Wall Of Bursa Research Articles

Ultrasound definition of subacromial chronic "fibro-adhesive" bursitis and its treatment via ultrasound guided hydrodilation: a prospective pilot study.

The shoulder pain is one of the main causes that lead the patient to medical evaluation. Today, the ultrasound (US) represents an essential tool in the orthopaedical, rheumatological and rehabilitative setting to address the musculoskeletal causes of pain. Amongst the commonest causes of shoulder complains lay the frequent subacromial chronic bursitis (SACB). In this condition, the thickening of the bursal walls and subsequent fusion of the two synovial sheets leads to the reciprocal loss of bursal walls gliding under the subacromial space and consequently pain. This condition represents a common cause of shoulder pain and may be easily addressed by musculoskeletal sonographers. The purpose of this paper will be to describe the US appearance of SACB and to evaluate the efficacy of US-guided hydrodilation in its treatment. We included patients with painful shoulder attending our outpatient clinic for shoulder complains with the diagnosis of SACB with a bursal wall > 1.5 mm. A group was treated via US-guided hydrodilation, while the control group was treated via a classical blind approach using triamcinolone acetonide. Both groups underwent the same rehabilitation program following the injections. The shoulder functionality was assessed via qDASH questionnaire at baseline, days 3, 7, 14, 30, 60, and 90. A p <0.05 was considered significant. Both groups displayed a significant reduction of pain; nevertheless, in the group treated with US-hydrodilation, there was no need for re-treatment. The US-guided hydrodilation for SACB should be the preferred technique to detach bursal walls and improve patient symptoms, since it requires fewer invasive maneuvers.

Rice bodies in a shoulder bursa: a cadaveric and histologic case report

ABSTRACT Introduction The subacromial/subdeltoid bursa can develop inflammation and effusion related to autoimmune, infectious, and musculoskeletal disorders. Rice bodies, or loose bodies within bursa, have been described as an uncommon complication of bursitis and have been the subject of case studies over a number of years. However, they have not been described in anatomical or physical therapy-related literature. Methods A donor body dissected for a physical therapy anatomy course was found to have an enlarged subacromial/subdeltoid bursa. This bursa, along with the biceps brachii tendon sheath, and the subscapularis muscle bursa, were filled with numerous rice-like bodies. The bursal wall was well developed and thickened. Tissue specimens were obtained of the suspected rice bodies, the subacromial/subdeltoid bursal wall, and the biceps brachii tendon sheath. The tissue was embedded, sectioned, and processed with hematoxylin and eosin or Masson’s Trichrome staining for blinded histologic assessment. Results The tissue samples from within the bursa were identified as tissue similar to that in prior descriptions of rice bodies. Tissue samples from the bursal wall and tendon sheath were identified as similar to synovial membranes. Conclusions Rice bodies found within the cadaveric body were similar histologically to those described in rheumatology, radiology, and orthopedic literature. Anatomists teaching future health-care providers and practicing physical therapists should be familiar with rice bodies as a potential finding in cadavers, and patients.

Imaging features of reactive bursitis secondary to osteochondroma.

The purpose of this study was to determine imaging features of reactive bursitis secondary to osteochondroma. Fourteen patients with reactive bursitis secondary to osteochondroma were retrospectively reviewed. The 14 patients were 11 males and 3 females ranging in age from 18 to 67years (mean, 33.6years). The locations were as follows: scapula (n = 2), lesser trochanter (n = 6), greater trochanter (n = 1), distal femur (n = 2), distal fibula (n = 1), iliac bone (n = 2). On CT, six bursae were hypodense and 1 was isodense compared to muscle. All bursae had a thickened wall, 6 contained multiple villous projections and septa. Five bursae contained a few calcifications. On enhanced CT, the bursa displayed mild enhancement of the wall, villous projections, and septa. On MRI, one bursa was hypointense, three were hyperintense, and 5 were isointense relative to muscles on T1-weighted images. All bursae were hyperintense relative to muscles on T2-weighted images. All bursae had a thickened wall, eight contained multiple villous projections and septa. In five bursae, a few fatty villous projections can be seen within the bursa. On enhanced MRI, all bursae displayed avid enhancement of the bursal wall, villous projections, and septa. Reactive bursitis secondary to osteochondroma most often occurred in young male adults. The most common involved site is lesser trochanter. The imaging features is that of an irregular, thick-walled fluid-filled bursa overlying an osteochondroma that containing multiple villous projections and septa. Calcification and/or lipoma arborescens may be developed within the bursa. On contrast-enhanced images, the bursa shows enhancement of the bursal wall, villous projections and septa.

