Orthopedics Book



Aka: Bursitis
  1. See Also
    1. Olecranon Bursitis
    2. Iliopsoas Bursitis
    3. Greater Trochanteric Bursitis
    4. Patellar Bursitis
    5. Prepatellar Bursitis
    6. Pes Anserine Bursitis
    7. Achilles Tendon Bursitis
    8. Septic Bursitis
  2. Definitions
    1. Bursa
      1. Fluid-filled sac between adjacent musculoskeletal structures (e.g. tendon over bone, skin over bone) to reduce friction
      2. Bursa sacs are lined with synovial cells that secrete fluid in response to injury or inflammation
    2. Bursitis
      1. Inflammation or injury involving bursa
  3. Causes: Bursitis
    1. Hemorrhage into bursa
      1. Direct Trauma
      2. Spontaneous with Coagulopathy
    2. Microtrauma
      1. Chronic, repetitive overuse (e.g. Olecranon Bursitis, Prepatellar Bursitis, calcaneal Bursitis)
    3. Inflammatory Bursitis
      1. Gouty Arthritis (esp. Olecranon Bursitis, Prepatellar Bursitis)
      2. Uncommon to rare causes include Pseudogout, Rheumatoid Arthritis
    4. Septic Bursitis
      1. Staphylococcus aureus accounts for >85% of cases, esp. Olecranon Bursitis, Prepatellar Bursitis
      2. Associated with focal erythema, warmth and tenderness
  4. Differential Diagnosis
    1. Joint effusion including Septic Arthritis
      1. Joint range of motion is maintained in Bursitis, but is reduced with joint effusion
    2. Cellulitis
    3. Fracture
    4. Tendinopathy
  5. Imaging
    1. XRay Indications
      1. Trauma with suspected underlying Fracture
      2. Underlying deformity suspected (e.g. Haglund Deformity in calcaneal Bursitis)
    2. Ultrasound Indications
      1. Defines bursa when exam is difficult (e.g. overlying Cellulitis)
      2. Negative color doppler is associated with a low likelihood of inflammatory Bursitis and Septic Bursitis
  6. Labs
    1. Consider inflammatory markers (CBC, CRP, ESR)
    2. Bursa Aspiration
      1. See Septic Bursitis
      2. Indicated in suspected Septic Bursitis (and may consider in inflammatory Bursitis)
      3. Z-Track needle insertion to reduce risk of fistula
      4. Obtain cell count with differential, Gram Stain, culture, Glucose, crystal analysis
        1. Leukocyte count >10,000 with >50% Neutrophils (PMNs) is consistent with Septic Bursitis
  7. Management
    1. Exclude Septic Bursitis and inflammatory Bursitis
    2. Avoid further Trauma to the region (e.g. kneeling, resting elbows against table)
    3. Conservative management
      1. RICE-M
      2. Padding (to prevent recurrent Trauma, such as knee pads)
      3. Compression wraps
      4. NSAIDs
    4. Other measures
      1. Avoid intrabursal Corticosteroid Injection (poor evidence for benefit and associated risks)
      2. Aspiration may be considered in cases of large acute Traumatic bursal effusions
        1. However, fluid typically reaccumulates and risk of fistula formation
    5. Refractory, recurrent or persistent Bursitis that interferes with function
      1. Endoscopic bursectomy
  8. References
    1. Raukar and Pensa (2022) EM:Rap 22(9): 10-1
    2. Khodaee (2017) Am Fam Physician 95(4): 224-31 [PubMed]

Bursitis (C0006444)

Definition (MSH) Inflammation or irritation of a bursa, the fibrous sac that acts as a cushion between moving structures of bones, muscles, tendons or skin.
Definition (CHV) an inflammation in the area around the joint
Definition (CHV) an inflammation in the area around the joint
Definition (CHV) an inflammation in the area around the joint
Definition (MEDLINEPLUS)

A bursa is a small, fluid-filled sac that acts as a cushion between a bone and other moving parts, such as muscles, tendons, or skin. Bursitis occurs when a bursa becomes inflamed. People get bursitis by overusing a joint. It can also be caused by an injury. It usually occurs at the knee or elbow. Kneeling or leaning your elbows on a hard surface for a long time can make bursitis start. Doing the same kinds of movements every day or putting stress on joints increases your risk.

Symptoms of bursitis include pain and swelling. Your doctor will diagnose bursitis with a physical exam and tests such as x-rays and MRIs. He or she may also take fluid from the swollen area to be sure the problem isn't an infection.

Treatment of bursitis includes rest, pain medicines, or ice. If there is no improvement, your doctor may inject a drug into the area around the swollen bursa. If the joint still does not improve after 6 to 12 months, you may need surgery to repair damage and relieve pressure on the bursa.

NIH: National Institute of Arthritis and Musculoskeletal and Skin Diseases

Definition (NCI) Painful inflammation of the bursa. It most often affects the hips, shoulders, and elbows.
Definition (NCI_NCI-GLOSS) Inflammation (swelling, pain, and warmth) of a bursa. A bursa is a flat, fluid-filled sac found between a bone and a tendon or muscle. It forms a cushion to help the tendon or muscle slide smoothly over the bone. Bursitis may be caused by long-term overuse, trauma, rheumatoid arthritis, gout, or infection. It usually affects the shoulder, knee, elbow, hip, or foot.
Concepts Disease or Syndrome (T047)
MSH D002062
ICD10 M71.9
SnomedCT 156686008, 156677003, 268000007, 202935009, 84017003
English Bursitides, BURSITIS, bursitis (diagnosis), bursitis, Bursal synovitis, Bursitis NOS, Bursitis [Disease/Finding], bursa inflammation, inflammation of bursa, Bursitis NOS (disorder), Inflammation of bursa, Bursitis (disorder), Bursitis, NOS, Bursitis
French BURSITE, Synovite bursale, Bursite, Hygroma
Portuguese BURSITE, Bursite sinovial, Bursite
Spanish BURSITIS, Sinovitis bursal, bursitis, SAI, bursitis, SAI (trastorno), Bursitis NOS, bursitis (trastorno), bursitis, inflamación de bolsa serosa, Bursitis
German BURSITIS, Synovitis der Bursa, Bursitis, Schleimbeutelentzündung
Dutch bursa synovitis, bursitis, Bursitis
Italian Sinovite della borsa, