciding with an increased prevalence of erectile dysfunction (ED).
  • Castration (leading to severe Hypogonadism) typically results in a marked decline in sexual function due to the loss of testosterone.
  • When men with severe Hypogonadism (often due to castration) are treated with exogenous androgens (testosterone replacement therapy), sexual function usually returns to normal, restoring both sexual desire and erectile function.

Hypogonadal men often experience reduced erectile frequency and firmness, with sexual function improving when treated with exogenous androgens. As men age, testosterone levels naturally decline—total and free testosterone drop significantly due to an increase in sex hormone-binding globulin (SHBG), which binds testosterone, reducing its bioavailability. However, the threshold of Hypogonadism that causes erectile dysfunction is not established. Though testosterone diminishes with age, normal adult testosterone levels aren’t necessary for erectile function. After a certain threshold, further increases in testosterone don’t correspond to improved erectile performance. This natural decline becomes particularly evident with aging. By age 75, free testosterone levels drop to approximately 50% of those seen in younger men. Despite this, defining Hypogonadism in older men remains a point of debate, as a significant portion of aged men may still maintain sufficient free testosterone, even though their total testosterone is reduced.

How Is Low-Testosterone (Hypogonadism) Treated? 

For treating Hypogonadism, testosterone supplementation is only indicated in symptomatic patients with confirmed low testosterone levels. Asymptomatic patients or those with normal testosterone levels typically do not benefit from supplementation, and lifestyle interventions such as weight loss and increased physical activity should be prioritized instead. Oral testosterone, especially methyltestosterone, is generally avoided due to its potential hepatotoxicity, which includes risks like liver damage and cholestasis.

Testosterone replacement therapy (TRT) in men with confirmed Hypogonadism has shown statistically significant improvements in symptoms such as libido, anaemia, bone density, muscle mass, depression, and erectile dysfunction. While testosterone therapy may show some promise in alleviating fatigue, improving energy levels, metabolic markers (e.g., hyperlipidemia, diabetes control), cognitive function, and overall quality of life, clinical data remain inconclusive. There is also some evidence supporting its use for depressive symptoms in hypogonadal men. However, certain studies have found no benefit over placebo, indicating that more research is needed. 

How Is Testosterone Replacement Therapy (TRT) Administered?

The ideal testosterone replacement therapy should closely replicate the body’s natural daily pattern of hormone secretion while maintaining physiological levels of testosterone and its key metabolites, including dihydrotestosterone (DHT) and estradiol (E2). The treatment should also be well-tolerated, convenient to use, and cost-effective. Current administration methods include oral formulations, intramuscular injections, and transdermal options (such as patches or gels), each having distinct benefits and challenges in maintaining stable hormone levels while minimizing side effects. Some of the most common medications include:

  • Clomiphene Citrate offers an effective treatment for both biochemical and clinical male Hypogonadism via a unique mechanism. As an anti-estrogen, it blocks estradiol from suppressing GnRH production in the hypothalamus, causing increased release of FSH and LH from the pituitary—this rise in FSH aids in preserving fertility and sperm production, while elevated LH boosts testosterone synthesis. Clomiphene is particularly suited for men wishing to maintain fertility. Standard dosing ranges from 25 to 50 mg daily, with testosterone levels typically monitored after 30 days.
  • Human chorionic gonadotropin (hCG) promotes testosterone production by stimulating the Leydig cells in the testes, similar to clomiphene. However, unlike other testosterone therapies, hCG does not negatively impact sperm counts or spermatogenesis. Its structure mimics luteinizing hormone (LH), though it has a longer half-life of around 36 hours than LH’s 30-minute half-life. Due to this extended half-life, hCG is often preferred in men with hypogonadotropic Hypogonadism, where maintaining fertility and increasing testosterone production are treatment goals.
  • Testosterone replacement therapy presents several administration options: oral, intranasal, transdermal (gel, solution, subcutaneous pellets), and intramuscular injections. Transdermal gels and intramuscular injections are the most prevalent methods in the US. An intranasal testosterone gel is accessible, delivered via a pump metered-dose applicator that dispenses 5.5 mg per activation. The recommended dose is one activation in each nostril three times daily. This approach reduces the risk of androgen transfer through contact, but many people find the frequent dosing cumbersome. There is also data indicating elevated testosterone levels in the brain, though the implications remain uncertain. Surgically implantable long-duration testosterone pellets provide a prolonged therapeutic effect, with up to six 75 mg pellets implanted every three to six months. These are placed subcutaneously in the lower abdomen, thighs, or buttocks using a trocar under local anaesthesia. However, there is limited data on the long-term maintenance of testosterone levels with this method, and the necessity for repeated procedures can make it less appealing.

Testosterone Replacement and Prostate Health

A significant risk factor linked to testosterone supplementation is its impact on the prostate. The prostate is an androgen-dependent gland, and antiandrogen agents can reduce prostate volume in patients with benign prostatic hyperplasia (BPH). As the population ages, both BPH and late-onset male Hypogonadism are expected to increase, necessitating that practitioners effectively counsel men about testosterone replacement therapy (TRT) and its effects on the prostate. In a randomized, double-blind, placebo-controlled trial involving 44 hypogonadal men, Marks et al. demonstrated that TRT over six months significantly enhances serum androgen levels but has minimal impact on prostate tissue androgen levels, biomarkers, or gene expression. Testosterone supplementation has been associated with a 12% increase in prostate size; however, lower urinary tract symptoms (LUTS) and urinary retention do not worsen in men receiving testosterone therapy. Notably, among 312 men with measurable LUTS, Hypogonadism did not predict worsening International Prostate Symptom Scores (IPSS) or maximal urinary flow rates. Some studies even report improvements in LUTS after one year of TRT. In a recent randomized controlled trial, 52 men received TRT, with 23 men receiving 250 mg of testosterone enanthate every four weeks. After one year, these men showed significant enhancements in IPSS and maximal urinary flow rates compared to baseline and control groups. Throughout the trial, no participants required additional medication or experienced urinary retention.