A novel Enterostomula (Platyhelminthes, Prolecithophora) species from two brackish lakes in Japan.

BackgroundThe genus Enterostomula Reisinger, 1926 belongs to the family Pseudostomidae and comprises generally small and often conspicuously coloured species living on hard bottoms, in gravel and amongst algae. The Pseudostomidae comprises approximately 44 known species from Europe as well as North and South America. Previously, only one species, Allostoma durum, had been recorded in Japan. Known Enterostomula species are predominantly found in marine and brackish habitats.New informationI collected seaweed and sand samples from two brackish lakes near the coast of Shimane Prefecture, Japan and isolated turbellarians from them. The animals were observed as both living and preserved. Here, I describe a novel Enterostomula species with two dorsal black bands and a thick bursal wall.

Ultrasound imaging-guided percutaneous treatment of rotator cuff calcific tendinitis: success in short-term outcome.

Rotator cuff calcific tendinitis (RCCT) is a common cause of shoulder pain in adults and typically presents as activity-related shoulder pain. Between non-surgical and surgical treatment options, today a few minimal invasive techniques are available to remove the calcific deposit, and they represent a cornerstone in the management of this painful clinical condition. The aim of the work was a retrospective evaluation of double-needle ultrasound-guided percutaneous fragmentation and lavage (DNL), focused on understanding the factors which are of major importance in determining a quick and good response at 1 month. A series of 147 patients affected by RCCT and suitable for DNL were evaluated. A systematic review of anamnestic, clinical and imaging data was performed in 144 shoulders treated in a single-centre setting. Clinical reports and imaging examinations were revisited. The inclusion criteria were submission to DNL, therefore fitness for the percutaneous procedure, and following 1-month follow-up. There was no exclusion owing to risk of bias. The treatment was defined as successful for constant shoulder modified score (CSS) improvement of >50% at 1 month. In 70% of shoulders, the treatment resulted in a quick and significant reduction of symptoms (successful). On the whole, CSS increase at 1 month was estimated at 91.5 ± 69.1%. CSS variations were significantly related to age of patients (better results between 30 and 40 years old), calcification size (more relevant improvement for middle-sized calcifications, 12-17 mm), sonographic and radiographic features of calcific deposits (softer calcifications) and thickening of subacromial/subdeltoid bursa walls. In the final model of stepwise regression for CSS variation, ultrasound score pre-treatment and post-treatment, the distance between bursa and calcification before treatment and the size of post-treatment calcification area were shown to be independently correlated to success. Numeric rating scale score for pain showed similar results. Pain at admission was also related to age, calcification size, ultrasound and Gärtner score, power Doppler positivity, bursal wall thickening and biceps tenosynovitis. The success of the procedure with quick improvement in function and symptoms is warranted in soft and middle-sized calcifications, in young adults. Ultrasound-guided percutaneous procedures for RCCT must be safe, effective and with prompt pain relief and function restoration. This study shows which clinical picture is more favourable to this purpose and actual prognostic factors for DNL (soft and middle-sized calcifications, in young adults, are more favourable).

Three-dimensional visualisation of brooding behaviour in two distantly related brittle stars from South African waters

Brooding in ophiuroids (Echinodermata: Ophiuroidea) is a highly-developed reproduction strategy and has evolved independently several times. In South African waters, brooding occurs both in the very small amphiurid Amphipholis squamata, which is hermaphroditic, and in the large ophiodermatid Ophioderma wahlbergii, which is gonochoric. For the first time, microcomputed tomography was applied to visualise and compare brooding and brooded young of these two brittle star species from two distantly related families. The scanned A. squamata brooded six young, whereas O. wahlbergii brooded 13 young. Volume measurements of the adults revealed that A. squamata dedicated about 25% of its disc volume to brooding and O. wahlbergii about 14%. Although the brooded young of O. wahlbergii are thought to be among the largest of all known ophiuroids, young of A. squamata were four times larger in relation to adult body disc volume. Other than differences in the sizes of brooded young, these distantly related species have evolved very similar brooding adaptations. All juveniles were found lying with the mouth upward, pressed against the mother's bursal wall, strengthening the hypothesis that the bursal wall acts as a nutritive organ. In both species, the large size of the young can only be explained by maternal nutrient supply. Both brittle star species, therefore, are regarded as truly viviparous.

