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<v ->Another interesting place that we see bursitis

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relates to a submuscular site

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beneath or deep to the subscapularis muscle.

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And this can be seen in patients

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who have an osteochondroma involving the

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anterior aspect of the scapular body.

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Here's a nice case from a number of years ago,

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showing you on the CT,

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the white arrow is showing you the osteochondroma

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and the black arrow is showing you bursitis.

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This is designated scapulothoracic bursitis.

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Now, one of the interesting locations

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of bursa are in a subfascial location.

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And here, the prototype that I would mention is

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the iliotibial band or tract.

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And the syndrome that may be created.

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The appearance of iliotibial band syndrome

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is quite variable.

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I show you three examples here.

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The common feature that we see is an altered signal

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deep to the iliotibial tract.

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In some cases, this represents edema.

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In other cases, it represents fluid perhaps

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within a deep bursa there.

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And sometimes the abnormal signal is associated

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with thickening of the iliotibial tract.

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There are some theories as to how

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this particular syndrome develops.

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Is it friction resulting in an adventitious bursitis?

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Is it inflammation of the tract itself?

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And a more recent theory is it results from

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compression of fat in this particular region about the knee.

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Another example here of the iliotibial band

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or tract syndrome pointing out that sometimes

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it's a little bit difficult to tell,

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are you dealing with bursal fluid,

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or are you dealing with joint fluid?

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I mean, think for a moment of a patient

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who has a large joint effusion

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and the fluid would pass along the lateral aspect

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of the lateral femoral condyle.

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And there would be posterior fluid back here

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that would pass anteriorly.

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So how do you know when you see fluid collection here

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that you're dealing with a bursa?

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Well, one interesting way you can tell is

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if the fluid is superficial to the epicondyle,

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to this bump it is likely not related to a joint effusion.

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And most of those cases in which you see that

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you're dealing with within that iliotibial bursa.