Bursitis profoma Flashcards
What is a bursa?
- Small sacs of fibrous tissue that are lined w/ synovial membrane & secrete synovial fluid.
- Reduces friction where ligaments & tendons pass over bone or skin
NOTE: view image
What is bursitis?
- Inflammation of a bursa.
- Thickening & proliferation of synovial lining
- Forming a fluid filled sac
- Can be idiopathic, part of a systemic inflammatory disease or due to injury, infection or gout
Epidemiology of bursitis
- Olecranon bursitis, prepatellar bursitis & trochanteric bursitis are most common
- Female = Male
- Trochanteric bursitis more common in middle-aged or elderly women.
- Those who had received a corticosteroid injection x2.7 times more likely to have recovered.
Presentation of bursitis
- Superficial bursa: swelling & erythema may be evident.
- Localised pain, particularly on movement.
- Dull achy pain
- More tender w/ pressure
- Passive motion → preserved
- Active motion → limited
- Secondary bursitis (crystal deposition): erythematous, painful, & warm to touch
Presentation of bursitis: olecranon bursitis
- Due to trauma to elbow or excessive friction.
- Superficial
- Swelling
- Painful when pressure applied.
- Movement of elbow is usually comfortable & not impaired
- Infection can occur in addition to O bursitis = pain on elbow flexion.
NOTE: view notes for images
Presentation of bursitis: prepatellar bursitis & infra patellar bursitis
- Hot, red swelling in front of patella or patella tendon.
- Active knee extension painful
- Common in people who kneel a lot e.g. carpet fitters
- Infection & gout need to be exluded by aspirating fluid.
- Treatment = rest.
- Recurrent episodes may need surgical excision.
NOTE: view notes for image
Presentation of bursitis: trochanteric bursitis
- Pain over affected trochanter.
- Pain exacerbated by movement e.g. pain at the extremes of rotation, abduction, or adduction.
- “Hip pain” but on questioning & examination will identify pain localized to trochanter rather than groin or buttock pain.
- Hurts to lie in bed at night.
- Pain can radiate down leg.
- Treatment = physio or steriods in more severe cases. Surgery may be needed.
NOTE: view images on notes
Presentation of bursitis: Pes Anserine bursitis- what is it?
Medial to the prepatellar bursa
NOTE: view diagram of tendons- v important!
Presentation of bursitis: septic bursitis
- Most common in prepatellar & olecranon bursae - superficial position.
- Low-grade temperature, local erythema, swelling, warmth & local cellulitis
- Requires antibiotics.
NOTE: view images on notes
Presentation of bursitis: subacromial bursitis
- Painful arc on abduction of arm
- Can occur in rotator cuff injuries
NOTE: view diagram on notes
Presentation of bursitis: Retrocalcaneal bursitis
Sits underneath the Achilles tendon, does not have a tendon sheath.
DO NOT inject steroids for this bursitis:
- Steroids can rupture the tendon
- Achilles tendon is a strong, weight bearing tendon.
- Steroids can soften the tissue & increase the rate of degeneration.
- Tendon commonly ruptures due to degeneration.
NOTE: view diagram on notes
Investigations for bursitis
- Should not be routinely aspirated as the patient can develop a chronic sinus.
- Aspirate synovial fluid only for potential septic bursitis or for differentiation from Gout if in doubt.
- Aspiration for prepatella or olecranon bursitis can be helpful.
- FBC - raised white cell count or grossly purulent fluid in septic bursitis.
- Crystal analysis
Management for non-specific bursitis
- Modify activity & lifestyle i.e. reduce weight, don’t kneel down…
- Rest affected area to allow inflammation to settle
- Physiotherapy may be beneficial
- Paracetamol or NSAIDs
- Corticosteroids - 2nd line treatment. Done by aseptic technique to prevent secondary infection. Not recommended in septic bursitis
- Surgery -Bursectomy - removal of the bursa. Last resort
Management for septic bursitis
- Needle aspiration
- Antibiotics
- Initial therapy should cover staphylococcus & streptococcus
- Conservative management & analgesia
- 2nd line - surgical debridement
Prognosis for bursitis
- Most patients respond well to conservative management & recover completely.
- May take a few weeks to heal.
- Those that play sport will benefit from modifying their activity & using protection e.g. padding.
