Bursae are sac-like structures which either lie superficially between the skin and bone or are located deeply between the tendons, ligaments, and bone. Inflammation of bursae could be septic (with the formation of pus) or non-septic. Septic bursitis (SB) is commonly encountered in the superficial bursae e.g. olecranon and prepatellar bursae. In a majority of the cases, SB follows direct inoculation of traumatic superficial cutaneous wounds or contiguous spread of infection from local cellulitis [1] [2]. Rarely, deep bursae e.g. subacromial and iliopsoas bursae may get infected secondary to hematogenous spread of micro-organisms e.g. in septic arthritis, bacteremia, bacterial endocarditis. Micro-organisms implicated in SB are Staphylococcus aureus in a majority of the cases followed by streptococci, mycobacteria (both tuberculous and nontuberculous strains), fungi (Candida), and algae (Prototheca wickerhamii) [3]. The incidence of SB is reported to be higher in men [4]. Risk factors for SB include loss of skin integrity, impaired response to infection (eg, diabetes mellitus, alcohol abuse), and autoimmune conditions that lead to an increased amount of bursal fluid or tissue (such as rheumatoid arthritis or tophaceous gout) [1] [5] [6].

Clinical presentation may help to differentiate between septic from nonseptic bursitis. SB is almost always associated with symptoms of pain, swelling, and fever [5] while non-septic bursitis is associated with only swelling [6]. Erythema is present in both SB and non-SB [5]. Other symptoms include local tenderness and a history of repeated trauma or movement. Concomitant symptoms of systemic comorbid conditions like syphilis or pulmonary tuberculosis, bacterial endocarditis may also be present.

• Fever

  Fever (body temperature of > or =37.8 degrees C) occurred in 20%. Staphylococcus aureus was identified in 88% of culture-proven cases of OBS. [ncbi.nlm.nih.gov]

  SB is almost always associated with symptoms of pain, swelling, and fever while non-septic bursitis is associated with only swelling. Erythema is present in both SB and non-SB. [symptoma.com]

• Chills

  The most common symptoms were pain (87%), redness (77%) and fever or chills (45%). Common signs included erythema (92%), swelling (85%), edema (75%), tenderness (59%), fluctuance (50%), heat (36%) and reduced range of motion (27%). [ncbi.nlm.nih.gov]

  Low grade fever and chills may also be present. The prepatellar bursa lies in front of the knee between the patella (kneecap) and the skin. [articlesurfing.com]

  However, a few symptoms are specific to septic bursitis: Extreme warmth or redness to the area above the joint Extreme tenderness to the area above the joint Fever or chills General feelings of sickness It can be difficult to tell the difference between [arthritis-health.com]

  Anyone with a fever, chills, low blood pressure, altered mental status, or other symptoms to suggest a systemic disorder should be treated surgically right away. [eorthopod.com]

• Weakness

  The rating scale is: AAA (Extremely Strong), AA (Very Strong), A (Strong), BBB (Good), BB (Marginal), B (Weak), CCC (Very Weak), CC (Extremely Weak), SD or D (Selective Default or Default), R (Regulatory Action), NR (Not Rated). [southerncross.co.nz]

  A person with a very weak immune system is more likely to suffer the condition. This is because the body is unable to fight opportunistic infections caused by bacteria. [findatopdoc.com]

  Pain along the front and side of the shoulder is the most common symptom and may cause weakness and stiffness. [3] If the pain resolves and weakness persists other causes should be evaluated such as a tear of the rotator cuff or a neurological problem [en.wikipedia.org]

  Relevant Paper(s) Author, date and country Patient group Study type (level of evidence) Outcomes Key results Study Weaknesses Ho G Jr & Tice AD, 1979, USA 30 consecutive patients with olecranon (25) or pre patellar (5) bursitis 20 non-septic and 10 septic [bestbets.org]

  […] damage around your knee joint can be a catalyst for infection penetration; an open wound or severe injury of your knee; any form of sepsis can cause formation of numerous cysts; too much body weight provides a significant load on your knee joint, causing weakness [yourhealthyjoints.com]

• Severe Pain

  Intensity of Pain - Severity of pain increased with joint movements. Tenderness Associated With Ankle Joint Bursitis Severe pain is felt following palpation of bursa or area around the anatomical location of bursa. [epainassist.com]

  Severe pain and erythema may indicate septic bursitis or gout. Olecranon Bursitis Xray / Diagnositc Tests A/P, lateral elbow films. Generally demonstrate soft tissue swelling. [eorif.com]