Although older men on testosterone therapy do experience an increase in overall prostate size, this increase is comparable to the prostatic hypertrophy observed in older men not undergoing testosterone treatment. Overall, TRT does not appear to worsen LUTS substantially and is not contraindicated in men diagnosed with BPH.

Testosterone and Male Breast Cancer

While there is no established physiological link between testosterone and the development of breast cancer, elevated testosterone levels may increase aromatization to active oestrogen derivatives. This process could potentially stimulate breast tissue receptors, raising the risk of male breast cancer. The exact role of testosterone in breast cancer development remains unclear. Current literature includes several case reports, and one retrospective review indicates an 11% incidence of breast cancer in 45 men undergoing long-term TRT over a decade. Future prospective studies with extended follow-up are necessary to clarify whether a true association exists between TRT and male breast cancer.

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Erectile Dysfunction and The Male Pelvic Floor – What’s The Connection?

September 16, 2024 /0 Comments/in /by

Erectile Dysfunction and The Male Pelvic Floor – What’s The Connection?

Introduction to The Male Pelvic Floor

The male pelvic floor is a complex network of muscles, ligaments, nerves, and fascia that stretches from the pubic bone to the tailbone. This structure is vital in several essential functions, including urinary and faecal continence, core stability, and sexual health. The pelvic floor muscles support the pelvic organs, providing control over bladder and bowel movements by ensuring the proper function of sphincters. In addition, these muscles contribute to erectile function, ejaculation, and the overall sexual experience by facilitating adequate blood flow and maintaining the rigidity of erections. Maintaining strength and flexibility in these muscles is critical. Weakness or dysfunction in the pelvic floor can lead to various issues, such as urinary incontinence, bowel dysfunction, pelvic pain, and sexual dysfunction, including erectile dysfunction and premature ejaculation. Strengthening the pelvic floor through targeted exercises can help restore balance and control in these areas. This is especially beneficial post-surgery, such as after prostate removal, where pelvic floor exercises can aid in the recovery of continence and sexual function.

What Are The Male Pelvic Floor Muscles?

The male pelvic floor muscles form a dome-like structure, crucial for maintaining continence, sexual function, and pelvic organ support. These muscles span the pelvis, creating a supportive “hammock” that engages in various bodily functions.

  • Superficial Layer: The superficial perineal pouch includes muscles like the bulbospongiosus, ischiocavernosus, superficial transverse perineal, and external anal sphincter. These muscles are essential for ejaculation and both urinary and faecal continence.
  • Intermediate Layer: The urogenital diaphragm consists of the deep, transverse perineal muscles, sphincter urethrae, and compressor urethrae. This layer is critical in maintaining urinary continence during increased intra-abdominal pressure, such as coughing or sneezing.
  • Deep Layer: The pelvic diaphragm is the deepest layer, composed of muscles like the pubococcygeus, puborectalis, pubourethral, iliococcygeus, and ischiococcygeus. These muscles are primarily responsible for supporting pelvic organs and ensuring continence. The pelvic diaphragm provides structural integrity to the pelvis. It is vital in preventing prolapse and maintaining the proper function of the pelvic organs.

Anatomy of the Prostate Gland

The prostate gland, approximately the size of a walnut, is located in the male pelvis beneath the bladder and surrounds the urethra. Its primary function is to secrete prostatic fluid, a component of semen that nourishes and protects sperm. The prostate is situated just behind the pubic ramus and has critical relationships with nearby structures. A key aspect of prostate anatomy is the presence of a neurovascular bundle on each side, encapsulated within its fascial sheath. These bundles contain nerves essential for erectile function. Damage to these nerves, especially during surgical removal of the prostate (radical prostatectomy), can lead to complications such as erectile dysfunction and incontinence. However, advancements in surgical techniques, pioneered by Walsh and Donker in 1982, introduced nerve-sparing procedures, significantly improving postoperative outcomes. Today, prostatectomy procedures range from non-nerve-sparing to bilateral nerve-sparing, depending on the extent of the cancer.

Additionally, the prostate houses two sphincter muscles: the proximal smooth muscle sphincter and the distal striated muscle sphincter. The proximal sphincter prevents retrograde ejaculation, while the distal sphincter is crucial for maintaining urinary continence. Damage to the latter during surgery can result in incontinence, making the preservation of this muscle group a priority during prostate-related procedures. Understanding the intricate anatomy of the prostate and its surrounding structures is vital for both surgical planning and the management of potential post-surgical complications.

The Nerve Pathway To The Male Pelvic Floor

The male pelvic floor is controlled by parasympathetic, sympathetic, and somatic nerve pathways, providing both involuntary and voluntary regulation. These pathways primarily involve the pudendal, pelvic splanchnic, and presacral nerves, originating from sacral roots S2-S4.

  • Pudendal Nerve: This nerve controls somatic functions, such as voluntary contraction of pelvic floor muscles, contributing to urinary continence and ejaculation.
  • Pelvic Splanchnic Nerves: These parasympathetic nerves innervate the blood vessels of the penis, playing a pivotal role in erectile function. Damage to these nerves, particularly during procedures like a prostatectomy, can lead to erectile dysfunction.
  • Sympathetic Innervation: The sympathetic nervous system contributes to ejaculation and detumescence (the process of the penis returning to a flaccid state after erection). Disruptions in sympathetic pathways can impact these functions.

