bursitis (subacrimial/imping, olecranon, greater trochanteric, pre/infra patellar

Question 1

What is subacromial /impingement syndrome

Answer 1

Pain in the bursa bewteen the acromion and the humerus - gets inflammed after repetitive strain
type of rotator cuff injury –in coracoacromial ligament

commonest cause of shoulder pain
>40y
30% assox with rotator cuff tears

characterized by pain on mouvement in “tip” of shoulder, no red flags

examin - can be tender to touch on anterior acromion
main one is PAINFUL arc– 60 to 120 degrees on abduction

Question 2

Management on subacromial /impingement syndrome

Answer 2

Mainone is conservative management with analgesia and physiotherapy/rest -70% sucess
usually its — steroid injection+nsaids and then use the time to strengthen rotator muscles with physio -

can also do arthroscopic subacromial decompression– 90% sucess after 9m

Question 3

What is olecranon bursitis

Answer 3

Inlfammation of elbow bursa at (the bony tip of elbow- in ulna)
usually a common result of repetitive strain- pressing elbow on hard surfaces (working at a desk)
but can be from infection or tauma

pain can develop over months or quickly -asymetrical, with no other red flags
swelling, tenderness and warm to touch, fluctuant
elbow movement fine except when fully flexed

REDFLAG- cellulitis, abrasion, fevers, Immunocompomined –sceptic bursitis

Question 4

Management of olecranon bursitis

Answer 4

Conserative is usually way forward - RICE
compression, NSAIDS

if sure non septic - reassure
can consider aspiration if large swelling
steroids if not working after a few weeks

if sceptic - refer and abx- fluclox

Question 5

WHat is greater trochanteric bursitis

Answer 5

Pain in hip - bursa over the greater trochanter
gradual onset, no trauma, can radiate down leg but not below knee
worse with activity AND lying down on that side (like when sleep)
Pain on palpation of trochanter

exam- antalgic gait
pain of palpation
can be pain on resisted abduction

Question 6

Management of trochanteric bursisits

Answer 6

REASSURE
Conversative - RICE
analgesia - NSAIDS 1st lline
weight loss etc

can consider walking aid, physio

if all fails consider steroid injections

Question 7

What is pre-patellar bursitis

Answer 7

close bursa at the anterior surface of kneecap (and skin)-
can occur after irritation, or rarely be septic
from repetitive kneeling
known as —-housemaid’s knee, carpet layer’s knee, miner’s knee or beat knee

gradual onset over days to weeks, swelling, tenderness
hx of repetitive knee use
red flags-sepsis

examin- warm, TENDER on patella, fluctuant
ROM normal- except sometimes at full flexion of knee

can aspirate if ? sceptic

Question 8

Mx of pre-patellar bursisits

Answer 8

non-sceptic - conservative RICE
NSAIDS
reassure
aspirate if ROM bad
if no respond- steroids and specialist after 2m
avoid repetitive behaviours

sceptic - refer and fluclox

Question 9

What is infrapatellar bursitis

Answer 9

2 Bursa between patella ligament and tibia - deep bursa and superficial bursa
called clergymans knee- also from repetitive kneeling
can also happen in Osgood schellter

Swelling of lower side of patella (distal to where pre-paterllar would be), pain

extreme flex and palpation cause pain
can try and differentiate bwteen superficial and deep depending if pain anterior/posterior to patellar tendon

Question 10

Management of infrapatellar bursisits

Answer 10

conservative - RICE, NSAIDS
avoid the repetitive injury

in large swelling aspirate
if not working- steroids

surgery if repeated