Bursitis

Question 1

Definition

Answer 1

Inflammation of the synovium-lined sac-like structures (bursa) found throughout the body, usually between bones, muscles, tendons, or ligaments.

Question 2

Epidemiology and risk factors

Answer 2

Repeated mechanical stress on a bursa:
- ‘clergymans’ (infrapatella bursitis)
- knee from praying ‘housemaids knee’ (prepatella bursitis)
Autoimmune conditions:
- rheumatoid arthritis,
- psoriatic arthritis
Gout or pseudogout
Hip osteoarthritis: trochanteric bursitis
Penetrative injury: introducing infection
Abnormal gait: mechanics may induce trochanteric bursitis
Low-riding shoes: excessive heel pressure can cause retrocalcaneal bursitis

Question 3

Signs

Answer 3

Tenderness on palpation
Altered gait: lower limb bursitis
Erythema: if septic bursitis

Question 4

Symptoms

Answer 4

Pain: at a particular bursa site
Reduced range of movement
Swelling

Question 5

Diagnosis

Answer 5

Clinical diagnosis
Investigations to consider: if septic bursitis or diagnosis uncertain
- FBC
- CRP
- Fluid aspiration culture: WCC count lower than septic arthritis < 20,000 mm3
- Fluid aspiration for crystal
Plain x-ray = usually normal may show underlying osteoarthritis
MRI = soft tissue swelling and fluid filled bursa

Question 6

Treatment

Answer 6

Non-septic bursitis
FIRST LINE:
- Conservative management: rest, ice, compression
- Simple analgesia: paracetamol, ibuprofen
SECOND LINE:
- Corticosteroids injection
THIRD LINE:
- Surgery: burstectomy
Septic bursitis
FIRST LINE:
- Aspiration of the bursa: culture, gram stain, sensitivities
- IV Abx
- Simple analgesia
SECOND LINE:
- As above + surgical debridement and lavage

Question 7

Complications

Answer 7

Septic arthritis: small risk of injection spreading from bursa to local joint
Infection secondary to aspiration or steroid injection
Chronic pain