New Austrognathiidae (Gnathostomulida: Conophoralia) from Hong Kong and Japan: microscopic anatomy, ultrastructure and evolutionary implications.

We describe two new species, Austrognathia glandifera and Austrognatharia orientis using observations on squeezed, live specimens as well as histological sections and transmission electron microscopy. The protonephridia of Austrognatharia orientis are composed of a terminal cell, a canal cell, and a nephroporus cell. The monociliated terminal cell constitutes the so-called filtration area. The canal cell harbors the lacunar system and the protonephridial duct, which is surrounded by six filamentous rods, which originate external to and in between the microvilli of the terminal cell and stretch along the entire length of the canal cell. The female copulatory organs of the investigated species are very different. Austrognathia glandifera has a bursa and a vagina whereas A. orientis only has a weakly defined bursal tissue and no detectable vagina. The bursa is divided into an anterior and a posterior part; at the anterior end a special area is formed by interdigitations of the cells of the bursal wall. The male copulatory organs in the Conophoralia are uniform, composed of an anterior, glandular portion consisting of a proximal part with medium-grained and a distal part with coarse-grained appearance and a penis that is delineated by a basal lamina and has an ejaculatory duct as well as a gonopore. Parenchymal cells are present and serve to embed the bursa and the male copulatory organ dorsolaterally. Our data on the fine structure of various tissues indicate that the Conophoralia are the "less derived" sister taxon of the Scleroperalia.

Cholinesterase activity in quail primary lymphoid organs

The present histochemical study was carried out to analyze the distribution and topography of acetylcholinepositive nerve fibers in the thymus and bursa of Fabricius of quails. The AChE-positive nerve fibers were demonstrated by direct thiocholine histochemical method. Nerve fibers present in the thymuses form periarterial nerve plexuses located mostly in the interlobular septa and on the cortico-medullary junction. Vessels-independent nerve fibers occur also in the parenchyma of thymic medulla, but rarely in parenchyma of the cortex. Within the connective tissue between the bursa of Fabricius and the wall of proctodeum we observed conspicuous AChE-positive ganglia, often in close relationship to greater arteries. Within the wall of bursa of Fabricius, AChE-positive nerve fibers create nerve plexuses around arteries. We observed a close relationship between lymphoid follicules in bursal submucosa and mucosa and AChE-positive nerve fibers. Nerve fibers create a ring around lymphoid follicles, but do not penetrate into the germinal center of the follicle. Arteries inside quail thymuses and bursae of Fabricius contain rich AChE-positive nerve plexuses, when compared to the veins, which have a very poor presence of AChE-positive nerves. According to lesser presence and decreased density of AChE-positive nerve fibers in older animals, we described age-dependent changes in both quail primary lymphoid organs.

THU0352 Trochanteric bursitis: Is there ultrasonographic evidence to suggest inflammation?

BackgroundTrochanteric bursitis (Tb) is one of the most common soft tissue abnormalities in the hip region. Tb is common; affecting 10-25% of the population.Power Doppler (PD) ultrasonography (US) is a...

Microstructure and diversity of the bursa copulatrix wall in Tortricidae (Lepidoptera)

The inner surface and muscle structure of the bursa copulatrix are examined for the first time with Electron Microscopy in some representatives of the family Tortricidae (Lepidoptera). The internal microprotuberances reveal taxon dependent characters unstudied in the Lepidoptera until now. Acanthae occur in almost all taxa studied, whereas ctenidia and papillae are found only in representatives of Tortricinae and Olethreutinae, respectively. Muscles are radially arranged from the signa. Areas of muscle insertion on the bursal wall are not covered by other muscle fibers. Muscle attachments to evaginated areas, e.g. capitulum and diverticulum, suggest an apodeme role for these structures, correlated with long protruding signa. The potential evolutionary and adaptive significance of these new findings are discussed.

