spinous bursitis
Introduction
Introduction to spinous bursitis Spinous process bursitis is a subcutaneous tissue in the back that can form a sac structure in the deep layer. The sacral sac is the most famous domestic name in the lumbosacral region. There are spinous sacs, scapular bursae, supraspinous ligament sacs, spines. The posterior ligament sac, the scapula of the spinous process and the posterior scapular sac of the spine. Considering that the spinous process of the atlas is merged into the medial malleolus, the lower lumbar region lacks the supraspinous ligament, and the atlas has no supraspinous ligament, which is defined as the lower back cutaneous bursitis, which may also be called the lumbar () back cutaneous bursitis. basic knowledge The proportion of illness: 0.002%-0.005% Susceptible people: mostly middle-aged and elderly Mode of infection: non-infectious Complications: swelling, muscle atrophy, gout
Cause
Cause of spinous bursitis
The lumbosacral load and activity range are large, the incidence of congenital variation and developmental defects is high, prone to degenerative changes, and there are many opportunities for injury. Therefore, acute and chronic injury are the main causes of lower back cutaneous bursitis. Mechanism can cause lower back skin bursitis:
(1) Acute injury to the structure of the bursae caused by trauma, surgery, etc., cystic wall congestion, edema, exudation, excessive secretion, so that the cyst filling is enlarged.
(2) Long-term bending work, excessive back and back flexion and extension activities, weak soft tissue in the lower back, lumbar spine deformity, lumbar instability, etc., the bursa structure is derived from the spinous process of the lumbar spine, the medial malleolus, the superior ligament of the lumbar spine, Abnormal wear, compression and traction of the erector spinae () and the posterior layer of the lumbar fascia, synovial hyperplasia, hypertrophy, hyperemia, edema, increased secretion or exudation, so that the sac effusion expands.
(3) Local repeated massage, acupuncture or foreign body retention can also directly stimulate the structure of the sac and cause an inflammatory reaction, resulting in accumulation of fluid in the sac.
(4) The synovial endothelial cells proliferate with the increase of age, causing excessive secretion of synovial fluid, leading to swelling of the sac effusion.
Prevention
Spinous bursitis prevention
Pay attention to hygiene
Strengthen labor protection and develop the habit of washing hands with warm water after work.
Attention to rest
Rest is the primary method of solving any joint pain, so the joint should be well rested.
Ice
If the joints are hot to the touch, you can use the ice method. Take 10 minutes of ice and 10 minutes of rest. Do not use hot compress as long as the joint is still hot.
Alternating ice
If the acute swelling and pain is weakened and the heat has been eliminated, it can be treated by alternating hot and cold methods, that is, hot compress for 10 minutes after 10 minutes of ice application, and so on.
Swinging pain arm
If the pain is on the elbow or shoulder, it is recommended to swing the arm freely to relieve the pain.
Health tips
For example, the anterior sacral bursitis of the squatting worker, the sciatic nodular bursitis after sedentary in a thin elderly woman, and the posterior bursitis caused by the tightness of the shoes.
Complication
Spinous bursitis complications Complications, swelling, muscle atrophy, gout
After multiple episodes of bursitis or repeated trauma, it can develop into chronic bursitis. The episode lasts for several days to several weeks and recurs many times. Acute symptoms can occur after abnormal exercise or excessive force. As the synovial membrane proliferates, the wall of the sac becomes thicker, and the sac becomes eventually stuck, forming villi, sputum and calcium deposits. Muscle atrophy and limited mobility due to pain, swelling and tenderness. Calcium deposition under the deltoid muscle, especially in the infraorbital tendon sac, can be confirmed by X-ray films. Infectious bursitis can be complicated by surrounding tissue cellulitis; gout bursitis can be accompanied by deposition of lime-like sediments.
Symptom
Symptoms of sacral bursitis common symptoms back pain cysts when bending over low back pain
The lower back cutaneous bursitis is mainly seen in adults, mostly in middle-aged and older people. The incidence rate of women is slightly higher than that of men, and the course of disease varies from several days to several years. Mainly manifested as soreness and tenderness in the middle of the lower back. It is aggravated when bending over. When the lesion is large, local uplift can occur and cystic mass can be touched. Generally, the skin has no redness and fever.
MRI features
(1) Located in the deep fascia of the dorsal medial region of the lumbar () segment, between the skin and the lumbar spine ligament and/or the posterior layer of the lumbar fascia.
(2) The sagittal and transverse axes are characterized by strip-shaped, long fusiform or suboccipital cystic lesions. The margin of the acute phase is unclear and the edge of the chronic phase is clear.
