Bursitis

Question 1

What is bursitis?

Answer 1

Inflammation of the bursa

Question 2

What is a bursa?

Answer 2

Sac-like structure lined by synovial membrane, that contains and secretes synovial fluid and is located between tendons/muscles and bony prominences

Question 3

Why are bursae located between tendons/muscles and bony prominences?

Answer 3

The secretion of synovial fluid from bursae reduces friction between tendons/muscles and bone

Question 4

What is the ratio of men to women affected by bursitis overall?

Answer 4

1:1

Question 5

How does location of bursae relative to the skin affect their susceptibility to traumatic bursitis, and give 3 examples of bursae which are affected?

Answer 5

Bursae that are closer to skin have thinner layer of protective subcutaneous fat covering them, so they are more likely to sustain direct impact

Commonly occurs in olecranon, prepatellar, trochanteric bursae

Question 6

What type of bursitis is an individual who constantly rests elbows on a surface, eg. due to manual labour or driving for a long time, commonly affected by

Answer 6

Olecranon bursitis

Question 7

In which kind of individual is prepatellar bursitis most common?

Answer 7

Individual who is constantly kneeling eg. for manual labour work, gardners, builders

Question 8

What 2 arm movements commonly cause bursitis in the shoulder bursae, and give 2 examples of individuals in which this commonly occurs?

Answer 8

Arm flexion and abduction

Commonly occurs in manual labourers, basketball athletes

Question 9

How does septic bursitis occur?

Answer 9

Direct inoculation by microorganism after trauma/puncture of site of bursa

Question 10

Give 5 examples of individuals that are at increased risk of septic bursitis?

Answer 10

Immunocompromised individuals

Diabetic individuals

Individuals with HIV

Alcoholic individuals

Individuals with certain rheumatological conditions

Question 11

What 2 bursae are most commonly affected by septic bursitis, and what is the most common microorganism that causes it?

Answer 11

Olecranon and prepatellar bursae

Staphylococcus aureus

Question 12

Does bursitis occur in all ages?

Answer 12

Yes

Question 13

Why is bursitis more common in elderly people?

Answer 13

Increased risk of bursitis due to higher prevalence of chronic diseases such as OA in the elderly population

Question 14

What 2 factors in a patient’s history causes presentation of traumatic bursitis?

Answer 14

History of injury or overuse of joint

Question 15

Give 4 clinical features of a region affected by bursitis?

Answer 15

Swelling

Erythema (skin redness due to injury or inflammation)

Affected region warm when palpated

Painful range of movement

Question 16

Are the symptoms of aseptic bursitis similar to symptoms of septic bursitis?

Answer 16

They have similar presentations but septic bursitis can present with other systemic features eg. fever

Question 17

What is trochanteric bursitis?

Answer 17

Inflammation of bursa on greater trochanter

Question 18

What is prepatellar bursitis?

Answer 18

Inflammation of bursa in front of patella

Question 19

What is anserine bursitis?

Answer 19

Inflammation of bursa between tibia and insertion of tendon of 3 hamstring muscles

Question 20

What is retrocalcaneal bursitis?

Answer 20

Inflammation of bursa behind achilles tendon insertion and above calcaneus

Question 21

Is radiological investigation necessary to diagnose bursitis?

Answer 21

No, but it can be useful to identify bony abnormalities that are predisposing factors to traumatic bursitis, such as osteophytes and fractures which can pierce bursa

Question 22

Why is ultrasound and MRI imaging used for bursitis investigation?

Answer 22

Used for further evaluation, to see soft tissue swelling and excess synovial fluid, which can indicate bursitis

Question 23

If septic bursitis is suspected, what 2 lab investigations are completed?

Answer 23

Synovial fluid of inflamed bursa is aspirated and sent in culture to test for infection

Full blood count to check WBC count and inflammatory markers

Question 24

If a patient is suspected of having septic bursitis, what treatment is immediately administered?

Answer 24

Patient is started on antibiotics

Question 25

How is swelling reduced in aseptic acute bursitis management?

Answer 25

Rest, Ice, Compress, Elevate (use padded splint to support area) affected region

Question 26

How is pain and inflammation reduced in aseptic acute bursitis management?

Answer 26

NSAIDs

Question 27

Why is physiotherapy useful for management of bursitis?

Answer 27

Promotes recovery and improves range of movement of affected region

Question 28

How can bursitis be treated if there is no response to conservative treatments like RICE?

Answer 28

Ultrasound-guided aspiration and steroid injection into bursa

Question 29

Is Ultrasound-guided aspiration and steroid injection into bursa suitable for all bursae?

Answer 29

Not suitable for olecranon and prepatellar bursitis

Question 30

Why is Ultrasound-guided aspiration and steroid injection into bursa not suitable for olecranon and prepatellar bursitis?

Answer 30

once drained, the bursa is likely to fill with fluid again quickly, and there is a risk for an iatrogenic infection (infection that occurs after medical/surgical management)

Question 31

What is the prognosis of bursitis?

Answer 31

Usually heals within few weeks but putting pressure or stress on your bursa before it’s completely healed increases your risk of reinjuring it