From the Guidelines
Bursa pain is typically greater with active range of motion rather than passive range of motion. When a patient actively moves a joint affected by bursitis, the muscles and tendons surrounding the inflamed bursa contract and move across the bursa, causing increased pressure and friction on the already irritated tissue. This mechanical stress directly aggravates the inflamed bursa, resulting in more pronounced pain. In contrast, during passive range of motion, when the examiner moves the joint without the patient's muscular effort, there is less compression of the bursa because the surrounding muscles remain relaxed.
Key Points to Consider
- The most recent and highest quality study, 1, provides evidence-based recommendations for managing hemiplegic shoulder pain, which can be related to bursitis, and suggests that active range of motion should be increased gradually in conjunction with restoring alignment and strengthening weak muscles in the shoulder girdle.
- The study 1 also recommends subacromial corticosteroid injections for patients with pain thought to be related to injury or inflammation of the subacromial region, including the bursa.
- The provided evidence does not directly address the question of whether bursa pain is exacerbated by passive or active range of motion, but based on the principles of bursitis and joint movement, active range of motion is more likely to exacerbate bursa pain.
- Treatment for bursitis typically includes rest, ice application, non-steroidal anti-inflammatory drugs, and avoiding activities that worsen symptoms, as well as corticosteroid injections in severe cases, as mentioned in the example answer and supported by 1.
Clinical Implications
- Clinicians should consider the type of range of motion (active vs. passive) when assessing and treating patients with bursitis, as active range of motion may worsen bursa pain.
- A thorough understanding of the underlying pathology and the effects of different types of movement on the inflamed bursa is essential for developing effective treatment plans, as highlighted by the recommendations in 1.
From the Research
Bursa Pain and Range of Motion
- Bursa pain can be exacerbated by both passive and active range of motion (ROM) 2, 3.
- The type of bursitis, such as prepatellar, olecranon, trochanteric, or retrocalcaneal, can affect the level of pain experienced during ROM 2.
- Chronic microtrauma, acute trauma, inflammatory disorders, and infection can all contribute to bursitis and subsequent pain during ROM 3.
Treatment and Management
- Conservative management, including ice, activity modification, and nonsteroidal anti-inflammatory drugs, can help alleviate bursa pain during ROM 2, 3.
- Corticosteroid injections may be used to treat bursitis, but the evidence for their effectiveness is limited 3, 4.
- Surgical intervention may be necessary for refractory cases of bursitis, such as trochanteric bursitis 4.
Specific Types of Bursitis
- Iliopsoas bursitis may not always be the primary cause of pain, and other underlying conditions should be considered 5.
- Pes anserine bursitis can be treated with mesotherapy, which has shown promising results in reducing pain and improving quality of life 6.
- The effectiveness of treatment for bursitis can vary depending on the type of bursitis, the underlying cause, and the individual patient's response to treatment 2, 3, 4, 5, 6.