Bursitis

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Definition/Description

Bursitis is the inflammation of a bursa.

Clinically Relevant Anatomy

A Bursa appears at a junction of a tendon on the bone. A bura is filled with a thin layer of synovial fluid. It protects and brakes the shocks of the joint. The structures nearby the bursa can move with minimal friction due to irritation. They have different measures and are mostly flattened.
 

Mechanism of Injury / Pathological Process

When a Bursa gets inflamed, it swells, develops friction and starts irritating the muscle tendon it is supposed to protect. This way the bursa and muscle tendon get more and more irritated.
These issues lead to bursitis and tendinitis.

Bellow is a summary of causes for bursitis, with the example for the olecranon bursa.

• Overuse of the joint: for example vacuuming for hours on end
• Repetitive strain: for example picking up and lifting heavy loads
• Trauma: by falling on your elbow or bumping it against something
• Pressure: leaning on the elbow at a desk is a common cause of bursitis among students
• Bacterial infection: from an unattended wound (this is called septic bursitis)
• Other inflammatory diseases: Gout for instance : the gout crystals can form in the bursa and cause the inflammation.
  
  

Epidemiology/Etiology

Bursitis may occur:

- Mainly by constant friction, thumping or pressure
- The inflammation of the bursa frequently appears in combination with tendinitis
- By an overuse injury or a trauma, especially when pulling and pushing heavy items
- After a forced period of rest
- There also can be an underlying rheumatic condition
- Diabetes, osteoarthritis and disability of the thyroid gland can be associated to bursitis

Clinical Presentation

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Diagnostic Procedures

In most cases bursitis can be diagnosed by physically examining the patient.

 Inspection:

• Redness and warmth can be signs of bursitis, but these symptoms are harder to spot when treating a Bursa that is not located superficial under the skin.
• Local tenderness or stiffness.
• Swelling  can occur when inflammation gets worse.

 

X-ray:

• Can rule out arthritis and bone deformities
• Can sometimes confirm the presence of following substances inside the bursa:
  - Gout crystals
  - Calcifications: When the condition is chronic or recurrent.

Bursa fluid punction:

• Can rule out infections.
  

Outcome Measures

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Management / Interventions

Bursitis due to movement/activity (without infection):

• Rest the affected joint/ bursa
• Ice packages
• NSAID’s ( non steroid anti inflammatory drugs)
• Injections with steroid agents
• When improvement is noticeable, gradual increase in exercise and activities is recommended.

 Note: Resting the affected joint does not mean immobilizing it, this could hold a risk towards adhesive capsulitis (especially in the shoulder).

Bursitis due to infection (= septic bursitis):

• Antibiotics
• Aspiration of the infected bursa fluid with the use of a sterile needle should be repeated approximately  every 3 days
• Never inject with steroids!

  Note: When measures mentioned above are inadequate surgical interventions may be necessary
in case of following factors:

• surgical removal of the bursa is recommended in case of tuberculous bursitis
• Surgical incision and drainage is recommended in case of :
   - Failure of adequately aspirating by needle
   - Bursa site inaccessible to multiple needle aspirations
   - Forming of abscess or necrosis
  

Differential Diagnosis

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Key Evidence

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Resources

http://www.medicinenet.com/bursitis/article.htm
http://emedicine.medscape.com/article/822693-treatment
http://www.reumaliga.be/vrliburs.htm
http://www.medicinenet.com/bursitis/article.htm
http://www.associatie-orthopedie-lier.be/Generic/servlet/Main.html;jsessionid=914EE2C36D10FED19214703AB3947179?p_pageid=102194
http://www.orthopedieherentals.be/index.php?page=olecranon-bursitis
http://www.reumanet.be/aandoeningen/bursitis.html

Case Studies

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References

3. Van de Perre S., Vanwambeke K., Vanhoenacker F.M., De Schepper A.M., Posttraumatic iliopsoas bursitis, JBR-BTR, 2005, 88:154-155

4. Johnston C.A.M., Wiley J.P., Lindsay D.M., Wisemand D.A., Iliopsoas bursitis and tendinitis (a review), Sports Med, april 1998; 25 (4): 271 – 283 (Level of evidence: A1)

5. Ombregt L., Bisschop P., ter Veer H.J., Van de Velde T., A System of Orthopaedic Medicine. 1999.

6. Woodley S.J., Nicholson H.D., Livingstone V., Doyle T.C., Meikle G.R., Macintosh J.E., Mercer S.R. Lateral Hip Pain: Findings From
7. Magnetic Resonance Imaging and Clinical Examination. Journal of orthopaedic & sports physical therapy, Vol 38, No. 6, June 2008, pp 313 – 328
8. Paluska S.A., An overview of Hip Injuries in Running. Sports Med 2005; 35, pp 991 – 1014

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