Bursitis

Question 1

What anatomical structures are involved in bursitis, and what is the primary function of bursae in the body?

Answer 1

Bursitis involves the inflammation of bursae, which are small sacs lined with synovium located around joints. Bursae serve to reduce friction between tendons, bones, muscles, and skin.

Question 2

What are some common types of bursitis and their associated anatomical locations?

Answer 2

Common types of bursitis include pre-patellar bursitis, olecranon bursitis, and bursitis over the medial 1st metatarsal head in hallux valgus, also known as bunions.

Question 3

How does bursitis typically develop, and what may lead to its secondary infection and formation of an abscess?

Answer 3

Bursitis often develops due to repeated pressure or trauma, leading to soft tissue swelling. In some cases, it may become secondarily infected, forming an abscess typically due to bacterial infections from small wounds on the limb.

Question 4

What is the usual course of inflammatory bursitis, and what issues might arise with persistent thickening of the bursal sac?

Answer 4

In cases of inflammatory bursitis, the fluid component of the swelling usually subsides, but it may leave a thickened bursal sac. Recurrence might occur, and a thickened bursal sac can lead to persisting problems.

Question 5

In what circumstances might excision be considered for managing bursitis, and what potential complications or challenges can arise from this procedure?

Answer 5

Excision may be considered for managing bursitis if recurrence is an issue, but complications can arise due to scarring and potential challenges with scarring after the procedure.

Question 6

What is the definition of olecranon bursitis, and how is it typically related to the olecranon and the underlying bone?

Answer 6

Olecranon bursitis refers to the inflammation and swelling of the bursa over the elbow, particularly the bony lump known as the olecranon, which is part of the ulna bone.

Question 7

What are bursae, and what role do they play in the body?

Answer 7

Bursae are small sacs lined with synovial membranes and filled with synovial fluid, found at bony prominences in the body. They reduce friction between bones and soft tissues during movement.

Question 8

What are the primary causes of bursitis in the context of the olecranon, and how might these causes lead to the inflammation of the bursa?

Answer 8

The primary causes of olecranon bursitis include repetitive movements, trauma, inflammatory conditions like rheumatoid arthritis or gout, and in some cases, infection leading to septic bursitis.

Question 9

Why might olecranon bursitis be termed “student’s elbow,” and what occupations or behaviors could contribute to its development?

Answer 9

The term “student’s elbow” is used due to students leaning on their elbows for extended periods while studying, leading to mild trauma and friction causing bursitis. Occupations such as plumbing or driving that involve leaning on the elbow can also contribute to its development.

Question 10

What are the common presentations of olecranon bursitis, and how can one differentiate between aseptic bursitis and infected (septic) bursitis?

Answer 10

Olecranon bursitis typically presents as a swollen, warm, tender, and fluctuant (fluid-filled) elbow. Distinguishing features between aseptic bursitis and infected bursitis include signs of infection like warmth, increased tenderness, spreading erythema, fever, and systemic symptoms such as tachycardia, hypotension, and confusion. Septic arthritis may be considered if swelling is primarily within the joint and is associated with painful, reduced elbow motion.

Question 11

What is olecranon bursitis, and what is another term for it?

Answer 11

Olecranon bursitis refers to inflammation and swelling of the bursa over the elbow. Another term for it is “student’s elbow”.

Question 12

What are the common causes of olecranon bursitis?

Answer 12

Common causes of olecranon bursitis include friction from repetitive movements, trauma, inflammatory conditions (like rheumatoid arthritis or gout), and infection.

Question 13

What is the typical presentation of a person with olecranon bursitis?

Answer 13

A typical presentation of a person with olecranon bursitis includes a swollen, warm, tender, and fluid-filled elbow.

Question 14

What are the signs that indicate an infection in olecranon bursitis?

Answer 14

Signs indicating infection in olecranon bursitis include the affected area being hot to touch, more tender, erythema spreading to the surrounding skin, fever, and features of sepsis.

Question 15

What differential diagnosis should be considered for a swollen joint in the elbow?

Answer 15

Septic arthritis should be considered as a differential diagnosis for a swollen joint in the elbow.

Question 16

What does aspiration of fluid from the bursa reveal, and how does it help in diagnosis?

Answer 16

Aspiration of fluid from the bursa provides clues for diagnosis. Pus indicates infection, straw-colored fluid suggests infection is less likely, blood-stained fluid may indicate trauma, and milky fluid indicates gout or pseudogout.

Question 17

What are the management options for olecranon bursitis?

Answer 17

Management options for olecranon bursitis include rest, ice, compression, analgesia, protecting the elbow, fluid aspiration, and sometimes steroid injections.

Question 18

What antibiotics are recommended for treating olecranon bursitis suspected to be infectious?

Answer 18

Flucloxacillin is recommended as the first-line antibiotic for treating infectious olecranon bursitis, with clarithromycin as an alternative.

Question 19

What steps are recommended for managing a patient with olecranon bursitis if they are systemically unwell?

Answer 19

Systemically unwell patients with olecranon bursitis need hospital admission for further management, including blood tests, IV antibiotics, and fluids.

Question 20

What is the significance of fluid appearance during aspiration in olecranon bursitis?