The Male Pelvic Floor and Erectile Dysfunction

Erections result from a sophisticated interplay between the vascular, parasympathetic, sympathetic, somatic, and central nervous systems, involving hormones and the muscular system. Blood flow to the corpus cavernosa (penile tubes) must outpace venous outflow, creating a closed hydraulic system to maintain rigidity.

Key muscles in the male pelvic floor, specifically the bulbospongiosus and ischiocavernosus, play pivotal roles in achieving and maintaining erections. Pelvic floor muscle training can enhance penile rigidity, positively affecting erectile function. Conversely, spasms or dysfunction in these muscles can limit blood flow, leading to erectile dysfunction. Strengthening these muscles is vital for sexual health and may serve as an adjunct to other erectile dysfunction treatments.

How To Activate The Male Pelvic Floor Muscles

Activating the male pelvic floor muscles correctly involves closing the sphincters and creating a general upward lift of the muscles, akin to pulling the bladder towards the belly button. To better target specific areas of the pelvic floor for continence and sexual function, you can divide the “hammock” into three sections: front, middle, and back. For example, cues like “shorten your penis” and “stop the flow of urine” focus on the anterior and middle sections, aiding in erectile function and urinary control. Meanwhile, cues like “tighten around the anus” can help activate the posterior region, which is crucial for maintaining faecal continence.

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Prepatellar Bursitis: What You Need To Know

September 16, 2024 /0 Comments/in , , , /by

Prepatellar Bursitis: What You Need To Know

Overview of Prepatellar Bursitis

Prepatellar bursitis, colloquially referred to as “housemaid’s knee” or “carpenter’s knee,” is an inflammatory condition of the prepatellar bursa. This fluid-filled sac cushions the area between the patella (kneecap) and the skin. This bursa is particularly susceptible to inflammation due to its superficial location, making it vulnerable to trauma, repetitive kneeling, and prolonged pressure on the knees—hence its association with occupations such as gardening, carpet laying, mining, and mechanics.

The condition can be classified into two main types: infectious (septic) and non-infectious. Non-infectious prepatellar bursitis accounts for most cases (around 70%). It is typically triggered by repetitive mechanical stress, direct trauma, or chronic pressure. Acute injuries such as a direct fall onto the knee or consistent friction from kneeling can inflame the bursa, leading to swelling, pain, and restricted movement. Over time, even minor trauma or repetitive motion can accumulate and manifest as bursitis, underscoring the importance of proper ergonomics and protective measures in high-risk professions. Infectious prepatellar bursitis (30%) occurs when bacteria infiltrate the bursa, leading to septic inflammation. This typically arises from cuts, abrasions, or puncture wounds near the knee that allow pathogens like Staphylococcus aureus to enter and infect the bursa. Septic bursitis presents more severely, often accompanied by fever, increased pain, and noticeable warmth or redness over the affected area. Prompt medical intervention is critical, as untreated septic bursitis can lead to severe complications, including abscess formation or systemic infection.

Anatomy of The Patella

The patella, commonly known as the kneecap, is a sesamoid bone embedded within the quadriceps tendon, playing a pivotal role in knee mechanics. Shaped like an inverted triangle, the patella is located anteriorly to the knee joint and resides within the patellofemoral groove of the femur. Its primary function is to protect the knee joint while enhancing the leverage of the quadriceps muscle, facilitating efficient knee extension. When the knee flexes or extends, the patella glides smoothly within this groove, guided by surrounding structures like the quadriceps tendon, which attaches to the superior aspect of the patella and the patellar tendon. This robust structure connects the inferior pole of the patella to the tibial tuberosity. This configuration allows the patella to act as a fulcrum, amplifying the force generated by the quadriceps muscle group during leg extension. Surrounding the patella are several bursae, which are fluid-filled sacs that reduce friction and cushion the movement of tendons and muscles over bony prominences. 

Bursae around the patella can be categorised into two primary groups. The first group includes the bursae around the patella, such as the suprapatellar bursa, the prepatellar bursa, and the superficial and deep infrapatellar bursae. These bursae are critical in minimising friction between the patella, skin, and surrounding soft tissues. The second group consists of bursae found elsewhere around the knee, such as the pes anserine bursa, located on the medial aspect of the knee, and the iliotibial (IT) bursa, which is associated with the IT band on the lateral side of the knee. These bursae, although not directly connected to the patella, still contribute to the overall functionality and health of the knee joint by ensuring smooth movement of tendons and muscles over adjacent bone structures.

How Common Is Prepatellar Bursitis

Prepatellar bursitis is more prevalent among men than women and typically affects individuals between the ages of 40 and 60. Men account for about 80% of cases within this age group. The condition can arise at any age, but the incidence is higher among men, especially those engaged in occupations or activities that involve prolonged kneeling. About one-third of prepatellar bursitis cases are septic, with infections being more common in children than adults. Non-septic cases make up the remaining two-thirds. The annual incidence of prepatellar bursitis is approximately 10 per 100,000 people, which is likely underestimated. Many cases, especially non-septic ones, may not be reported as only the most severe instances typically require hospitalisation.

What Causes Prepatellar Bursitis

Prepatellar bursitis arises from various mechanical and infectious causes. Direct trauma or repeated impact to the anterior knee, such as frequent falls or constant friction between the skin and the patella, can lead to inflammation of the prepatellar bursa. This results in swelling due to damaged blood vessels. However, infection via hematoma is rare because of limited vascular supply in the bursal tissue. Septic prepatellar bursitis typically occurs when bacteria, most commonly Staphylococcus aureus (80% of cases), infiltrate the bursa through a skin break. Symptoms of an infected bursa may include pain, fever, tenderness, and elevated white blood cells. Additionally, underlying inflammatory diseases such as rheumatoid arthritis or gout may contribute to the development of prepatellar bursitis.

What Are The Symptoms of Prepatellar Bursitis?

