Bursitis

Last updated 20.09.12

 

Index

 

Definition

-  Inflammation or degeneration of bursae caused by local insult or systemic disease

 

Features

-  Clinical Dx

-  Superfical or deep bursa

 

Sites

-  Most commonly effected

-  Subdeltoid

-  Olecranon

-  Ishcial

-  Trochanteric

-  Prepatellar

-  Superfical bursae

-  Olecranon

-  Prepatellar

-  Bunion

-  Deep bursae

-  Iliopsoas

-  Subacromial

-  Trochanteric

 

Associated S/S

-  Pain on motion & at rest

-  Periodic loss of active movement

-  Swelling if bursa close to surface

-  Local tenderness at site of bursa

-  Inflammation limited to portion of bursae common w repetitive movement injuries

-  Localised inflammation

-  Cellulitiis

-  Taphaceous gout

-  Septic bursitis

-  Peribursal erythema, warmth

-  Often associated with DM, immunosupression, EtOH Dependance

-  Deep bursa uncommon

-  Recent/recurrent bacterial infection

-  Fever

 

DDx

-  Acute monoarthritis

-  If localised pain & reduced active ROM

-  Tendonitis

-  Muscle injury

-  If reduced active + passive ROM

-  Synovitis

-  Soft tissue contracture

-  Structural abnormality

 

Causes

-  Local

-  Acute trauma

-  Repetitive movement injury

-  Infection: septic bursitis

-  Bleeding

-  Systemic

-  RA

-  Tophaceous gout

-  Pseudogout

 

Ix

-  Vitals

-  Fever: septic arthritis

-  BP, HR: septic arthritis

-  +/- FBE, CRP

-  +/- BC

-  Aspiration: Gram Stain + MCS, WBC, polarised microscopy for crystals

-  16 or 18 gauge needle

-  Superfical bursa + effusion + inflammation

-  Deep bursa with imaging if any of

-  Bacteraemia

-  Fever

-  Leukocytosis

-  Imaging

-  Usually not helpful for superficial bursa unless traumatic

-  X-ray: exclude foreign body

-  Deep bursa + inflammation

-  X-ray: exclude to exclude OA etc as cause of pain

-  CT &/or US +/- guided aspiration

-  +/- MRI

 

Mx

-  Rest + ice + heat until acute pain resolved

-  Nonseptic Bursitis

-  NSAIDs several days

-  Indomethacin 75mg BD

-  OR Naproxen 500mg BD

-  +/- Corticosteroids

-  If poor response to NSAIDs

-  Intrabursal injection

-  Equal volume 1% Lidocaine + Methylprednisolone 10-40mg (small to large bursae)

-  Not repeated until 6-8 weeks later

-  If poor response with x2 injections consider other Mx

-  +/- Surgery

-  Septic Bursitis

 

 

 

Trochanteric Bursitis

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Features

-  Type of bursitis

-  Lies between tendon of gluteus medius & posteriolateral prominence of greater trochanter

-  May also involve more superficial burse directly over greater trochanter

 

Cause

-   

 

Associated S/S

-  +/- ass w OA of hip

 

Ix

-   

-   

 

Mx

-   

 

 

 

References

 

UpToDate: Bursitis: An overview of clinical manifestations, diagnosis & management

Prepatellar bursitis (pic): www.joint-pain-expert.net/bursitis.html