Recurrent Dislocation of the Shoulder Joint

Recurrent Dislocation of the Shoulder Joint

The anatomy of fertilization in the yellow dung fly Scathophaga stercoraria

Female yellow dung flies, Scathophaga stercoraria, can influence the traffic of sperm stored in their spermathecae to the site of fertilization in the bursa copulatrix. However, the anatomical mechanisms employed are largely unknown. We investigated the anatomy of the female genital tract, seeking structures involved in sperm transfer and egg fertilization. We found a membranous structure descending from the ends of the spermathecal and accessory gland ducts into the bursa copulatrix. We call this the prolatus. Sperm accumulate in the prolatus during oviposition. When an egg is in the bursa the egg micropyle, rather than being aligned towards the dorsal openings of the spermathecal ducts, lies on the opposite, ventral side. We also confirm the presence, and suggest a function for, a cuticularized pouch on the ventral wall of the anterior bursa copulatrix. This pouch, plus a previously undescribed chamber, may be homologous to the ventral receptacle/fertilization chamber found in other dipterans. Further, we describe a translucent cap, apparently transversed by channels, covering the micropyle. Sperm were observed to aggregate on and in the micropyle cap, which appears to attract and hold sperm. We interpret the prolatus as a structure that allows an ovipositing female to transfer a few sperm onto the ventral bursal wall and thus, indirectly, onto the micropyle cap. Such anatomy potentially gives the female a large degree of control over sperm traffic from storage to the site of fertilization.

Sclerosing polidocanol injections to treat chronic painful shoulder impingement syndrome-results of a two-centre collaborative pilot study

The histological changes found in the supraspinatus tendon have similarities with the findings in Achilles-, patellar- and extensor carpi radialis brevis (ECRB)-tendinopathy. In recent studies, we have found a vasculo-neural ingrowth in chronic painful Achilles and patellar tendinopathy, and demonstrated good short-term clinical effects with injections of the sclerosing substance polidocanol. In this collaborative two-centre pilot study, 15 patients (10 males and 5 females, mean age 46 years) with a long duration of shoulder pain (mean 28 months), and given the diagnosis chronic painful shoulder impingement syndrome, were included. They had tried rest, traditional rehabilitation exercises and multiple subacromial corticosteroid injections, without effect. We found vascularity (neovessels) in chronic painful, but not in pain-free, supraspinatus tendons, and prospectively studied the clinical effects of ultrasound (US) and colour Doppler (CD)-guided injections of polidocanol, targeting the area with neovessels. The patients evaluated the amount of shoulder pain during horizontal shoulder activity on a visual analogue scale (VAS), and satisfaction with treatment. Two (median) (range 1-5) polidocanol treatments (with 4-8 weeks in between) were given. In four patients (considered treatment failure), cortisone was injected into an inflamed subacromial bursa at one separate occasion weeks after the last polidocanol injection. At follow-up, 8 (median) (range 4-17) months after the treatment, 14 patients were satisfied with the result. Using the visual analogue scale evaluation (VAS), the pain dropped from 79 before treatment to 21 at follow-up (P < 0.05). In the short-term perspective, sclerosing polidocanol injections targeting the neovessels in the supraspinatus tendon and/or bursa wall seems to have a potential to reduce the pain during shoulder loading activity.

Imaging features of ischial bursitis with an emphasis on ultrasonography.

The aim of this study was to evaluate the imaging features of ischial bursitis with an emphasis on ultrasonography (US). Our study included 31 patients with a painful mass or tenderness in their buttock who underwent US (n=27), CT (n=1), or MR imaging (n=4). A needle aspiration (n=6) or a bursal excision (n=5) was performed in those patients who had no clinical improvement in spite of the conservative treatment. Evaluation included lesion location, size, wall of the bursae, and intrinsic characteristics on US, CT and MR imaging. Ischial bursitis was superficial to the ischial tuberosity in all patients (n=31). The lesion ranged from 1.5 cm to 7 cm (average 3.8 cm) in diameter. The bursal wall was identifiable in 25 cases (81%). Internal septa and mural nodules were seen in 12 (39%) and 17 cases (55%), respectively. Sonography showed that fluid within the bursa was hypoechoic (59%), hyperechoic (26%), or of mixed echogenicity (15%). The bursae were compressible by the transducer. Power Doppler examination (n=7) showed hypervascularity of the bursal wall. All lesions imaged with contrast-enhanced CT and MR imaging had an enhancing thin wall and mural nodule. Ischial bursitis, superficial to the ischial tuberosity, can be clearly demonstrated on sonography and appears as a thin-walled cystic lesion, with or without internal septa and mural nodules.

