Spinous process bursitis

　　The lumbar sacral region has a large load-bearing capacity and a wide range of activities, a high incidence of congenital variations and developmental defects, and it is prone to degenerative changes. There are many opportunities for injury, so acute and chronic injuries are the main causes of subcutaneous bursitis of the lower back. Analysis of multiple mechanisms can cause subcutaneous bursitis of the lower back:

　　1. Acute injury to the bursal structure due to trauma, surgery, etc., causes the bursal wall to become congested, edematous, exudative, and hypersecretory, leading to the expansion of the sac cavity.

　　2. In cases such as long-term bending work, excessive lumbar and sacral flexion-extension activities, weak soft tissues of the lower back, lumbar lordosis deformity, lumbar instability, etc., the bursal structure is subjected to abnormal wear, compression, and traction from the lumbar spinous process, midline sacral spine, lumbar supraspinous ligament, erector spinae (tendon), and posterior layer of the lumbar and sacral fascia. Synovial hyperplasia, hypertrophy, congestion, edema, increased secretion, or exudation cause the bursal effusion to expand.

　　3. Local repeated massage, acupuncture, or foreign body retention can also directly stimulate the bursal structure and cause inflammatory reactions, leading to the accumulation of fluid in the sac cavity.

      4. The villous proliferation of synovial endothelial cells with age can cause excessive secretion of synovial fluid, leading to the enlargement of the bursal effusion.

　　After multiple attacks or repeated trauma of bursitis, it can develop into chronic bursitis. Attacks can last for several days to several weeks, and they can recur multiple times. Acute symptoms can appear after abnormal movement or overexertion. Due to synovial hyperplasia, the bursal wall thickens, and the bursa eventually becomes adherent, forming villi, exostoses, and calcifications. Pain, swelling, and tenderness can lead to muscle atrophy and restricted movement. The calcification of the bursa under the deltoid muscle, especially the bursa of the tendons of the infraspinatus muscle, can be confirmed by X-ray. Infectious bursitis can be accompanied by cellulitis of surrounding tissues; gouty bursitis can be accompanied by calcium-like precipitates.

　　Subcutaneous bursitis of the lower back is mainly seen in adults, with middle-aged and elderly people being more common, and the incidence rate in women is slightly higher than that in men. The course of the disease ranges from several days to several years. The main manifestations are soreness and tenderness in the central area of the lower back, which worsens when bending over. When the lesion is large, local bulging and palpable cystic masses may occur. Generally, there is no redness and swelling of the skin, nor fever.

　　1, located in the deep fascia of the middle back of the lumbar (sacral) segment, between the skin and the supraspinous ligament of the lumbar spine and/or the posterior layer of the lumbar and dorsal fascia.

　　2, in the sagittal and coronal planes, it appears as strip-like, long fusiform or compartmental cystic lesions, with unclear edges in the acute stage and clearer edges in the chronic stage.

　　3, the range is not uniform, symmetrical or asymmetrical on both sides, a few extending upwards or downwards beyond the lumbar (sacral) segment.

　　4, mostly showing long T1, long T2 fluid-like signal, a few showing blood serum signal.

　　4, often accompanied by other related structural changes of the lumbar (sacral) spine.

　　First, prevention

　　1, Pay attention to hygiene

　　Strengthen labor protection and develop the habit of washing hands with warm water after work.

　　2, Pay attention to rest

　　Rest is the primary method to solve any joint pain, so the joint should be well rested.

　　3, Ice敷

　　If the joint feels very hot, you can use the method of ice敷. In the form of 10 minutes of ice敷, 10 minutes of rest, alternating in this way. Do not use heat敷 as long as the joint is still hot.

　　4, Alternate ice and heat敷

　　If the acute swelling and pain weaken and the heat has been eliminated, you can use the method of alternate ice and heat敷 to treat, that is, ice敷 for 10 minutes and heat敷 for 10 minutes, and repeat in this way.

　　5, Swing the painful arm

　　If the site of pain is the elbow or shoulder, it is recommended to swing the arm freely to relieve pain.

　　6, Health tips

　　such as patellar bursitis in kneeling workers, and sciatic tubercle bursitis in thin elderly women after sitting for a long time; heel bursitis caused by tight shoes, etc.