Prepatellar bursitis presents various symptoms, primarily characterised by localised pain and swelling at the front of the knee. Swelling is often pronounced and may be accompanied by warmth in the affected area due to inflammation. Pain intensifies with movement, leading to a restricted range of motion (ROM) in the knee joint. In cases where an infection causes bursitis, additional symptoms such as fever and chills may be observed. The infected bursa may also become particularly tender to touch, further complicating mobility.

How Is Prepatellar Bursitis Diagnosed?

Diagnosing prepatellar bursitis requires a thorough assessment involving a clinical history and a physical examination. The history focuses on understanding the onset and progression of symptoms, particularly knee pain swelling, and their impact on daily activities. Physical examination evaluates the knee’s appearance, palpation for warmth, and pain with movement. Imaging studies such as X-rays, MRI, or CT scans may be employed to exclude other conditions like fractures or soft tissue injuries. If infection is suspected or the diagnosis is unclear, arthrocentesis (joint aspiration) is performed to analyse the synovial fluid. This 

procedure serves several purposes:

  • Obtaining critical diagnostic information
  • Alleviating pressure and pain by draining excess fluid
  • Enabling therapeutic injections if needed

Fluid analysis can help confirm or rule out septic bursitis. If a bacterial infection is present, further interventions are guided accordingly. In cases where bursitis coexists with systemic inflammatory diseases like rheumatoid arthritis or gout, additional diagnostic considerations must be made to tailor treatment effectively. Accurate diagnosis is essential for formulating a comprehensive and targeted treatment plan that addresses the local pathology and any underlying contributing factors.

How Is Prepatellar Bursitis Treated?

Treatment for prepatellar bursitis is multifaceted and tailored to the underlying cause and specific pathological changes in the bursa. The primary focus of treatment is to control inflammation, alleviate pain, and promote tissue repair.

  • HPL Therapy For Prepatellar Bursitis:

High Power Laser (HPL) Therapy offers a non-invasive approach, utilising focused light energy to penetrate deep tissues. Although specific evidence for bursitis is limited, it’s shown promise in reducing pain and inflammation in other musculoskeletal conditions. The therapy stimulates blood circulation, accelerates the removal of inflammatory mediators, and enhances cellular energy production (ATP) to aid tissue regeneration. This non-invasive modality can be a valuable addition to the overall treatment plan for prepatellar bursitis.

  • Shockwave Therapy For Prepatellar Bursitis:

Extracorporeal Shockwave Therapy (ESWT) utilises high-energy acoustic waves to stimulate healing in inflamed tissues. Though more commonly used for conditions like tendinopathy, it has also proven helpful in managing bursitis. The waves create microtrauma within the tissue, promoting the body’s natural healing processes. This can help reduce inflammation, improve tissue regeneration, and relieve pain. Given its effectiveness, ESWT may be a valuable option, especially for chronic or recalcitrant cases of prepatellar bursitis.

  • Medications For Prepatellar Bursitis:

Non-steroidal anti-inflammatory drugs (NSAIDs) and topical treatments like creams, sprays, gels, and patches provide localised relief by reducing inflammation and pain when applied directly to the affected area. These topical options may benefit patients who wish to avoid gastrointestinal side effects commonly associated with oral medications. In cases of septic prepatellar bursitis, antibiotics are necessary to combat the infection, addressing the root cause while simultaneously managing symptoms.

The treatment plan should be individualised to ensure optimal recovery and minimise the risk of recurrence.

Physical Therapy and Rehabilitation of Prepatellar Bursitis

Physical therapy and rehabilitation play a crucial role in managing and recovering prepatellar bursitis. The initial approach often involves the RICE method—Rest, Ice, Compression, and Elevation. While common, this method should be applied with caution, especially since there is limited high-level evidence to support its efficacy in randomised clinical trials fully. The rest phase is vital immediately following trauma to reduce the affected tissue’s metabolic demands and prevent further inflammation. However, prolonged immobilisation should be avoided, as it can lead to joint stiffness and muscle weakening. Ice application helps reduce inflammation by causing vasoconstriction. Still, it should be applied cautiously—no longer than 20 minutes, with 30-60 minute intervals between applications. Compression through wraps or braces helps minimise swelling, and elevation can reduce hydrostatic pressure, further decreasing fluid accumulation and promoting blood flow.

Once acute inflammation has subsided, therapeutic exercises become essential. Rehabilitation focuses on restoring the full range of motion and strengthening the muscles that support the knee joint. Quadriceps exercises like static contractions are particularly important for maintaining muscle tone and improving stability. Patients should perform these exercises daily, ensuring that movements remain pain-free. The goal is to reintroduce normal activities while avoiding overloading the joint, which could trigger a recurrence of bursitis.

Incorporating quadriceps stretching is also crucial, as it reduces friction between the skin and the patellar tendon, enhancing flexibility and preventing further irritation. A practitioner may supplement the rehabilitation plan with Laser Therapy to reduce pain and inflammation and educate the patient on protective measures such as knee pads for prolonged kneeling activities.

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Pes Anserine Bursitis – What You Need To Know

September 16, 2024 /0 Comments/in , , , /by

Pes Anserine Bursitis – What You Need To Know

Overview of Pes Anserine Bursitis

Pes anserine bursitis, also known as intertendinous bursitis, is an inflammation of the bursa located at the conjoined insertion of the sartorius, gracilis, and semitendinosus muscles. This condition manifests at the proximal medial aspect of the knee, approximately two inches below the medial knee joint line, situated between the pes anserine tendons and the tibia. This specific bursa acts as a cushion, reducing friction between the tendons and the underlying bone during movement. However, when subjected to repetitive stress or injury, inflammation of the bursa can occur, leading to pain, swelling, and discomfort along the medial knee. The condition is prevalent in athletes, especially runners and individuals whose activities require frequent knee flexion and extension.