  When inflammation causes severe pain, your doctor will prescribe anti-inflammatory orally or as a cream. If there is a suspicion of infection, a specialist will prescribe antibiotics. [yourhealthyjoints.com]

• Intravenous Drugs

  In addition to prior history of trauma to superficial bursae, other predisposing factors may include prior rheumatoid arthritis or gouty involvement of the bursae, alcoholism, diabetes mellitus, renal insufficiency, intravenous drug use, and other forms [arthritisresearch.us]

  At admission she denied any dyspnea, chest pain, rash, dysuria, diarrhea, or intravenous drug abuse. [jrheum.org]

  While local factors predominate, systemic illnesses such as diabetes mellitus, alcoholism, and intravenous drug abuse may also predispose to infection by lowering host resistance to bacterial disease. [healio.com]

• Aspiration

  Using percutaneous needle aspirations, serial bursal fluids were cultured. [ncbi.nlm.nih.gov]

  Ultrasonography is useful when the diagnosis is uncertain and to perform ultrasound guided aspiration of the bursa. [symptoma.com]

  If the fluid in the elbow is aspirated (drawn out), then it can be tested to find out the specific bacteria present. An antibiotic that will target the identified bacteria can be prescribed. [eorthopod.com]

• Fracture

  Patient Population: Prevalence and Epidemiology Knee // Shoulder & Elbow // Hip // Spine // Foot & Ankle // Hand & Wrist Fragility Fractures: Diagnosis and Treatment Shoulder & Elbow The Characteristics of Surgeons Performing Total Shoulder Arthroplasty [amjorthopedics.com]

  ボクサー骨折〈中手骨頚部骨折〉 brace装具（＝orthosis） brachial plexus腕神経叢（わんしんけいそう） brachial plexus injury腕神経叢損傷 Brown-Séquard syndrome脊髄半（片）側麻痺、Brown-Séquard症候群 burn熱傷、やけど、火傷 bursa 滑液包（かつえきほう） bursitis滑液包炎 burst[ing] fracture破裂骨折 buttonhole deformityボタン穴変形 c café-au-lait [tokyo-med.ac.jp]

  The diagnosis must differentiate bursitis from arthritis, tendinitis, fracture, tendon or ligament injury, infection, and neoplasm. Bursitis may be septic or nonseptic, and distinguishing between the two forms can be challenging. [aaos.org]

  MRI is also used to rule out fracture, dislocation or arthritis of ankle joint. 2 Fluid Culture Fluid from bursa is collected using CAT scan, X-ray, or Ultrasound. Fluid is studied for infection and inflammation. [epainassist.com]

  /*fracture 【骨粗鬆症】【骨多孔症】*osteoporosis 【骨端炎】*epiphysitis 【骨端骨折】*epiphyseal fracture 【骨端症】*apophysitis 【骨痛】*bone pain *ostalgia *osteodynia 【骨頭下骨折】*subcapital fracture 【骨内膜腫】*endosteoma 【骨軟化症】*osteomalacia 【骨軟骨腫】*osteochondroma 【骨肉腫】*osteosarcoma *osteogenic [medo.jp]

• Osteoporosis

  Submitted by: Nathan Wei Nathan Wei, MD FACP FACR is a rheumatologist and Director of the Arthritis and Osteoporosis Center of Maryland. He is a Clinical Assistant Professor of Medicine at the University of Maryland School of Medicine. [articlesurfing.com]

  […] orthop[a]edics 整形外科［学］ orthosis 装具 ossification of ligamentum flavum (OLF)黄［色］靭帯骨化［症］ ossification of posterior longitudinal ligament (OPLL) 後縦靭帯骨化［症］ osteoarthritis (OA) 骨関節症、変形性関節症 osteogenesis imperfecta (OI)骨形成不全症 osteoid osteoma類骨骨腫 osteon骨単位、オステオン osteoporosis [tokyo-med.ac.jp]

  […] infarction 【骨腫】*osteoma 【骨症】【骨障害】*osteopathy (＝オステオパシー) 【骨髄炎】*osteomyelitis 【骨髄脂肪腫】*myelolipoma 【骨髄腫】*myeloma 【骨髄性白血病】*myelogenous leukemia 【骨髄線維症】*myelofibrosis 【骨髄癆】*myelophthisis 【骨性斜頚】*osseous torticollis 【骨折】*bone fracture/*fracture 【骨粗鬆症】【骨多孔症】*osteoporosis [medo.jp]

