Bursitis

Question 1

What is bursitis

Answer 1

Acute or chronic inflammatory condition of a bursa

Bursa = jelly-like sac that contains a small amount of synovial fluid, lying between tendon and skin/bone to act as a friction buffer
Thickening and proliferation of the synovial lining, bursal adhesions, villus formation, tags, deposition of chalky deposits

Question 2

Potential sites of bursitis

Answer 2

Prepatellar bursitis (‘housemaid’s knee’)
Infrapatellar bursitis (‘clergyman’s knee’)
Anserine bursitis (anserine refers to the classic appearance of a swollen bursa being restrained by the 3 tendons overlying it - sartorius, gracilis, and semitendinosus - creating the impression of a goose’s foot)
Olecranon bursitis (‘student’s elbow’)
Retrocalcaneal bursitis
Trochanteric bursitis
Subacromial (subdeltoid) bursitis.

Question 3

Aetiology of bursitis

Answer 3

Repetitive stress
Infection
Autoimmune disease e.g. rheumatoid arthritis
Trauma
Gout/pseudogout (crystal deposition)
Osteoarthritis

Question 4

Symptoms of bursitis

Answer 4

Pain at the site of bursa
- Subacromial: painful arc on shoulder abduction
- Trochanteric: lateral hip pain, pain one extremes of movement + pain radiating down the lateral thigh
- Prepatellar: impalpable patella
- Retrocalcaneal: palpable bump over heel
Tender
Reduced range of active motion
Swelling

Question 5

Symptoms and signs of septic bursitis

Answer 5

Fever
Erythema
Warmth of overlying skin

Question 6

Investigations for bursitis

Answer 6

Clinical diagnosis

Joint aspirate for MC&s and crystal analysis: exclude septic arthritis/gout
X-ray affected joint: normal, rule out tumours/osteonecrosis
MRI: soft-tissue swelling + fluid-filled bursa

Question 7

Management for bursitis

Answer 7

Conservative:
- Avoid activities that worsen symptoms e.g. kneeling with prepatellar bursitis
- Protect the area e.g. kneepads
- Walking aids e.g. crutches or a walking sticks
- Physiotherapy
- Ice to reduce swelling

Medical:
- Simple analgesia - paracetamol, NSAIDs
- Corticosteroid injections

Surgical:
- Bursectomy: Considered after 3-6 months of conservative management

Question 8

Prognosis for bursitis

Answer 8

Most respond well to conservative management and recover completely
Those who participate in sport or have an occupation entailing repetitive activity that is likely to have precipitated the bursitis will benefit from advice on modifying their activity and using protection to prevent recurrence.