Bursitis

Question 1

Define bursitis.

Answer 1

Bursitis is an acute or chronic inflammatory condition of a bursa. A bursa is a jelly-like sac that usually contains a small amount of synovial fluid. A bursa lies between a tendon and either bone or skin to act as a friction buffer and facilitate movement of adjacent structures.

Question 2

Where does bursitis most commonly present?

Answer 2

In primary care, bursitis most commonly presents in the knee, subacromial (subdeltoid), trochanteric, retrocalcaneal, and olecranon bursae.

Question 3

Who is most affected by bursitis?

Answer 3

Males (80%) with mean age 52

Question 4

What are the causes of bursitis?

Answer 4

• Repetitive injury or acute trauma
• Crystal deposition
• Autoimmune disease
• Infection
• OA of hip - no association with knee OA and bursitis

Question 5

Where are these types of bursitis?

• Student’s elbow
• Housemaid’s knee
• Clergyman’s knee

Answer 5

• Student’s elbow - Olecranon bursitis
• Housemaid’s knee - Prepatellar bursitis
• Clergyman’s knee - Infrapatellar bursitis

Question 6

What investigations should be done to diagnose bursitis?

Answer 6

Usually clinical diagnosis is sufficient

On examination:

• Pain on movement
• Swelling and erythema - if superficial
• Limited active but not passive movement
• Subacromial bursitis –> painful arc
• Tenderness

Exclude septic arthritis:

• Joint fluid gram strain and culture +/- crystal analysis

Question 7

What are the signs and symptoms of bursitis?

Answer 7

• pain at site of bursa
• tenderness to palpation at site of bursa
• decreased active range of motionpresence of risk factors
• low-grade temperature (septic bursitis)
• swelling
• erythema (septic bursitis)
• warmth of overlying skin (septic bursitis)
• painful arc on shoulder abduction (subacromial)
• lateral hip pain (trochanteric)

Question 8

What is the management of bursitis?

Answer 8

1st line: conservative

• Modify activity and lifestyle to minimise mechanical stress on the inflamed bursa.
• Ice to reduce swelling in first 24hrs.
• Analgesia - paracetamol and topical diclofenac are preferred first line
• Walking aids
• Gentle mobilisation

2nd line: Corticosteroid injection

3rd line: Surgery to remove the affected bursa

If the bursa is infected then abx (dicloxacillin) for 1-4 weeks and aspiration/debridement may be done.

Question 9

What are the complications of bursitis and its management?

Answer 9

• Septic arthritis
• Tendon rupture secondary to corticosteroid injection
• Infection secondary to aspiration or corticosteroid injection

Question 10

What is the prognosis in bursitis?

Answer 10

Most will recover completely after modifying activity