Anatomy of The Pes Anserine

The pes anserine bursa is a fluid-filled sac that secretes synovial fluid to reduce tissue friction, acting as a cushion for bones, tendons, and muscles. Bursitis, the inflammation of this bursa, develops gradually over time rather than suddenly. While bursitis can affect various body parts, such as the shoulder, hip, and elbow, the pes anserine bursa is located at the medial side of the tibia, near the knee. Anatomically, the pes anserine, or “Goose Foot,” refers to the conjoined tendinous insertion of three muscles: the sartorius, gracilis, and semitendinosus. These muscles work together to flex the knee and rotate it internally. Positioned superficially to the medial collateral ligament (MCL), the pes anserine tendons also serve to stabilise the knee joint during movement. The sartorius and gracilis muscles, which are adductors of the leg, help pull the leg toward the body’s median axis, pivotal in stabilising the knee during dynamic movements. The semitendinosus muscle, part of the hamstring group, is responsible for knee flexion and internal rotation, further contributing to the stability and function of the knee.

How Common Is Pes Anserine Bursitis

Research indicates that this condition is more prevalent among overweight middle-aged women. This prevalence can be attributed to the wider pelvis in females, which results in a greater valgus alignment (knees angled inward) and increases pressure at the pes anserine insertion. This biomechanical factor, combined with excess weight, places undue stress on the medial knee structures, predisposing this population to bursitis. Notably, pes anserine bursitis is often secondary to another underlying issue rather than a primary condition. It commonly results from pre-existing biomechanical imbalances, trauma, or degenerative joint diseases. Therefore, managing pes anserine bursitis requires addressing the inflammation and the contributing factors to prevent recurrence.

What Causes Pes Anserine Bursitis

Pes anserine bursitis frequently arises from repetitive stress on the pes anserine bursa, primarily due to repeated knee flexion and adduction. Activities such as running, squatting, or climbing stairs increase friction and pressure on the bursa, leading to inflammation. Trauma, such as a direct blow to the inner knee, can also result in this condition by causing a sudden increase in synovial fluid, which triggers inflammation and pain. An underlying factor in pes anserine bursitis is often knee osteoarthritis. Osteoarthritis contributes to abnormal joint mechanics, increasing stress on the pes anserine region, which can lead to bursitis.

What Are The Symptoms of Pes Anserine Bursitis?

Pes anserine bursitis presents primarily as pain in the inner aspect of the knee, particularly during activities like running or climbing stairs. Patients often report spontaneous anteromedial knee pain, exacerbated by pivoting, kicking, or side-to-side movements. Clinically, tenderness is noted over the pes anserine region, and the area may exhibit swelling or be sensitive to touch. This condition can also lead to reduced muscle strength, altered gait, limited range of motion, and decreased knee function. Postural dysfunction and impaired lower extremity biomechanics are also common. Movements involving knee flexion, internal rotation, and external rotation and adduction aggravate the condition further. These symptoms and physical examination findings are critical indicators in diagnosing pes anserine bursitis and differentiating it from other knee pathologies.

How Is Pes Anserine Bursitis Diagnosed?

The physical assessment of Pes Anserine bursitis involves careful palpation, range of motion testing, and strength assessments to identify characteristic symptoms. The pes anserine bursa can be located approximately 3-4 cm medial to the tibial tubercle. Palpation in this area often elicits tenderness and may reveal localised swelling. Hamstring flexibility should be evaluated with the patient in a supine position, and knee extension should be tested. At the same time, the hip is flexed at 90°. Tight hamstrings may contribute to this condition, particularly in athletes. In sports-related cases, pain may be reproduced with resisted internal rotation or flexion of the knee. However, knee flexion and extension might not provoke significant discomfort in chronic variants commonly seen in older adults. Imaging studies are crucial in differentiating Pes Anserine bursitis from other pathologies. Lateral X-rays of the knee can help rule out fractures or arthritis. At the same time, MRI provides a detailed view of the medial structures and can help avoid unnecessary invasive procedures. Sonography may be an option if other imaging modalities are not feasible. 

  • Differential Diagnosis of Pes Anserine Bursitis

Differential diagnosis for Pes Anserine bursitis is critical due to the overlap in symptoms with other medial knee pathologies. Here are some critical differential diagnoses for Pes Anserine bursitis:

  • Medial Meniscus Lesions: Pain localised to the medial compartment, different from inferomedial Pes Anserine pain.
  • Patellofemoral Syndrome: Anterior knee pain, often worsened by stair climbing.
  • Medial Plica Syndrome: Causes medial knee pain and tenderness.
  • Stress Fracture of The Proximal Tibia: Pain at the proximal medial tibia.
  • L3-L4 Radiculopathy: Knee pain with associated lumbar pain.
  • Semimembranosus Tendinitis: Common in runners, presenting pain in the posteromedial knee.
  • Extra-articular Cystic Lesions: Including synovial, ganglionic, and parameniscal cysts.

These conditions should be considered and ruled out during the diagnostic process.

How Is Pes Anserine Bursitis Treated?

Pes Anserine bursitis treatment is multifaceted, aiming to control inflammation, relieve pain, and promote tissue repair. The underlying cause of the bursitis and the specific pathological changes in the bursa dictate the course of treatment.

HPL Therapy: High Power Laser (HPL) Therapy is a non-invasive modality that uses focused light energy to penetrate deeply into the tissue. Although clinical evidence specific to bursitis is limited, HPL therapy has effectively reduced pain and inflammation in other musculoskeletal conditions. The treatment works by improving blood circulation, accelerating the removal of inflammatory mediators, enhancing cellular energy production (ATP), and promoting tissue regeneration. HPL therapy can be incorporated into the broader treatment plan for Pes Anserine bursitis, particularly in chronic or severe cases.

