IF WE compare the simplicity and results of the non-surgical treatment employed in bursitis today with that of twenty years ago, at the dawn of physical therapy, we can say with regard to the latter: “Sibi gratulentur homines talem tantumque humani liberatorem doloris existere.” Even the most clever physician or surgeon did not possess any proper non-surgical method for the cure of bursitis, though such methods were employed. Among the notables surgeons that employed non-surgical methods in those days was Codman. But the methods were very poor, even dangerous and soon abandoned.
In fact, Codman 1Quoted by Brickner: “Subacromial Bursitis,” Med. Recorder., 15, January 2, 1915. himself admitted that his treatment “was a very arduous are for the surgeon and cause a good deal of complaint from the patients.” Brickner, 2Brickner, Walter: “Concerning the Non-Operative Treatment of Subacromial Bursitis,” Amer. Jour. Orthopaedic Surg., vol. 14, No.4, p. 231, April, 1916. discussing Codmans method, says, “he (Codman) seems to have abandoned both the apparatus and the “brisement force of the bursal adhesions- a procedure which is much more uncertain and more dangerous than open operation.”
Other surgeons like the just mentioned Brickner recognized for the relief of pain in bursitis, especially with lime deposit, only one method-operation. “None of my case with lime deposit,” says Brickner, 3Ibid. “has been relieved of pain except those operated upon”.
Today we have definite physical therapy methods for the cure of bursitis. They are, however, wrongly employed by the average practitioner, though he possesses the apparatus. Many pitiful examples corroborating this statement could be cited, but for lack of space, I shall use of an illustration the following case only. A man of thirty-eight, a laborer by occupation, suffered from an acute traumatic subdeltoid bursitis.
His physician, in order to relieve the pain, administered an injection of morphine and applied diathermy to the acutely inflamed shoulder. The patient felt relieved for two hours. The pain then returned with greater severity. The doctor repeated the same treatment. This was done for three days with the result that the pain grew progressively severer with every time the effect of the morphine wore off; and the patient, according to his statement, nearly became insane from the unbearable pain.
In this condition he came under my care. The treatment that I have instituted in this case, with rather rapid results, is the standard treatment which I have employed successfully in my clinics and office for a number of years, probably in 99 cases our of 100.
According to Alexander Monro: “Description of All Bursae Mucosae of the Human Body”, p.8, edited, 1788. (Obtained at the New York Academy of Medicine.) (Professor of Anatomy of University of Edinburgh) there are 140 bursae in the body: thirty-three in each of the upper extremities and thirty-seven in each of the lower extremities. Such a vast number of bursae warrants the necessity of some proper treatment of this structure in disease.
The bursa, however, most often affected is, I believe, the subdeltoid +The subacromial bursa is next in frequency, though in reality it is a part of the subdeltoid one: if the arm is abducted, the bursa is subacromial; when in contact with the side of the body is (or at least a large part of it) is subdeltoid (Codman Quoted by Da Costa: “Modern Surgery,” p. 728, 1915 edition. one, as it was the subdeltoid bursitis that most often came under my care, and was of traumatic etiology. I shall, therefore, refer to it in discussing the treatment which holds good for any other bursitis usually met with in practice and having the same etiology.
Bursitis, just as any other “itis,” has there stages: acute, subacute and chronic. For the appreciation of the methods of treatment employed, I shall refresh out knowledge, when deemed necessary, of the pathologic, physiologic, or biochemic processes that take place in these stages as well as of the physiology and biochemic effects of some of those methods. For it is the considerations of those three staples of medical science (pathology, physiology, and biochemistry) together with years of experience, that form the basis of the treatment discussed in this paper.
Pathology of the First Stage of Bursitis.- In this stage we deal with an acute inflammation, the cardinal symptoms of which, as we all know, are: rubor, tumor, calor, and door. When the bursa is located superficially, the first three symptoms are well noticed. If the inflamed bursa is situated in the deeper tissues, the signs can be detected with difficulty, if at all. The bursa is distended by fluid; thee is hyperemia and edema of the tissues surrounding it, producing pressure upon the neighboring nerve structures. This pressure is, as we know, a factor in the causation of pain. Treatment of the Acute Stage.- This consists of (1) cold applications (home treatment), and (2) galvanization (office treatment).
