Bursitis Flashcards
What is bursitis?
Inflammation of a bursa, typically caused by trauma, overuse, or an underlying inflammatory condition.
What are the two main types of bursitis?
Nonseptic bursitis (sterile inflammation) and septic bursitis (infection of the bursa).
What are common locations for bursitis?
Olecranon, prepatellar, subacromial, pes anserine, and trochanteric bursae.
What are typical symptoms of nonseptic bursitis?
Localized swelling, mild pain, and preserved range of motion.
What are red flag symptoms suggestive of septic bursitis?
Fever, erythema, warmth, severe tenderness, and purulent aspirate.
What is the most common pathogen in septic bursitis?
Staphylococcus aureus.
What imaging modality can be used to evaluate suspected bursitis?
Ultrasound (for fluid accumulation) or MRI (for deeper evaluation).
When is bursal aspiration indicated?
If infection or crystal deposition disease (gout) is suspected.
What findings on bursal fluid analysis suggest septic bursitis?
WBC > 1000–5000 cells/μL, positive Gram stain or culture.
What findings on bursal fluid analysis suggest gout-related bursitis?
Monosodium urate crystals, negative Gram stain.
What is the first-line treatment for nonseptic bursitis?
Rest, ice, NSAIDs, and compression.
When are corticosteroid injections considered for bursitis?
For chronic or refractory nonseptic bursitis, avoiding injection into superficial bursae.
What is the treatment for septic bursitis?
Empiric antibiotics (e.g., cephalexin or TMP-SMX for MRSA risk) and drainage.
What is the role of surgery in bursitis management?
Bursectomy is reserved for recurrent, severe, or refractory cases.
What is a ganglion cyst?
A benign mucin-filled cyst that develops along tendons or joints and lacks a true epithelial lining.
Where are ganglion cysts most commonly located?
Dorsal wrist (most common), followed by volar wrist, fingers, and foot.
What is the pathophysiology of ganglion cysts?
Herniation of connective tissue due to repetitive trauma or mucoid degeneration of periarticular structures.
What is the most common type of hand mass?
Ganglion cyst.
What are common symptoms of ganglion cysts?
Usually asymptomatic, but can cause pain, tenderness, or nerve compression (numbness, tingling, weakness).
How can a ganglion cyst be differentiated from other soft tissue masses?
It is fluctuant, transilluminates, and may change in size over time.
What special physical exam maneuver helps confirm a ganglion cyst?
Transillumination: light passes through the cyst, distinguishing it from solid masses.
What are differential diagnoses for a ganglion cyst?
Epidermoid cyst, lipoma, rheumatoid nodule, infectious tenosynovitis, soft tissue tophus.
What imaging modality is used for uncertain cases of ganglion cysts?
Ultrasound (to confirm cystic nature) or MRI (if deeper structures are involved).
What is the first-line management for an asymptomatic ganglion cyst?
Observation, as many resolve spontaneously.
What are treatment options for symptomatic ganglion cysts?
Aspiration or surgical excision if the cyst is painful or recurrent.
Why is surgical excision preferred over aspiration for recurrent ganglion cysts?
Lower recurrence rate, as the cyst wall and stalk are removed.
What complication may arise from volar wrist ganglion cysts?
Compression of the median or ulnar nerve leading to sensory deficits or weakness.
Which nerves can be affected by ganglion cysts in the wrist?
Median nerve (carpal tunnel syndrome) and ulnar nerve (Guyon tunnel syndrome).
What is the recurrence rate after aspiration of a ganglion cyst?
Up to 50%.
When is surgical removal indicated for a ganglion cyst?
Persistent pain, nerve compression, or recurrent cysts after aspiration.