Shockwave Therapy (ESWT): Extracorporeal Shockwave Therapy (ESWT) involves the application of high-energy acoustic waves to the affected area. This therapy is commonly used for conditions such as tendinopathy but has also shown promise in treating bursitis. The acoustic waves create microtrauma in the tissue, stimulating the body’s natural healing response, reducing inflammation, promoting tissue regeneration, and alleviating pain. ESWT can be particularly beneficial for patients with chronic Pes Anserine bursitis who have not responded to other treatments.

Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed to reduce inflammation and provide pain relief. Topical medications, such as creams, gels, sprays, and patches, can be applied directly to the skin over the affected area to offer localised pain relief while minimising the gastrointestinal side effects associated with oral NSAIDs. For cases of septic pes anserine bursitis, antibiotics are necessary to treat the infection. It’s crucial to address the infection promptly to prevent further complications.

Physical Therapy: A comprehensive physical therapy program is essential for restoring function, improving strength, and reducing biomechanical stress on the bursa. Therapeutic exercises focus on stretching and strengthening the surrounding muscles, particularly the quadriceps, hamstrings, and adductors. A well-structured rehabilitation plan can help prevent recurrence and promote long-term recovery.

An individualised treatment plan is essential to ensure optimal recovery and minimise the risk of recurrence. Regular follow-up with a healthcare provider is necessary to monitor progress and adjust the treatment plan as needed.

What’s The Prognosis of Pes Anserine Bursitis?

Pes anserine bursitis generally has a favourable prognosis, as it is typically self-limiting and responds well to conservative, nonoperative treatment. Surgical intervention is rarely required. The prognosis improves significantly when aggravating factors, such as joint overuse, are appropriately managed. Symptom duration can vary, often influenced by co-existing conditions like osteoarthritis, obesity, and physical deconditioning. Prompt recognition and management of underlying conditions, particularly arthritis, can significantly enhance pain relief and restore function.

In sports injury cases, athletes usually recover without long-term issues, even if they continue participating. A targeted rehabilitation program lasting 6 to 8 weeks, focusing on stretching and strengthening exercises for the posterior chain, can effectively alleviate symptoms and facilitate a safe return to activity. Regular follow-up is crucial to ensure complete recovery and prevent recurrence.

How Do You Prevent Pes Anserine Bursitis?

Preventive strategies for pes anserine bursitis centre on mitigating known risk factors and maintaining overall joint health. Key recommendations include:

  • Maintaining a Healthy Weight: Reduces stress on the knee joint and surrounding structures.
  • Innovative Exercise Practices: Include proper stretching, warm-ups, and avoiding sudden increases in exercise intensity.
  • Correct Biomechanical Issues: Addressing improper movement patterns or gait abnormalities.
  • Selecting Appropriate Footwear: Ensures adequate support and reduces unnecessary strain.
  • Proper Posture and Hydration: Ensures muscle health and flexibility.

Secondary Prevention focuses on avoiding reinjury and educating patients on safe return-to-activity practices. This includes:

  • Reinforcing Proper Form During Exercise: Helps prevent reoccurrence.

Targeted Stretching and Strengthening: Specifically, hamstrings and quadriceps, aiding in joint stability.

  • Gradual Progression of Activity Levels: Avoids overloading the joint too quickly.
  • Rest: Crucial in Acute Phases, balanced with a home-tailored physical therapy program to avoid disuse atrophy.

Education for patients, trainers, and coaches on gradually increasing activity levels is essential in athletic settings. A comprehensive, multifaceted approach to Prevention proves more effective than targeting individual factors alone.

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Bursitis: The Simple Facts

September 16, 2024 /0 Comments/in , , , /by

Bursitis: The Simple Facts

What Is Bursitis?

Bursitis is a condition characterised by the inflammation or swelling of a bursa. A bursa is a synovium-lined, sac-like structure found throughout the body, particularly near bony prominences and between bones, muscles, tendons, and ligaments. There are over 150 bursae in the human body, which facilitate movement within the musculoskeletal system by providing a cushion between tissues that move against one another. When bursitis occurs, the bursa becomes enlarged with fluid, resulting in pain whenever there is movement against or direct pressure on the affected area. This condition can arise from various causes, including overuse injuries, infectious diseases, trauma, and inflammatory disorders. It’s important to note that not all forms of bursitis are primarily due to inflammation; often, the swelling of the bursa is a response to a noxious stimulus. 

What Causes Bursitis?

Bursitis can be caused by a variety of factors, with the most common being prolonged pressure on a bursa. This typically occurs when the bursa is compressed between a hard surface and a bony prominence, such as in students resting their elbows on desks or workers kneeling without adequate padding. Repetitive motions can also irritate the bursa, leading to inflammation. Trauma is another frequent cause, where direct pressure on the bursa can induce bursitis. In such cases, the patient might not recall the specific incident since it may have seemed minor at the time. Traumatic bursitis increases the risk of septic bursitis, often due to the direct penetration of the bursa through the skin, typically caused by Staphylococcus aureus. Though rare, septic bursitis can also occur through hematogenous spread. Autoimmune and systemic inflammatory conditions, such as rheumatoid arthritis, osteoarthritis, lupus, scleroderma, spondyloarthropathy, and gout, are also significant causes of bursitis. In some instances, bursitis can be idiopathic, meaning it arises without a known cause. Additionally, invasive procedures can induce septic bursitis.

Who Is Prone To Bursitis?

