Bursitis Flashcards
What is bursitis?
Inflammation of the bursa
What is a bursa?
Sac-like structure lined by synovial membrane, that contains and secretes synovial fluid and is located between tendons/muscles and bony prominences
Why are bursae located between tendons/muscles and bony prominences?
The secretion of synovial fluid from bursae reduces friction between tendons/muscles and bone
What is the ratio of men to women affected by bursitis overall?
1:1
How does location of bursae relative to the skin affect their susceptibility to traumatic bursitis, and give 3 examples of bursae which are affected?
Bursae that are closer to skin have thinner layer of protective subcutaneous fat covering them, so they are more likely to sustain direct impact
Commonly occurs in olecranon, prepatellar, trochanteric bursae
What type of bursitis is an individual who constantly rests elbows on a surface, eg. due to manual labour or driving for a long time, commonly affected by
Olecranon bursitis
In which kind of individual is prepatellar bursitis most common?
Individual who is constantly kneeling eg. for manual labour work, gardners, builders
What 2 arm movements commonly cause bursitis in the shoulder bursae, and give 2 examples of individuals in which this commonly occurs?
Arm flexion and abduction
Commonly occurs in manual labourers, basketball athletes
How does septic bursitis occur?
Direct inoculation by microorganism after trauma/puncture of site of bursa
Give 5 examples of individuals that are at increased risk of septic bursitis?
Immunocompromised individuals
Diabetic individuals
Individuals with HIV
Alcoholic individuals
Individuals with certain rheumatological conditions
What 2 bursae are most commonly affected by septic bursitis, and what is the most common microorganism that causes it?
Olecranon and prepatellar bursae
Staphylococcus aureus
Does bursitis occur in all ages?
Yes
Why is bursitis more common in elderly people?
Increased risk of bursitis due to higher prevalence of chronic diseases such as OA in the elderly population
What 2 factors in a patient’s history causes presentation of traumatic bursitis?
History of injury or overuse of joint
Give 4 clinical features of a region affected by bursitis?
Swelling
Erythema (skin redness due to injury or inflammation)
Affected region warm when palpated
Painful range of movement
Are the symptoms of aseptic bursitis similar to symptoms of septic bursitis?
They have similar presentations but septic bursitis can present with other systemic features eg. fever
What is trochanteric bursitis?
Inflammation of bursa on greater trochanter
What is prepatellar bursitis?
Inflammation of bursa in front of patella
What is pes anserine bursitis?
Inflammation of bursa between tibia and insertion of tendon of 3 hamstring muscles
What is retrocalcaneal bursitis?
Inflammation of bursa in front of achilles tendon insertion and above calcaneus
Is radiological investigation necessary to diagnose bursitis?
No, but it can be useful to identify bony abnormalities that are predisposing factors to traumatic bursitis, such as osteophytes and fractures which can pierce bursa
Why is ultrasound and MRI imaging used for bursitis investigation?
Used for further evaluation, to see soft tissue swelling and excess synovial fluid, which can indicate bursitis
If septic bursitis is suspected, what 2 lab investigations are completed?
Synovial fluid of inflamed bursa is aspirated and sent in culture to test for infection
Full blood count to check WBC count and inflammatory markers
If a patient is suspected of having septic bursitis, what treatment is immediately administered?
Patient is started on antibiotics
How is swelling reduced in aseptic acute bursitis management?
Rest, Ice, Compress, Elevate (use padded splint to support area) affected region
How is pain and inflammation reduced in aseptic acute bursitis management?
NSAIDs
Why is physiotherapy useful for management of bursitis?
Promotes recovery and improves range of movement of affected region
How can bursitis be treated if there is no response to conservative treatments like RICE?
Ultrasound-guided aspiration and steroid injection into bursa
Is Ultrasound-guided aspiration and steroid injection into bursa suitable for all bursae?
Not suitable for olecranon and prepatellar bursitis
Why is Ultrasound-guided aspiration and steroid injection into bursa not suitable for olecranon and prepatellar bursitis?
once drained, the bursa is likely to fill with fluid again quickly, and there is a risk for an iatrogenic infection (infection that occurs after medical/surgical management)
What is the prognosis of bursitis?
Usually heals within few weeks but putting pressure or stress on your bursa before it’s completely healed increases your risk of reinjuring it