Imaging features of iliopsoas bursitis

The aim of this study was firstly to describe the spectrum of imaging findings seen in iliopsoas bursitis, and secondly to compare cross-sectional imaging techniques in the demonstration of the extent, size and appearance of the iliopsoas bursitis as referenced by surgery. Imaging studies of 18 patients (13 women, 5 men; mean age 53 years) with surgically proven iliopsoas bursitis were reviewed. All patients received conventional radiographs of the pelvis and hip, US and MR imaging of the hip. The CT was performed in 5 of the 18 patients. Ultrasound, CT and MR all demonstrated enlarged iliopsoas bursae. The bursal wall was thin and well defined in 83% and thickened in 17% of all cases. The two cases with septations on US were not seen by CT and MRI. A communication between the bursa and the hip joint was seen, and surgically verified, in all 18 patients by MR imaging, whereas US and CT failed to demonstrate it in 44 and 40% of the cases, respectively. Hip joint effusion was seen and verified by surgery in 16 patients by MRI, whereas CT (4 of 5) and US ( n=12) underestimated the number. The overall size of the bursa corresponded best between MRI and surgery, whereas CT and US tended to underestimate the size. Contrast enhancement of the bursal wall was seen in all cases. The imaging characteristics of iliopsoas bursitis are a well-defined, thin-walled cystic mass with a communication to the hip joint and peripheral contrast enhancement. The most accurate way to assess iliopsoas bursitis is with MR imaging; thus, it should be used for accurate therapy planning and follow-up studies. In order to initially prove an iliopsoas bursitis, US is the most cost-effective, easy-to-perform and fast alternative.

Histologic, neurologic, and immunologic effects of methylmercury in captive great egrets.

Captive great egret (Ardea albus) nestlings were maintained as controls or were dosed with methylmercury chloride at low (0.5), and high doses (5 mg/kg, wet weight) in fish. Low dosed birds were given methylmercury at concentrations comparable to current exposure of wild birds in the Everglades (Florida, USA). When compared with controls, low dosed birds had lower packed cell volumes, dingy feathers, increased lymphocytic cuffing in a skin test, increased bone marrow cellularity, decreased bursal wall thickness, decreased thymic lobule size, fewer lymphoid aggregates in lung, increased perivascular edema in lung, and decreased phagocytized carbon in lung. High dosed birds became severely ataxic and had severe hematologic, neurologic, and histologic changes. The most severe lesions were in immune and nervous system tissues. By comparing responses in captive and wild birds, we found that sublethal effects of mercury were detected at lower levels in captive than in wild birds, probably due to the reduced sources of variation characteristic of the highly controlled laboratory study. Conversely, thresholds for more severe changes (death, disease) occurred at lower concentrations in wild birds than in captive birds, probably because wild birds were exposed to multiple stressors. Thus caution should be used in applying lowest observed effect levels between captive and wild studies.

Collagen type III in rotator cuff tears: An immunohistochemical study

The presence and distribution of collagen type III, which represents newly formed fibers of early repair, were investigated in four surgically removed en bloc specimens of complete rotator cuff tears. The patients were two men and two women who ranged in age from 63 to 71 years. They had received preoperative, conservative treatment for a period varying from 3 months to 3 years. For the identification of the collagen immunohistochemical staining was performed by the peroxidase-antiperoxidase method with the use of monoclonal antibody against human collagen type III. Collagen type III was discernible throughout the tendon proper in all specimens. It often occurred in association with proliferating fibroblastic cells. Collagen type III was abundant only in the perivascular spaces of the much thickened bursal wall that extended over the margins of the tear. We concluded that the presence of collagen type III indicates the need for a continued attempt for repair at the site of the tear, including both bursal and tendinous tissues.