• Skin Lesion

  No redness, hotness, or skin lesion of the right arm was observed. Yet, there was tenderness over deltoid muscle and stiffness in the range of motion (ROM) of the right shoulder. [ijcasereportsandimages.com]

• Acne Vulgaris

  [L] 【尋常性ざ瘡】*acne vulgaris[L] 【尋常性膿瘡】*vulgar echyma 【尋常性魚鱗癬】*ichthyosis vulgaris[L] (略 IV) 【尋常性天疱瘡】*pemphigus vulgaris[L] 【尋常性白斑】*vilitigo vulgaris[L] 【尋常性疣贅】*verruca vulgaris[L] 【尋常性痒疹】*prurigo vulgaris[L] 【尋常性狼瘡】*lupus vulgaris[L] (靭) 【靭帯炎】*syndesmitis [medo.jp]

• Skin Ulcer

  otitis, peritonitis, pneumonia, pyelonephritis, sepsis, septic arthritis, sinusitis, skin infection, skin ulcer, urinary tract infection, vasculitis, and wound infection. [mymemory.translated.net]

• Skin Rash

  […] eruption *skin rash 【皮膚炎】*dermatitis 【皮膚関節炎】*dermatoarthritis 【皮膚乾燥症】*dry skin *xeroderma/*xerodermia *xerosis cutis[L] (＝乾皮症、乾燥皮膚) 【皮膚癌】*skin cancer 【皮膚筋炎】*dermatomyositis 【皮膚硬化症】*scleroderma (＝強皮症) 【皮膚疾患】【皮膚病】*dermopathy *skin disease 【皮膚症】*dermatosis [medo.jp]

• Withdrawn

  In some cases, fluid may be withdrawn (aspirated) from the bursa and examined in a laboratory for signs of infection. Bursitis Treatment Treatment for bursitis depends on the underlying cause. [healthcommunities.com]

  In some cases, fluid may be withdrawn (aspirated) from the bursa and examined in a laboratory for signs of infection. Treatment Apply ice packs for the first 48 hours to relieve pain and swelling. [healthcentral.com]

Although the diagnosis of SB is not based on the clinical presentation, it may be suspected in presence of fever, and bursal inflammation as these symptoms are less severe in non-SB. Also, joint mobility is usually preserved in SB while it is limited in other types of bursitis. A detailed history to exclude trauma, occupation injury, comorbid medical conditions (rheumatoid arthritis, gout, diabetes mellitus, syphilis, HIV) should be obtained. A thorough physical examination needs to be performed to look for signs of inflammation locally as well as to exclude bacteremia. Routine laboratory blood work may reveal leukocytosis, elevated inflammatory markers (erythrocyte sedimentation rate, C-reactive protein) while blood culture is indicated if SB in the deep bursae is suspected. Rheumatoid factor (RF), and anti–citric citrullinated peptide (anti-CCP) tests should also be ordered to exclude autoimmune diseases. Aspiration and analysis of the bursal fluid form the mainstay of diagnosing SB as it is likely to show cell counts exceeding 70,000/µL, with a predominance of polymorphonuclear leukocytes (PMNs). Microbiological analysis of the aspirated fluid demonstrates Staphylococcus aureus and other gram-positive organisms in a majority of the cases [2].

Plain radiography will only reveal joint effusion or soft tissue swelling but does not help to detect SB. Although computed tomography (CT) is not required magnetic resonance imaging (MRI) can help to identify local joint anatomy, soft tissue abscesses as well as the bursal fluid [7]. Ultrasonography is useful when the diagnosis is uncertain and to perform ultrasound guided aspiration of the bursa. Ultrasonography can also differentiate between solid and cystic masses and detect popliteal bursitis in presence of extensive joint deformities [8] [9].

• Staphylococcus Aureus

  Staphylococcus aureus is responsible for around 80% of cases. However, information regarding bursitis caused by non-Staphylococcus aureus microorganisms (NSAB) is scant. [ncbi.nlm.nih.gov]

  Microbiological analysis of the aspirated fluid demonstrates Staphylococcus aureus and other gram-positive organisms in a majority of the cases. [symptoma.com]

In septic bursitis, the effects of delay in treatment are deleterious by prolonging culture-positivity despite adequate antibiotic therapy. [ncbi.nlm.nih.gov]

In this article, surgeons from The Philadelphia Hand Center explore the best treatment for septic olecranon bursitis. Since studies of this problem are limited, evidence-based treatment has not been established. [eorthopod.com]