Bursitis is a reasonably common condition, affecting at least 1 in 10,000 people annually, particularly in the knees and elbows. About one-third of these cases are due to bacterial infections. If the inflamed area is rested, the symptoms typically subside within 2-3 weeks. However, chronic diseases like diabetes and rheumatoid arthritis can delay recovery. Bursitis affects both genders equally overall, but certain types like pes anserine and trochanteric bursitis are more common in women, particularly those who are obese. Men, on the other hand, are more prone to olecranon bursitis due to their higher likelihood of engaging in manual labour jobs. Various types of bursitis have been colloquially named based on their common causes, such as “housemaid’s knee” for prepatellar bursitis and “student’s elbow” for olecranon bursitis. Infrapatellar bursitis is often called “clergyman’s knee,” and ischial bursitis is known as “weaver’s bottom.” Tight or ill-fitting footwear can provoke bursitis of the subcutaneous calcaneal bursa, commonly seen in dancers and figure skaters. While bursitis can affect people of all ages, the elderly are at higher risk due to chronic conditions like osteoarthritis. Immunocompromised individuals, such as those with diabetes, certain rheumatologic disorders, alcoholism, or HIV, are at increased risk for septic bursitis.

How Is Bursitis Diagnosed?

Diagnosing bursitis, particularly for bursae located just under the skin, can often be straightforward. Inflamed bursae present with swelling, pain, and sensitivity to pressure. Additionally, reddened and warm skin indicates inflammation. Determining whether the inflammation is bacterial in origin is crucial. Symptoms like fever or a nearby wound often suggest a bacterial infection. To confirm, a doctor might extract fluid from the bursa using a hollow needle for lab testing. Blood tests can further identify infections or conditions like gout that might cause inflammation. Imaging techniques like ultrasound or X-rays can be valuable tools for ruling out other potential causes, such as bone or joint injuries. These methods also help assess if the bursitis has affected surrounding tissues. There is a particular focus on separating bursitis from septic bursitis. Ultrasonography is an effective tool to differentiate bursitis from cellulitis. Blood tests, including white blood cell counts and inflammatory markers, alongside magnetic resonance imaging (MRI), are instrumental in distinguishing infectious causes from non-infectious ones. A thorough clinical assessment focuses on visible symptoms like swelling, redness, and warmth. It considers patient history to identify potential repetitive motion or trauma. Lab tests, imaging, and fluid aspiration collectively guide an accurate diagnosis and appropriate treatment plan.

How Is Bursitis Treated?

Treating bursitis usually begins with conservative measures to alleviate pain and restore function. Most cases resolve independently, but several approaches can expedite recovery and provide symptomatic relief. Key strategies include rest, ice, compression, and elevation (RICE). These methods help reduce inflammation and discomfort. Patients should be educated on proper ergonomics to avoid aggravating movements. Protective padding is recommended for those whose occupations involve prolonged pressure on joints, such as elbows or knees. A foam doughnut can relieve ischial bursitis while stretching and core strengthening exercises can help improve symptoms. However, in circumstances where bursitis doesn’t resolve on its own, multiple first-line treatments have been shown to improve bursitis symptoms:

  • Extracorporeal Radial Shockwave Therapy (EWST) For Bursitis Treatment

Extracorporeal Radial Shockwave Therapy (ESWT) has emerged as a valuable treatment for bursitis. This non-invasive technique delivers shockwaves to the afflicted area, penetrating 3-5 centimetres below the skin’s surface. These shockwaves induce microtrauma in the tissue, catalysing the body’s natural healing mechanisms and fostering tissue regeneration by promoting growth factors and stem cells, primarily Vascular Endothelial Growth Factor (VEGF) and Transforming Growth Factor-beta (TGF-β). ESWT’s efficacy extends beyond pain relief; it also disrupts bursitis calcifications and stimulates neovascularisation, effectively enhancing blood flow to the area by encouraging the formation of new blood vessels. This dual-action approach of disrupting calcifications and boosting blood circulation significantly aids healing.

Clinical studies have consistently highlighted ESWT’s effectiveness in alleviating pain and improving functionality in bursitis patients. This makes it a preferred treatment option in reputable pain management clinics. The non-surgical nature of ESWT, coupled with its ability to target specific areas with precision, positions it as an appealing choice for those seeking relief from bursitis without the invasiveness of traditional surgical methods.

  • High-Intensity Laser Therapy For Bursitis Treatment

High-Intensity Laser Therapy (HLT) presents an innovative and non-invasive approach to managing bursitis, effectively targeting pain and inflammation associated with the condition. Utilising high-intensity lasers, HILT focuses on the affected bursa, promoting tissue repair and diminishing inflammation in the bursitis-impacted regions. HILT operates by penetrating the skin and activating chromophores within the mitochondrial cells, leading to enhanced adenosine triphosphate (ATP) production and improved cellular metabolism. This biochemical process fosters tissue healing while modulating inflammatory mediators such as cytokines and prostaglandins, crucial in reducing pain and enhancing function for bursitis patients. Clinical research underscores the efficacy of HILT, with numerous studies documenting significant improvements in pain levels and functional outcomes for those afflicted by bursitis. 

  • Physical Therapy For Bursitis Treatment

Physical therapy and range-of-motion exercises are critical in treating bursitis, particularly for subacromial bursitis, where preventing immobilisation-related issues like atrophy, retraction, and frozen shoulder is paramount. Physiotherapy is central to a comprehensive bursitis management plan, offering various interventions for pain reduction, mobility enhancement, and functional improvement. A fundamental component of this approach is exercise therapy, which involves targeted exercises designed to strengthen muscles, improve joint stability, and restore range of motion. Addressing muscle imbalances and promoting proper biomechanics through these exercises can significantly alleviate stress on the affected bursa, reducing the risk of further injury. For instance, strengthening exercises targeting the rotator cuff and scapular stabilisers benefit shoulder bursitis. At the same time, hip abductors and gluteal muscles are often the focus of hip bursitis.