Operative treatment of the large post-traumatic subcutaneous haematoma or bursa

A study of the large subcutaneous haematoma or bursa was carried out in 85 adult patients who were mostly injured in traffic accidents as pedestrians hit by automobiles or in motorcycle accidents. The lesions, mostly located at trochanteric and lumbosacral regions, were produced by direct, tangential traumatic forces splitting the subcutaneous fat from the fascia and creating a massive haematoma which was subsequently transformed into a real bursal cyst, resistant to the conventional methods of treatment. As the results of conservative measures were unsatisfactory in 74 per cent of cases, a simple operation has been developed, consisting of excision of the bursal wall and inserting cutaneofascial sutures to allow complete elimination of any dead spaces where tissue fluids could re-accumulate. As the results of this operation were favourable in 95 per cent of cases, it is recommended for the management of this condition.

Compartmentalized Mast Cell Degranulations in the Ovarian Hilum, Fat Pad, Bursa and Blood Vessel Regions of the Cyclic Hamster: Relationships to Ovarian Histamine and Blood Flow

Ovaries from hamsters on each day of the oestrous cycle at 09.00 h were observed for the number of mast cells, the pattern of mast cell degranulation, histamine concentration and blood flow. On day 4 (pro-oestrus), ovaries were also observed at 9.00, 15.00 and 21.00 h. Mast cell degranulation was evaluated by 3 criteria: (1) no degranulation = less than 5 granules dispersed from the cell; (2) moderate degranulation = 5 or more granules dispersed but less than 15, and (3) extensive degranulation = 15 or more granules released. Blood flow was determined using radio-active microspheres in anaesthetized animals. Mast cells were observed in fat pad (beyond 2 mm of the bursal mesothelium), bursa (within 2 mm of the bursal mesothelium), hilum and near ovarian blood vessels (these 4 regions are collectively called the ovarian complex). The distribution of ovarian mast cells was not uniform. Most mast cells were near ovarian blood vessels (42.2%) and in the fat pad (37.2%). A moderate number of cells were in the bursal wall (20%) and only a few cells were observed in the hilum (0.64%). Mast cell number remained unchanged on days 1-4 of the cycle in each ovarian compartment. However, summation of the number of mast cells in the entire ovarian complex revealed a significant decline in number at 15.00 h on pro-oestrus. Alterations in mast cell degranulation were primarily restricted to 2 periods of the cycle (pro-oestrus and di-oestrus). An increase in moderate but not extensive degranulation was observed in only the fat pad and bursa on day 2 when compared with day 1 values. In most ovarian compartments on pro-oestrus, degranulation was higher than on any other day of the cycle. At 15.00 h on pro-oestrus, extensive degranulation in bursa, fat pad and blood vessel regions (but not hilum) coincided with an increase in ovarian histamine and decline in number of mast cells; ovarian blood flow also increased at the time but remained unchanged the remainder of the cycle.(ABSTRACT TRUNCATED AT 250 WORDS)

Prepatellar bursitis in wrestlers.

As part of a larger retrospective study examining all knee injuries sustained by the University of Iowa wrestling team over 6 years, prepatellar bursitis was found to be the most frequent injury and, therefore, was examined in depth. Of the 136 wrestlers studied, 13 developed an initial case of prepatellar bursitis. This represented 21% of all initial episodes of knee injuries. Five of these wrestlers had no recurrences, but the other eight together had 20 recurrences. Median time lost for the initial injury was only 4 days, but recurrences and surgeries added significantly to the total time lost. There were only two cases of septic prepatellar bursitis, but there have been six cases (in four wrestlers) in the three seasons since the end of the larger study period. The infecting organism in all but one case was Staphylococcus aureus and was penicillin-resistant in all but one. There was no clinical evidence of infection in 50% of the cases, emphasizing the need to do a Gram's stain and culture (and, therefore, an aspiration) on all cases of prepatellar bursitis. The prognosis appeared better if the wrestler had no previous history of bursitis, suggesting that pathologic changes in the bursal wall may impair its defense mechanisms. In sharp contrast to all other knee injuries, most prepatellar bursitis cases occurred in the off-season. Most developed insidiously, but direct impact during a takedown maneuver is suspected as being the most frequent cause.(ABSTRACT TRUNCATED AT 250 WORDS)