Bursitis Flashcards
Definition
Inflammation of the synovium-lined sac-like structures (bursa) found throughout the body, usually between bones, muscles, tendons, or ligaments.
Epidemiology and risk factors
Occupation causing repeated mechanical stress on a bursa: ‘clergymans’ (infrapatella bursitis) knee from praying ‘housemaids knee’ (prepatella bursitis)
Autoimmune conditions:
- rheumatoid arthritis,
- psoriatic arthritis
Gout or pseudogout
Hip osteoarthritis: trochanteric bursitis
Penetrative injury: introducing infection
Abnormal gait: mechanics may induce trochanteric bursitis
Low-riding shoes: excessive heel pressure can cause retrocalcaneal bursitis
Common locations of bursitis
Prepatella bursitis
Infrapatella bursitis
Anserine bursitis
Olecranon bursitis
Trochanteric bursitis
Subacromial bursitis
Retrocalaneal bursitis
Signs
Tenderness on palpation
Altered gait: lower limb bursitis
Erythema: if septic bursitis
Symptoms
Pain: at a particular bursa site
Reduced range of movement
Swelling
Diagnosis
Clinical diagnosis
Investigations to consider: if septic bursitis or diagnosis uncertain
- FBC
- CRP
- Fluid aspiration culture: WCC count lower than septic arthritis < 20,000 mm3
- Fluid aspiration for crystal
Plain x-ray = usually normal may show underlying osteoarthritis
MRI = soft tissue swelling and fluid filled bursa
Treatment
Non-septic bursitis
FIRST LINE:
- Conservative management: rest, ice, compression
- Simple analgesia: paracetamol, ibuprofen
SECOND LINE:
- Corticosteroids injection
THIRD LINE:
- Surgery: burstectomy
Septic bursitis
FIRST LINE:
- Aspiration of the bursa: culture, gram stain, sensitivities
- IV Abx
- Simple analgesia
SECOND LINE:
- As above + surgical debridement and lavage
Complications
Septic arthritis: small risk of injection spreading from bursa to local joint
Infection secondary to aspiration or steroid injection
Chronic pain