Education and self-management strategies are integral components of physiotherapy for bursitis. These strategies empower patients with the knowledge and skills needed to manage their condition effectively and prevent the recurrence of symptoms. Patients are educated on ergonomics, posture correction, and activity modification to avoid movements and positions that exacerbate bursitis. The holistic approach of physiotherapy addresses both immediate symptom relief and long-term functional improvement, optimising outcomes for individuals with bursitis. Combining targeted exercises, manual therapy, and patient education, physiotherapy provides a robust framework for managing bursitis, ultimately enhancing the patient’s quality of life and functional independence.

  • Antibiotic Therapy For Septic Bursitis Treatment

Addressing the underlying disease is crucial for bursitis resulting from systemic inflammatory conditions. Septic bursitis requires systemic antibiotics targeting gram-positive organisms, with most cases managed outpatiently using oral antibiotics. Hospital admission is necessary if systemic or joint involvement is suspected or if the patient appears unstable. In stubborn cases, surgical excision of the bursa may be required to resolve the issue, typically via endoscopic or arthroscopic procedures.

  • Corticosteroid Injections For Bursitis

For deeper bursae, corticosteroid injections may provide short-term relief when combined with a local anaesthetic. However, local injections are not recommended for superficial bursae due to risks like septic bursitis, tendon injury, skin atrophy, or sinus tract formation. Furthermore, Corticosteroid injections may also mask other conditions, such as a rotator cuff tear, delaying necessary diagnosis and treatment. The evidence supporting corticosteroid injections for chronic bursitis is limited, with some studies suggesting no significant benefit.

  • Custom Insoles and Proper-fitting Footwear For Bursitis 

Custom insoles or orthotics can be a vital part of the treatment plan for bursitis, particularly for those suffering from foot-related bursitis. Orthotics can help for several key reasons:

  • Enhanced Support: Proper support for the heel and foot arch is crucial. Without it, instability can exacerbate the pain and inflammation of the bursa. Custom orthotics are designed to provide the precise support needed for your feet, stabilising the area and reducing stress on the bursa.
  • Stress Reduction: Continuous stress on an inflamed bursa impedes healing. Custom orthotics help mitigate this stress by offering increased arch and ankle support, essential for recovery.
  • Symptom Relief: By improving support and minimising stress, custom orthotics can alleviate the pain associated with retrocalcaneal and intermetatarsal bursitis. Additionally, they aid in controlling and reducing inflammation, thereby easing overall symptoms.

Fascia PCuzzle

1. All is connected. Literally.

We know instinctively that inside the body everything is connected on some level. Fascia is the missing piece of that puzzle. It truly runs through the whole body, connecting every part with every other part. It has different layers, with a superficial and deeper layer, but even those are not entirely separate.

With more than six times as many nociceptors than muscles, fascia has an important role in pain complaints, and the full extent is still as yet unknown. In clinical practise, it is well known that pressing certain tender points can elicit a referred pain in a distant body part. You cannot treat pain seriously without at least considering the role of the fascia.

1. All is connected. Literally.

We know instinctively that inside the body everything is connected on some level. Fascia is the missing piece of that puzzle. It truly runs through the whole body, connecting every part with every other part. It has different layers, with a superficial and deeper layer, but even those are not entirely separate.

With more than six times as many nociceptors than muscles, fascia has an important role in pain complaints, and the full extent is still as yet unknown. In clinical practise, it is well known that pressing certain tender points can elicit a referred pain in a distant body part. You cannot treat pain seriously without at least considering the role of the fascia.

2. Working on one area will have an effect on the whole system and different parts.

The concept of tensegrity describes how seemingly free-floating parts are suspended and held in place through tension and connection to other parts balancing the whole. By altering the suspension in one area, or picking up one solid part and taking the balance off that part, every other part is affected. Fascia enables a sophisticated blend of mobility and rigidity to exist within a physical system made of many individual anatomical parts.

2. Working on one area will have an effect on the whole system and different parts.

The concept of tensegrity describes how seemingly free-floating parts are suspended and held in place through tension and connection to other parts balancing the whole. By altering the suspension in one area, or picking up one solid part and taking the balance off that part, every other part is affected. Fascia enables a sophisticated blend of mobility and rigidity to exist within a physical system made of many individual anatomical parts.

3. Fascia connects but also separates.

Fascia connects our skin with underlying muscles, bones, and nerves, penetrates organs, and runs all throughout the whole body… It creates space between different sets of tissues, within tissues, and between single cells. It makes it possible to absorb shock and impact forces, allows muscles and tendons to slide to do their job properly, allows nutrients and waste products to travel, and communicates with other parts of the body. It is a fabulously c complex blend of deliberate separation and connection.

4. Fascia is adaptable.

Your fascia is an ever changing system, adapting to the demands of daily living that you apply to it. This adaptability is referred to as plasticity. If you are tied to the desk for your job, chances are your fascia has adapted and holds you in what you call “bad posture”. Changing it requires a lot of patience and a fair amount of (regular!) work. When you have an injury, the fascia plays the role of redirecting forces away from it and directing your body in compensatory movements that may remain long after the injury has healed. Facia is full of nerve receptors and has a huge impact on your coordination or lack thereof. 

5. The best care for your fascia is regular, varied movement.

Due to its plasticity fascia requires care in order to remain healthy. Putting your body through repetitive, unchanging movement patterns makes your fascia stiff and less willing to allow other movements. Ingrained postures or patterns are hard to break and need time and ongoing effort. By giving your fascia different input on a regular basis, it allows for better, smoother range of movement, improving balance, and preventing you from injuries.

If you are wondering if your fascia is playing a role in perpetuating your pain; it’s well worth getting checked out by some professionals who have put the necessary time and effort into diagnosing fascial issues… with your tissues!  Thats where we come in :)

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