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Causes and symptoms
bursitis/bur·si·tis/ (bur-si´tis) inflammation of a bursa; specific types of bursitis are named according to the bursa affected, e.g., prepatellar bursitis, subacromial bursitis, etc.
bursitisInflammation of a bursa, which may be accompanied by calcification of the supraspinatus tendon or of the subdeltoid bursa.
Inflammation, pain, limited movement, decreased ROM.
Idiopathic, chronic overuse, trauma, rheumatoid arthritis, gout, infection.
Shoulder, knee, elbow, Achilles tendon, first metatarsal of the foot (bunion), etc.
Rest, ice, NSAIDs, analgesics.
Antibiotics, aspiration, surgery.
bursitisInflammation of a bursa, which may be accompanied by calcification of the supraspinatus tendon, or of the subdeltoid bursa Clinical Inflammation, pain, limited movement, ↓ ROM Etiology Idiopathic, chronic overuse, trauma, rheumatoid arthritis, gout, infection Sites Shoulder, knee, elbow, Achilles tendon, first metatarsal of the foot–bunion, etc Management–non-infectious Rest, ice, NSAIDs, analgesics Infectious Antibiotics, aspiration, surgery. See Anserine bursitis, Aseptic bursitis, Calcific bursitis, Knee bursitis, Septic bursitis, Shoulder bursitis.
Synonym(s): bursal synovitis.
bursitis(bur-sit'is) [ bursa + -itis]
Therapy includes rest and immobilization of the affected part during the acute stage. Active mobilization as soon as acute symptoms subside will help to reduce the likelihood of adhesions. Nonsteroidal anti-inflammatory drugs, analgesics, local application of cold then heat, and diathermy are helpful. Fluid removal (aspiration of the bursa) and injection of local anesthetics and cortisone into bursae may be required to reduce inflammation and relieve pain. In chronic bursitis, surgery may be necessary.
Rest is prescribed, and movement of the affected part is restricted during the acute phase if pain and limited range of joint motion are present. If pain and loss of function are severe and do not improve with rest, the patient is referred for medical evaluation; physical therapy may also be needed to maintain joint mobility and prevent neighboring muscle atrophy.
bursitisInflammation of a BURSA. Bursitis is commonly due to excess local pressure or undue friction, but it may also result from rheumatic disease or infection. Common examples are HOUSEMAID'S KNEE, TENNIS ELBOW and BUNION.
bursitisinflammation, with swelling, of a bursa. olecranon bursitis of the bursa over the point of the elbow; prepatellar bursitis ( syn housemaid's knee) of the bursa in front of the patella, frequently associated with excessive kneeling; retrocalcaneal bursitis of the bursa at the back of the heel between the calcaneum and the Achilles tendon near to its insertion, causing a swelling at both sides of the tendon. See also knee joint, trochanteric bursitis.
bursitisbursal inflammation (pain, swelling, redness) due to local chronic trauma (shear stress, pressure, friction), local or contiguous spread of infection, or characteristic of rheumatological disease; treatment includes identification and resolution of the underlying cause, together with local deflective padding/strapping, orthoses and shoe modification to minimize mechanical stresses and impose rest, together with topical medicaments (e.g. weak iodine solution, Burow's solution or hamamelis water), therapeutic ultrasound, contrast footbaths, and systemic anti-inflammatory agents (e.g. non-steroidal anti-inflammatory drugs; Box 1); infected bursae require systemic antibiosis (see knee joint)
|O||Operate||Remove the cause of the infection where possible, e.g. remove focal hyperkeratosis/foreign body/nail spike|
|C||Cleanse||Irrigate area/cleanse cavity with Warmasol delivered under pressure from a sterile syringe|
|H||Heat||Assist drainage of pus/exudate by applying heat, e.g. immersion in a warm hypertonic NaCl bath|
|A||Antiseptic||Apply a liquid or powder antiseptic (e.g. Betadine)|
|D||Dress||Cover the lesion with a sterile dressing (e.g. sterile gauze; Lyofoam)|
|R||Rest||Impose rest, e.g. deflective padding; shoe modification; walking cast; crutches, as necessary|
|A||Reappoint||Arrange to review case in 24–72 hours|
|R||Review||At the subsequent appointment, review progress|
If resolution has been initiated, continue to treat as above (O–A) and review weekly until healing is complete
If the infection has not improved, arrange for antibiosis, and continue to review and dress until healing is complete
|R||Refer||Refer for specialist review via GP: remember, slow-to-resolve infection can characterize undiagnosed diabetes, or other ‘at-risk’ patient category|
Use all normal preoperative procedures; keep infected lesions covered until ready to treat; take a swab for pathology laboratory analysis of any exudate; use a sterile dressings pack; follow the OCH-A-DRARR treatment mnemonic.
‘At-risk’ patients presenting with infection or patients presenting with acute or spreading infection should be treated using the OCH-A-DRARR protocol, but provided with or referred for immediate antibiosis.