(3) The range is different, the sides are symmetrical or asymmetrical, and a few extend upward or downward beyond the waist () segment.
(4) Most of them are long T1 and long T2 water-like signals, and a few are bloody effusion signals.
(5) More associated with other related structural lesions of the lumbar () vertebrae.
Examine
Examination of spinous bursitis
The MRI examination is as follows:
1. Located in the deep fascia of the dorsal medial part of the lumbar () segment, between the skin and the lumbar spine ligament and/or the posterior layer of the lumbar fascia.
2, the sagittal and transverse axis showed banded, long fusiform or suboccipital cystic lesions, the edge of the acute phase was not clear, and the edge of the chronic phase was clearer.
3, the range is different, the sides are symmetrical or asymmetrical, a few extend up or down beyond the waist () segment.
4, more long T1, long T2 water sample signal, a small number of bloody effusion signal.
5, more with other related structural lesions of the lumbar () vertebra.
Although the lower back skin bursitis is not a serious disease, its lower back pain symptoms can affect the daily activities of patients, and some cases may even have repeated or chronic pathogenesis, which should be paid enough attention.
Diagnosis
Diagnosis and differentiation of spinous bursitis
diagnosis
The clinical diagnosis of the disease is difficult, especially when the lesion is small, often missed or misdiagnosed. MRI makes a clear diagnosis of lower back cutaneous bursitis, which helps to objectively evaluate the causes of lower back pain, fully understand the symptoms and signs of lumbar (sputum) disease, and correctly treat lower back cutaneous bursitis and waist (Other diseases, to avoid improper treatment of the waist () disease or aggravate the lower back skin bursitis.
Differential diagnosis
The most common bursitis occurs in the shoulder (under the shoulder or deltoid bursitis). Other common sites include the humeral olecranon (miner elbow), the anterior (wife's knee) or the iliac crest, and the Achilles tendon (the Achilles bursa). Inflammation), sputum (squatting waist), ischial bone (tailor or weaver arm), greater trochanter and first metatarsal head (? bursitis). The main clinical manifestations are as follows:
Acute bursitis, the treatment of chronic bursitis is characterized by pain, localized tenderness and limited mobility. Such as shallow bursal involvement (anterior and olecranon), local redness, chemical (such as crystal) or bacterial bursitis have severe pain, local skin is obviously red, temperature rises, the attack can be It lasts for a few days to several weeks and has recurred many times. Acute symptoms can occur after abnormal exercise or excessive force.
Chronic bursitis, chronic bursitis is developed after multiple episodes of acute bursitis or repeated trauma. As the synovial membrane proliferates, the wall of the sac becomes thicker, and the sac becomes eventually adhered, forming villi, sputum and calcium deposits. Muscle atrophy and limited mobility due to pain, swelling and tenderness. During the acute onset of gout inflammation, crystals can form in the sac sac and the anterior synovial sac.
Acromial bursitis, acromion bursitis (delta bursitis) manifested as shoulder pain and tenderness. Especially when the abduction is 50°~130°. Acromial bursitis and calcified supraspinatus tendonitis are difficult to distinguish between clinical and X-ray examination. The latter may be the result of partial or total tearing, or by release crystallization.
Injury bursitis, bursitis is more common and chronic. Often in the prominent part of the bone structure, due to long-term, repeated friction and compression, such as thin elderly women can occur sitting bursitis; sedentary workers can occur anterior bursitis; shoes too tight can cause after Bursitis and the like. The pathological manifestations were synovial congestion, edema, and villus. Increased synovial fluid and filling of the bursa can cause thickening and fibrosis of the sac wall. Acute bursitis often occurs on the basis of chronic bursitis, when the damage is large. May be accompanied by bloody synovial exudation.
Infectious bursitis, infectious bursitis due to infection caused by pathogenic bacteria, can cause suppurative bursitis, and can cause cellulitis around the tissue, often residual sinus after ulceration.
Gouty bursitis, gouty bursitis is prone to occur in the olecranon and anterior sac sac, chronic inflammatory changes can occur in the wall of the sac, and lime deposits are deposited. Patients have a history of chronic injury and a history of illness associated with the disease. There are round or elliptical bones near the joints, and the edges are clearly sized. Acute pain and tenderness are obvious, while those in the chronic are mild, and the affected limbs may have different degrees of activity disorder. The superficial bursa can detect the sense of fluctuation. The deep bursa or the capsular pressure is often difficult to touch and fluctuate. The puncture can obtain mucus or bloody mucus. If it is secondary to infection, it may have redness, swelling, heat and pain.
