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Bursitis

Bursitides

Bursitis is an inflammation of a bursa. The subacromial, olecranon, prepatellar, trochanteric and infrapatellar bursae are the most commonly affected.


Presentation

The following common symptomatology is seen among patients with acute, chronic and recurrent bursitis:

Most of this signs and symptoms are conservatively treated at home or in a primary health facility. Patients are however advised to seek professional help if they experience the following with bursitis:

Cerebral Palsy
  • Palsy and Developmental Medicine, Pediatric Orthopaedic Society of North America Disclosure: Nothing to disclose.[emedicine.com]
Swollen Knee
  • For example, don’t kneel on a swollen knee. Put an ice pack, gel pack, or package of frozen vegetables wrapped in a cloth on the area every 3 to 4 hours for up to 20 minutes at a time to help relieve pain.[summitmedicalgroup.com]
Inguinal Mass
  • Physical examination revealed an inguinal mass and groin pain. X-ray examination indicated destruction of the hip joint.[ncbi.nlm.nih.gov]
Leg Swelling
  • We present the characteristic images from this case and review all previously reported cases of RA iliopsoas bursitis causing leg swelling or neuropathy, and summarize the background.[ncbi.nlm.nih.gov]
Pertussis
  • The most frequently involved vaccines were influenza and pneumococcal vaccines, respectively; followed by diphtheria-tetanus-pertussis, diphtheria-tetanus toxoid, human papillomavirus, and hepatitis A vaccines.[ncbi.nlm.nih.gov]
Hip Pain
  • Iliopsoas bursitis is a poorly recognized cause of hip pain that requires early recognition to avoid potentially serious complications caused by compression of adjacent structures.[ncbi.nlm.nih.gov]
  • The symptoms, including left hip pain, quickly disappeared following treatment. Clinicians should be aware that iliopsoas bursitis may resemble an iliopsoas abscess. As a result, it is important to make an accurate differential diagnosis.[ncbi.nlm.nih.gov]
  • We present a case report of a 73-year-old man with chronic left hip pain that did not respond to conservative treatments.[ncbi.nlm.nih.gov]
Knee Pain
  • Calcific bursitis of the MCL of the knee is very uncommon, but should be taken into account in differential diagnoses for medial knee pain. UGPL is proposed as a treatment for this condition.[ncbi.nlm.nih.gov]
  • It is a rare but important cause of medial knee pain. A 65-year-old woman with knee osteoarthritis (OA) presented with severe pain and swelling in her left knee. She did not have a traumatic injury.[ncbi.nlm.nih.gov]
  • Rm K4-121, Vancouver, V6H3V4, Canada. jqanatish@hotmail.com Abstract Children with juvenile idiopathic arthritis (JIA) may infrequently present with localized anterior knee pain or swelling, in addition to generalize knee pain induced by JIA.[ncbi.nlm.nih.gov]
  • Knee pain is commonly seen in orthopedic and rehabilitation outpatient clinical settings, and in the aging population.[ncbi.nlm.nih.gov]
  • METHODS: A total of 157 female patients with the diagnosis of knee OA on both knees (314 knees), and 30 age, and body mass index- matched healthy female controls without knee pain (60 knees), were included in the study.[ncbi.nlm.nih.gov]
Heel Pain
  • Continue reading… Achilles heel pain from Achilles tendinitis and bursitis, treatment and prevention Achilles tendinitis and Achilles bursitis are two types of heel pain that result from inflammation in the Achilles tendon.[belmarrahealth.com]
  • Heel Bursitis Heel pain can be caused by a variety of reasons. Pain in the back of the heel may be due to inflammation of the bursa located in the area where the heel bone connects to the Achilles tendon.[onhealth.com]
  • How to treat your knee, hip, and heel pain. Click To Tweet[runnersconnect.net]
  • Patients complain of posterolateral heel pain and may have a posterior heel prominence (“pump bump”), as well as local swelling and tenderness over the Achilles tendon.[emedicine.com]
Joint Swelling
  • Symptoms of bursitis may include any of the following: Joint pain and tenderness when you press around the joint Stiffness and aching when you move the affected joint Swelling, warmth or redness over the joint Pain during movement and rest Pain may spread[nlm.nih.gov]
  • Symptoms of bursitis may include any of the following: Joint pain and tenderness when you press around the joint Stiffness and aching when you move the affected joint Swelling , warmth or redness over the joint Pain during movement and rest Pain may spread[medlineplus.gov]
Arthralgia
  • We must, therefore, include bursitis as a possible diagnosis in patients complaining of arthralgia duruing long-term hemodialysis.[ci.nii.ac.jp]

Workup

The following diagnostic procedures and tests are commonly used among patients suffering from bursitis:

Imaging

Although X-ray radiographs cannot detect bursitis, this tool is most useful in ruling out any osseous pathology in the area that could mimic the symptom. Magnetic resonance imaging (MRI) and ultrasonology may be used to ascertain the diagnosis of bursitis when physical examination remains uncertain [7].