Answer 20

The appearance of fluid during aspiration in olecranon bursitis provides information that helps identify the underlying cause, aiding in appropriate treatment.

Question 21

What causes trochanteric bursitis, and how does repetitive trauma contribute to its development?

Answer 21

Trochanteric bursitis is caused by inflammation of the trochanteric bursa due to repetitive trauma from the iliotibial band tracking over the bursa.

Question 22

Which demographic groups are commonly affected by trochanteric bursitis, and what association might exist with gluteal cuff syndrome?

Answer 22

Trochanteric bursitis commonly affects female patients, including both young runners and older individuals. It may be linked to gluteal cuff syndrome, wherein the broad tendinous insertion of the abductor muscles, mainly the gluteus medius, experiences significant strain, leading to tendonitis and potential tears.

Question 23

What are the typical symptoms and signs associated with trochanteric bursitis?

Answer 23

Typical symptoms of trochanteric bursitis include pain on the lateral aspect of the hip. Clinical signs may involve pain on palpation of the greater trochanter and discomfort during restricted abduction.

Question 24

What role do X-rays and MRI play in the diagnosis of trochanteric bursitis, and which imaging modality is generally preferred for diagnosis?

Answer 24

X-rays for trochanteric bursitis usually show unremarkable findings. While visible on MRI, it’s generally not essential for diagnosis, as the condition is primarily diagnosed clinically.

Question 25

What are the primary management strategies for trochanteric bursitis, and why is surgery not typically recommended?

Answer 25

Management for trochanteric bursitis often involves analgesia with NSAIDs, physiotherapy to strengthen other muscles and avoid abductor weakness, and steroid injections. Surgery is not usually recommended as it has not shown proven benefits for treating this condition.

Question 26

What is trochanteric bursitis, and where is the affected bursa located in the body?

Answer 26

Trochanteric bursitis refers to the inflammation of a bursa situated over the greater trochanter on the outer hip.

Question 27

What characterizes greater trochanteric pain syndrome associated with trochanteric bursitis?

Answer 27

Greater trochanteric pain syndrome is characterized by pain localized at the outer hip, often associated with trochanteric bursitis.

Question 28

Define bursae and their role in the body, particularly at bony prominences.

Answer 28

Bursae are sacs formed by a synovial membrane containing a small amount of synovial fluid. They are located at bony prominences and serve to reduce friction between bones and soft tissues during movement.

Question 29

Explain the term “bursitis” and the changes that occur in a bursa during inflammation.

Answer 29

Bursitis denotes inflammation of a bursa, resulting in thickening of the synovial membrane and increased fluid production, leading to swelling within the bursa.

Question 30

What are the various causes of bursitis, leading to inflammation of the bursa?

Answer 30

The inflammation of a bursa, known as bursitis, can be caused by friction due to repetitive movements, trauma, inflammatory conditions like rheumatoid arthritis, and occasionally due to infection, known as septic bursitis.

Question 31

When bursitis is associated with an infection, what term is used, and what is this specific condition referred to as?

Answer 31

In cases where bursitis is due to an infection, it is termed septic bursitis, representing an inflamed bursa with an underlying infectious cause.

Question 32

What is the typical presentation of a patient with trochanteric bursitis in terms of age, onset, and the nature of pain?

Answer 32

A typical presentation of trochanteric bursitis involves a middle-aged patient with gradual-onset lateral hip pain over the greater trochanter, possibly radiating down the outer thigh. The pain is described as aching or burning, exacerbated by activity and post-sitting standing, and may disrupt sleep.

Question 33

What signs and symptoms are commonly observed during the physical examination of a patient with suspected trochanteric bursitis, and which area demonstrates tenderness in particular?

Answer 33

During the physical examination, tenderness over the greater trochanter is commonly observed. Swelling is usually absent, particularly in contrast to bursitis affecting other areas.

Question 34

Which special tests, as recommended by NICE clinical knowledge summaries, are employed to establish the diagnosis of trochanteric bursitis, and how are these tests performed?

Answer 34

Special tests recommended for diagnosing trochanteric bursitis include the Trendelenburg test and resisted movements like hip abduction, internal rotation, and external rotation. These tests are performed by asking the patient to resist movements of their hip while examining physicians attempt to move the hip.

Question 35

Describe the Trendelenburg test and its significance in diagnosing trochanteric bursitis.

Answer 35

The Trendelenburg test involves asking the patient to stand one-legged on the affected leg. A positive test is when the pelvis on the opposite side drops down, indicating weakness in the affected hip.

Question 36

What management options are typically recommended for trochanteric bursitis based on the diagnosis derived from history and examination findings?

Answer 36

Management options for trochanteric bursitis generally involve rest, ice, analgesia (e.g., ibuprofen or naproxen), physiotherapy, and steroid injections.

Question 37

In cases of trochanteric bursitis caused by an infection, how might the presentation differ, and what treatment approach is warranted?

Answer 37

Infection-induced trochanteric bursitis may present with warmth, erythema, swelling, and fever over the bursa. Treatment typically involves antibiotics.

Question 38

What is the typical duration of recovery for patients with trochanteric bursitis, and why might it take longer in certain instances?

Answer 38

Recovery from trochanteric bursitis may take around 6-9 months, and sometimes even longer, depending on the severity and response to treatment.