　　Second, dietary principles

　　1, Eat:blood-activating and stasis-relieving, aromatic and orifice-opening foods, such as Panax notoginseng, hawthorn, hoelen, allium macrostemon, shepherd's purse, etc.

　　2, Eat more:fresh vegetables, fruits, and legumes.

　　3, In the later stage of the disease:Eat foods that tonify Qi and nourish blood, nourish the liver and kidney, etc., which contain nutrition, such as grapes, black soybeans, goji berries, longan, and turtle meat.

　　4, Avoid:such as fried, grilled, salty, and sweet foods.

　　5, Taboo:Avoid: spicy, fishy, and thick foods, as well as stimulants such as cigarettes and alcohol.

　　The MRI examination is as follows:

　　1, located in the deep fascia of the middle back of the lumbar (sacral) segment, between the skin and the supraspinous ligament of the lumbar spine and/or the posterior layer of the lumbar and dorsal fascia.

　　2, in the sagittal and coronal planes, it appears as strip-like, long fusiform or compartmental cystic lesions, with unclear edges in the acute stage and clearer edges in the chronic stage.

　　3, the range is not uniform, symmetrical or asymmetrical on both sides, a few extending upwards or downwards beyond the lumbar (sacral) segment.

　　5, showing long T1, long T2 fluid-like signal, a few showing blood serum signal.

　　4, often accompanied by other related structural changes of the lumbar (sacral) spine.

　　What foods are good for spur滑囊炎: It is advisable to eat foods that promote blood circulation and remove blood stasis, and open the orifices, such as Panax notoginseng, hawthorn, hoelen, allium macrostemon, shepherd's purse, etc. In addition, eating more fresh vegetables, fruits, and legumes is a good choice. It is necessary to avoid foods such as fried, grilled, salty, and sweet foods in daily life. In the later stage of the disease, it is advisable to eat foods that tonify Qi and nourish blood, nourish the liver and kidney, etc., which contain nutrition, such as grapes, black soybeans, goji berries, longan, and turtle meat, and to avoid foods with strong flavors such as spicy and fishy, as well as stimulants such as cigarettes and alcohol.

　　1. Treatment of Non-Infectious Acute Bursitis

　　Temporary rest or immobilization of the affected area and high-dose NSAIDs, with analgesic sedatives as needed, may be effective. After the pain subsides, active exercise should be increased. Swing exercises are particularly beneficial for the recovery of the shoulder joint. If ineffective, the synovial fluid can be aspirated, and then a long-acting adrenal cortical hormone preparation, such as 0.5~1ml of triamcinolone acetonide 25mg/ml or 40mg/ml, mixed with at least 3~5ml of local anesthetic, can be injected into the bursa after infiltrative anesthesia with 1% local anesthetic (such as lidocaine). The dose of the long-acting adrenal cortical hormone preparation and the volume after mixing depend on the size of the bursa. In determining the cause, infection must be ruled out. Patients with refractory inflammation require repeated fluid aspiration and drug injection. For poor outcomes in acute cases, systemic adrenal cortical hormones (such as prednisone 15~30mg/d or equivalent hormones, taken for 3 days) can be used after excluding infection and gout.

　　2. Treatment of Chronic Bursitis

　　The treatment methods for chronic bursitis are the same as those for acute bursitis, but splint fixation and rest may be less effective than for acute bursitis. Chronic calcifying tendinitis of the supraspinatus muscle confirmed by X-ray, if treatment with adrenal cortical hormones is ineffective, in a very few cases, surgical resection or aspiration with a large gauge needle may be required. Disabling adhesive capsulitis requires repeated intra-articular and extra-articular injections of adrenal cortical hormones and enhanced physical therapy. Manipulation under anesthesia does not improve the long-term outcome unless manipulation is performed after the above measures for correcting adhesive bursitis are applied. It is necessary to correct muscle atrophy through exercise to restore the range of motion and muscle strength. Those with infection need to be given appropriate antibiotics, drainage, or incision. If the primary disease (such as rheumatoid arthritis, gout, chronic occupational overuse, etc.) is not cured, bursitis may recur.