Laboratory tests

A fine needle may be inserted at the swollen bursae to harvest the inflamed fluids for laboratory testing. Tests may reveal the state of the inflammation and the type of organism that causes the infection within the bursae.

Mycobacterium Kansasii
  • Olecranon bursitis secondary to Mycobacterium kansasii infection in a patient receiving infliximab for Behcet's disease. J Med Microbiol. 2009 Mar. 58:371-3. [Medline]. Brinks A, van Rijn RM, Bohnen AM, Slee GL, Verhaar JA, Koes BW, et al.[emedicine.com]
Candida
  • However, many other organisms have been implicated in septic bursitis, including mycobacteria (both tuberculous and nontuberculous strains), fungi ( Candida ), and algae ( Prototheca wickerhamii ). [22] Factors predisposing to infection include diabetes[emedicine.com]
Mycobacterium Avium Complex
  • Among these are non-tuberculous mycobacteria (NTM), with Mycobacterium avium complex being the most commonly described finding. Antimycobacterial treatment of NTM in cases of IRIS is controversial.[ncbi.nlm.nih.gov]
Human Papillomavirus
  • The most frequently involved vaccines were influenza and pneumococcal vaccines, respectively; followed by diphtheria-tetanus-pertussis, diphtheria-tetanus toxoid, human papillomavirus, and hepatitis A vaccines.[ncbi.nlm.nih.gov]

Treatment

The majority of cases of bursitis are treated conservatively by affording adequate rest to affected area, application of ice packs, and the use of pain relievers. Where conservative management fails to offer palliative relief and resolution, the following therapies are being implored in cases of bursitis:

  • Antibiotics when bursitis is found to be caused by an infective agent.
  • Physical therapy to ease the pain and prevent the recurrence of the discomfort.
  • Corticosteroid injections may be given directly to the bursae to afford instant relief of the pain among patients [8]. Corticosteroid injections can be guided accurately by the use of ultrasound [9].
  • Assistive devices. The use of walkers and walking canes may assist the patient’s mobility and reduce pain symptoms during ambulation.
  • Surgery. Inflamed and infected bursae may be surgically drained to relieve the pressure and shorten the clinical course of the disease. Sometimes the whole bursa is surgically removed to permanently address the recurrent problem [10].

Prognosis

There is a very low mortality rating for bursitis. Patients with bursitis are usually treated and followed up on an outpatient basis in most medical facilities. The prognosis of bursitis is generally good for all cases.

Etiology

The most common cause of bursitis is associated with the repetitive movements and friction that may irritate the bursae. The following common movements and situations may give rise to bursitis:

  • Repetitive pitching of a baseball
  • Regular lifting of dumbbells overhead
  • Extensive kneeling among monks and nuns
  • Leaning on the elbows on an extended period of time
  • Prolonged sitting on a hard surface 

The less common causes of bursitis include rheumatoid arthritis, gouty arthritis, and infectious arthritis [2].

Epidemiology

The world prevalence rate of bursitis in primary care centers is only 4 out of 1000 patient visits. The most common sites of bursitis are the shoulder, elbow, hip, thigh and knee joints. Here is a high incidence of bursitis among athletes especially among the running sports, reaching an incidence ratio of up to 1 of 10 runners. Studies have revealed that men are more prone to bursitis especially those involved in heavy workload labor that involves frequent kneeling [3]. In septic superficial bursitis, men are more predisposed than women with a relative ratio of 17:3.

Sex distribution
Age distribution

Pathophysiology

The advent of the repetitive trauma to the bursae over the joints encourages synovial cytosis. The thickening of the membranes through continuous collagen formation will increase fluid production within the joint. Chronically, this will result in granulation formation on the surface of the synovial which is followed by the onset of fibrosis. The fibrin rich fluid within the bursae can become hemorrhagic is some cases that could trigger an inflammation [4]. Studies relates that these reactions may be mediated by cyclooxygenases, metalloproteases, and cytokines during the inflammatory process.