Most of their cases underwent this method of treatment as a salvage procedure due to previous treatment failures. In spite of this, 82% of them had "fair" to "good" short term results. [healio.com]

Keywords : Septic bursitis, Cloxacillin, Rifampicin, Gentamicin, Prognosis [em-consulte.com]

Prognosis: Most patients recover completely without sequelae. BIBLIOGRAPHY Ho G, Su EY. Antibiotic therapy of septic bursitis: its implication in the treatment of septic arthritis. [rheumaknowledgy.com]

When septic bursitis is diagnosed early and treated accordingly, the prognosis is excellent. [cid.oxfordjournals.org]

Prognosis Prepatellar bursitis can lead to pain and reduced function of the knee joint. This may be worse if septic bursitis is not recognised promptly. Generally the prognosis is very good with appropriate treatment. [patient.info]

Staphylococcus aureus was isolated from 70% of bursal fluid aspirations; other etiologic organisms included gram negative bacteria and Mycobacterium marinum. The majority of patients were able to be treated as outpatients with oral antibiotics. [ncbi.nlm.nih.gov]

Can result from a direct blow, repetitive microtrauma, or infection Etiology: overuse, inflammation, infection, trauma. [eorif.com]

Patient characteristics and epidemiologic exposures may provide clues to unusual causative organisms that are occasionally encountered, such as Neisseria gonorrhoeae, Pasteurella multocida, atypical mycobacteria, fungi, and protothecosis. [ncbi.nlm.nih.gov]

Patient Population: Prevalence and Epidemiology Knee // Shoulder & Elbow // Hip // Spine // Foot & Ankle // Hand & Wrist Fragility Fractures: Diagnosis and Treatment Shoulder & Elbow The Characteristics of Surgeons Performing Total Shoulder Arthroplasty [amjorthopedics.com]

Introduction Swelling and inflammation of the anterior knee Epidemiology incidence most common bursitis of the knee location bursa anterior to patella risk factors excessive kneeling common in wrestlers concern for septic bursitis in wrestlers Pathophysiology [orthobullets.com]

Introduction Swelling and inflammation of the anterior knee Epidemiology incidence most common bursitis of the knee location bursa anterior to patella risk factors excessive kneeling common in wrestlers concern for septic bursitis in wrestlers Pathophysiology [orthobullets.com]

Overview of Common Superficial Bursitis Major risk factors Location Prevalence Occupation, type of athlete, and other contributors Body positions Most common pathophysiologic mechanism Other pathophysiologic mechanisms Olecranon Common Miners, students [aafp.org]

Pathophysiology [ edit ] The literature on the pathophysiology of bursitis describes inflammation as the primary cause of symptoms. Inflammatory bursitis is usually the result of repetitive injury to the bursa. [en.wikipedia.org]

Pathophysiology Inflammation of the bursa causes synovial cells to multiply and thereby increases collagen formation and fluid production. A more permeable capillary membrane allows entrance of high protein fluid. [emedicine.medscape.com]

Early recognition, prompt therapy, and preventive measures are necessary to reduce the morbidity of septic bursitis. [ncbi.nlm.nih.gov]

Bursitis Prevention To prevent bursitis, it is important to stretch and warm up properly before exercising, and to cool down afterward. [healthcommunities.com]

Prevention To prevent a fall on the tip of the elbow, athletes need to be taught how to fall to safely protect their wrists, forearms, and elbows from injury. [sportsmd.com]

Surgery is advised to prevent further spread of inflammation and infection to surrounding tissue. [epainassist.com]

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2. Zimmermann B 3rd, Mikolich DJ, Ho G Jr. Septic bursitis.Semin Arthritis Rheum. 1995;24(6):391.
3. Torralba KD, Quismorio FP Jr. Soft tissue infections. Rheum Dis Clin North Am. 2009 Feb; 35(1):45-62.
4. Laupland KB, Davies HD, Calgary Home Parenteral Therapy Program Study Group. Olecranon septic bursitis managed in an ambulatory setting. The Calgary Home Parenteral Therapy Program Study Group. Clin Invest Med. 2001;24(4):171.
5. Ho G Jr, Tice AD, Kaplan SR. Septic bursitis in the prepatellar and olecranon bursae: an analysis of 25 cases. Ann Intern Med. 1978;89(1):21.
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9. Tsai YH, Huang TJ, Hsu WH, et al. Detection of subacromial bursa thickening by sonography in shoulder impingement syndrome. Chang Gung Med J. 2007 Mar-Apr; 30(2):135-41.