bursitis

Bursitis

 

Definition

Bursitis is the painful inflammation of the bursa, a padlike sac found in areas subject to friction. Bursae cushion the movement between the bones, tendons and muscles near the joints. Bursitis is most often caused by repetitive movement and is known by several common names including weaver's bottom, clergyman's knee, and miner's elbow, depending on the affected individual's occupation and area of injury.

Description

There are over 150 bursae in the human body. Usually bursae are present from birth, but they may form in response to repeated pressure. Each sac contains a small amount of synovial fluid, a clear liquid that acts as a lubricant. Inflammation causes pain on movement. The most common site for bursitis to occur is the shoulder (subdeltoid), but it also is seen in the elbows (olecranon), hips (trochanteric), knees, heels (Achilles), and toes. The affected area may be referred to as "frozen," because movement is so limited. In the knee there are four bursae, and all can become inflamed with overuse.

Causes and symptoms

The most common cause of bursitis is repeated physical activity, but it can flare up for no known reason. It can also be caused by trauma, rheumatoid arthritis, gout, and acute or chronic infection.

Pain and tenderness are common symptoms. If the affected joint is close to the skin, as with the shoulder, knee, elbow, or Achilles tendon, swelling and redness are seen and the area may feel warm to the touch. The bursae around the hip joint are deeper, and swelling is not obvious. Movement may be limited and is painful. In the shoulder, it may be difficult to raise the arm out from the side of the body. Putting on a jacket or combing the hair becomes a troublesome activity.

In acute bursitis symptoms appear suddenly; with chronic bursitis, pain, tenderness, and limited movement reappear after exercise or strain.

Diagnosis

When a patient has pain in a joint, a careful physical examination is needed to determine what type of movement is affected and if there is any swelling present. Bursitis will not show up on x-rays, although sometimes there are also calcium deposits in the joint that can be seen. Inserting a thin needle into the affected bursa and removing (aspirating) some of the synovial fluid for examination can confirm the diagnosis. In most cases, the fluid will not be clear. It can be tested for the presence of microorganisms, which would indicate an infection, and crystals, which could indicate gout. In instances where the diagnosis is difficult, a local anesthetic (a drug that numbs the area) is injected into the painful spot. If the discomfort stops temporarily, then bursitis is probably the correct diagnosis.

Treatment

Conservative treatment of bursitis is usually effective. The application of heat, rest, and immobilization of the affected joint area is the first step. A sling can be used for a shoulder injury; a cane is helpful for hip problems. The patient can take nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofin, and naproxen. They can be obtained without a prescription and relieve the pain and inflammation. Once the pain decreases, exercises of the affected area can begin. If the nearby muscles have become weak because of the disease or prolonged immobility, then exercises to build strength and improve movement are best. A doctor or physical therapist can prescribe an effective regimen.

If the bursitis is related to an inflammatory condition like arthritis or gout, then management of that disease is needed to control the bursitis.

When bursitis does not respond to conservative treatment, an injection into the joint of a long-acting corticosteroid preparation, like prednisone, can bring immediate and lasting relief. A corticosteroid is a hormonal substance that is the most effective drug for reducing inflammation. The drug is mixed with a local anesthetic and works on the joint within five minutes. Usually one injection is all that is needed.

Surgery to remove the damaged bursa may be performed in extreme cases.

If the bursitis is caused by an infection, then additional treatment is needed. Septic bursitis is caused by the presence of a pus-forming organism, usually staphylococcus aureus. This is confirmed by examining a sample of the fluid in the bursa and requires treatment with antibiotics taken by mouth, injected into a muscle or into a vein (intravenously). The bursa will also need to be drained by needle two or three times over the first week of treatment. When a patient has such a serious infection, there may be underlying causes. There could be undiscovered diabetes, or an inefficient immune system caused by human immunodeficiency virus infection (HIV).

Key terms

Arthritis — Inflammation of a joint that may lead to changes in the joint's structure. It causes pain and swelling. Rheumatoid arthritis is a chronic disease that leads to crippling deformities.

Diabetes mellitus — A metabolic disease caused by a deficiency of insulin, which is essential to process carbohydrates in the body.

Gout — A hereditary metabolic disease that is a form of arthritis and causes inflammation of the joints. It is more common in men.

Inflammation — The reaction of tissue to injury.

Kinesiology — The science or study of movement.

Alternative treatment

Alternative treatments take into consideration the role of diet in causing bursitis. The faulty use of calcium by the body, magnesium deficiency, and food allergies may have a role. Diet changes and vitamin supplements may be helpful. The use of herbs, homeopathy, aromatherapy, and hydrotherapy can help relieve symptoms. Ginger is useful in reducing inflammation. Acupuncture has been proven effective in treating hip and shoulder pain caused by bursitis and other conditions. Other therapies that deal effectively with musculoskeletal problems (relating to the muscles and skeleton), may also be helpful, such as body work, magnetic field therapy, naturopathic medicine, chiropractic, and applied kinesiology.

Prognosis

Bursitis usually responds well to treatment, but it may develop into a chronic condition if the underlying cause is not corrected.