By convention, there are three kinds of bursitis: Acute, recurrent and chronic forms [5]. Acute bursitis results during the sudden thickening of the synovial fluid causing pain during movement. Chronic bursitis results with long standing pain causing the weakening of the joint muscles, tendons, and ligaments as a complication. The recurrent forms are those sporadic and intermittent attacks of acute bursitis in a period of time like those seen in swimmers, gymnasts, and weight lifters [6].

Prevention

There are some modifiable factors that can be resorted to prevent the recurrence of bursitis and allay its symptoms. The use of knee pads can greatly reduce the friction of the kneeling surface towards the afflicted bursa. Avoidance of lifting excessive weight loads will prevent the undue pressure on the hips and knee bursae. For those involved in repetitive tasks, frequent breaks may be needed to afford some rest on the bursae and joints involved. Changing one’s position frequently while doing repetitive tasks may also do the trick efficiently. Athletes should do pre-activity warm ups and stretching to strengthen the joints and the muscles around the bursae.

Summary

Bursitis is a clinical disease characterized by acute and chronic inflammation of the bursa. This inflammation is usually caused by repetitive trauma or friction, infections, and crystal depositions. Patients usually complain of pain during movement, tenderness, and swelling.

Bursitis is a disorder described as a painful swelling and inflammation of the fluid filled sacs that cushions the bone, muscles and tendons called bursae. These bursae are found in some of the major joints of the body including the shoulder, hip, elbow and the knee joints. Bursitis commonly occurs on joints that do frequent and repetitive movements. In bursitis, the synovial lining histologically thickens and produces excessive fluid that leads to localized swelling and tenderness [1]. Most of the cases are resolved within weeks after resting the affected site or by giving simple pain control measures.

Patient Information

Definition

Bursitis is a medical disorder described as a painful swelling and inflammation of the fluid filled sacs that cushion the bone, muscles and tendons called bursae.

Cause

 Bursitis is caused by any repetitive motion and friction over a bursa. It is caused by trauma, infections. It can also be secondry to crystal depositions.

Symptoms

The common symptoms the patient experiences is pain in the affected area, tenderness, limitation of movement, and swelling.

Diagnosis

The diagnosis of bursitis can be made by proper physical examination most of the times. Imaging studies sometimes can give a better clue. Specific diagnosis of the causative agent can sometimes be made by laboratory examination of bursa aspirate.

Treatment

Treatment involves adequate rest, applying ice packs, analgesics, antibiotics for infection, physical therapy, joint injections with corticosteroids, and surgery.

References

Article

  1. Sheon RP, Moskowitz RW, Goldberg VM. Soft Tissue Rheumatic Pain: Recognition, Management, Prevention. 3rd ed. Baltimore: Williams and Wilkins; 1996.
  2. Torralba KD, Quismorio FP Jr. Soft tissue infections. Rheum Dis Clin North Am. Feb 2009; 35(1):45-62.
  3. Le Manac'h AP, Ha C, Descatha A, Imbernon E, Roquelaure Y. Prevalence of knee bursitis in the workforce. Occup Med (Lond). Jul 9 2012.
  4. Hirji Z, Hunjun JS, Choudur HN. Imaging of the bursae. J Clin Imaging Sci. 2011; 1:22.
  5. Reilly JP, Nicholas JA. The chronically inflamed bursa. Clin Sports Med. Apr 1987; 6(2):345-70.
  6. Blankstein A, Ganel A, Givon U, Mirovski Y, Chechick A. Ultrasonographic findings in patients with olecranon bursitis. Ultraschall Med. Dec 2006; 27(6):568-71.
  7. Guanche CA. Clinical update: MR imaging of the hip. Sports Med Arthrosc. Mar 2009; 17(1):49-55.
  8. Rowand M, Chambliss ML, Mackler L. Clinical inquiries. How should you treat trochanteric bursitis? J Fam Pract. Sep 2009; 58(9):494-500.
  9. D'Agostino MA, Schmidt WA. Ultrasound-guided injections in rheumatology: actual knowledge on efficacy and procedures. Best Pract Res Clin Rheumatol. Apr 2013; 27(2):283-94.
  10. Slawski DP, Howard RF. Surgical management of refractory trochanteric bursitis. Am J Sports Med. Jan-Feb 1997; 25(1):86-9.

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Last updated: 2019-07-11 22:48