Bursitis

Question 1

Defintion

Answer 1

Bursa are sacs overlying the elbow and knee that aim to reduce friction in the joints. Bursitis occurs when bursa are irritated which causes thickening of its walls.

Can be septic and non septic

Question 2

Presentation - 5

Answer 2

Swelling (if septic then red and warm). Swelling gets worse when joint is used

No ROM restriction

Transilluminates

Lump is moveable and compressible

Movement is painless except at full flexion

Question 3

Causes - 5

Answer 3

NON SEPTIC
- trauma
- overuse
- gout, RA, SLE

SEPTIC
- Staph. Aureus (90% of cases)
- pseudomonas, E.coli. H.influenzae

Question 4

Types - 2

Answer 4

Olecranon Bursitis (students elbow)

Pre-patellar bursitis

Question 4

Investigations - 2

Answer 4

SUSPECTED SEPTIC
- aspirate the bursae if it contains pus then its septic, it its clear or straw coloured then non-septic
-send fluid for gram stain and culture

SUSPECTED NON-SEPTIC
- from history and examination

Question 5

Management - 3

Answer 5

• Rest, ice, compressive bandage
• paracetamol or NSAID

SEPTIC
- whilst waiting for labs, treat with Flucloxacillin or Clarithromycin if allergy

Question 6

Complications of Septic Bursitis - 4

Answer 6

Fistulae
Septic arthritis
Sepsis/Bacteraemia
Necrotizing fasciitis

Question 7

Differentials - 7

Answer 7

RA
Septic arthritis
Gout
Cellulitis
Tennis elbow (lateral epicondylitis)
Trauma
Soft tissue tumour

Question 8

x-ray signs of RA

Answer 8

Loss of joint space
Erosion
See through bone (osteopneia)
Soft tissue swelling and subluxation