Prevention

Aggravating factors should be eliminated to prevent bursitis. Overexercising or the repetition of a movement that triggers the condition should be avoided. Doing exercises to strengthen the muscles around the joint will also help. When doing repetitive tasks, frequent breaks should be taken and the activity should be alternated with others using different parts of the body. To cushion the joints, it is a good idea to use cushioned chairs when sitting and foam kneeling pads for the knees. Leaning on the elbows, kneeling or sitting on a hard surface for a long period of time should be avoided. Not wearing high heels can help prevent bursitis in the heel, as can changing to new running shoes as soon as the old ones are worn out.

Resources

Other

"Bursitis." HealthAnswers.com. 1998. http://www.healthanswers.com.

bursitis

 [ber-si´tis]

inflammation of a bursa; types are usually named for the bursa involved. The subdeltoid bursa in the shoulder is most commonly affected, but inflammation may develop in almost any bursa in the body. Excessive use of the joint is often the cause. Acute bursitis comes on suddenly; severe pain and limitation of motion of the affected joint are the principal symptoms. Resting the joint, moist heat, and the use of analgesics or nonsteroidal antiinflammatory drugs frequently are sufficient treatment. Chronic bursitis may follow the acute attacks. There is continued pain and limitation of motion around the joint. X-ray examination will usually reveal the deposit of calcium salts. If rest, heat, and medications do not relieve the condition, surgery may be required to remove the calcium deposits or free the area of chronic inflammation.

bur·si·tis

(ber-sī'tis),

Inflammation of a bursa.

Synonym(s): bursal synovitis

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.

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calcific bursitis  see under tendinitis.

ischiogluteal bursitis  inflammation of the bursa over the ischial tuberosity, characterized by sudden onset of excruciating pain over the center of the buttock and down the back of the leg.

subacromial bursitis , subdeltoid bursitis see calcific tendinitis, under tendinitis.

Tornwaldt's bursitis  chronic inflammation of the pharyngeal bursa.

bursitis

(bər-sī′tĭs)

n.

Inflammation of a bursa, especially in the shoulder, elbow, or knee joint.

bursitis

[bərsī′tis]

inflammation of the bursa, the connective tissue structure surrounding a joint. Bursitis may be precipitated by arthritis, infection, injury, or excessive or traumatic exercise or effort. The chief symptom is severe pain of the affected joint, particularly on movement. Treatment goals include the control of pain and the maintenance of joint motion. Acute pain is often treated with an intrabursal injection of an adrenocorticosteroid. Other common treatments are analgesics, antiinflammatory agents, cold, and immobilization of the inflamed site. After the inflammation has subsided, heat may be helpful. In chronic cases, surgery may be required to remove calcium deposits. Kinds of bursitis include housemaid's knee, miner's elbow, and weaver's bottom. See also rheumatism.

bursitis

Inflammation of a bursa, which may be accompanied by calcification of the supraspinatus tendon or of the subdeltoid bursa.
 
Clinical findings
Inflammation, pain, limited movement, decreased ROM.

Aetiology
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.
 
Management—infectious
Antibiotics, aspiration, surgery.

bursitis

Inflammation 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.

bur·si·tis

(bŭr-sī'tis)

Inflammation of a bursa that is most often caused by overuse or repeated stress to a joint. Symptoms include swelling, pain, and decreased range of motion.
Synonym(s): bursal synovitis.

[Med. L. bursa, purse + itis]

bursitis

(bur-sit'is) [ bursa + -itis]

Inflammation of a bursa, esp. between bony prominences and muscle or tendon, as in the shoulder and knee. It is typically caused by repeated stresses placed on a joint during work or play, but sometimes results from sudden trauma, from inflammatory joint disease, or bacteria. Common forms include rotator cuff, miner's or tennis elbow, and prepatellar bursitis. Fluid accumulation in the bursa results in irritation, inflammation, sudden or gradual pain, and symptoms such as impaired joint movement.

Treatment

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.

Patient care

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.

anserine bursitis

Inflammation of the sartorius bursa located over the medial side of the tibia just below the knee.

PREPATELLAR BURSITIS

prepatellar bursitis

An inflammation of the bursa anterior to the patella, with accumulation of fluid. It may be seen in those who have to kneel frequently or continually while working. Synonym: carpetlayer's knee; housemaid's knee; roofer's knee See: illustration

septic bursitis

Bursitis caused by bacterial invasion of the joint.

bursitis

Inflammation 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.

bursitis

inflammation, 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.

bursitis

bursal 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)

Table 1: Treatment of local sepsis

Mnemonic	Rationale	Treatment modality
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.

bursitis (bur·sīˑ·tis),

n painful condition in which the connective tissue, or bursa, that surrounds the joints becomes inflamed, often chronically.

Bursitis.

bursitis

inflammation of a bursa. Acute bursitis comes on suddenly; severe pain and limitation of motion of the affected joint are the principal signs. See also hygroma, intra-abdominal abscess.

Chronic bursitis may follow the acute attacks. There is continued pain and limitation of motion around the joint.

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atlantal bursitis

see poll evil.

carpal bursitis

see carpal hygroma.

trochanteric bursitis

inflammation, in the horse, of the bursa between the tendon of the middle gluteal muscle and the major trochanter of the femur or its cartilage. Causes lameness and atrophy of muscles in long-standing cases. Called also whirlbone lameness.

Traumatic bursitis (capped hock) in horse. By permission from Knottenbelt DC, Pascoe RR, Diseases and Disorders of the Horse, Saunders, 2003.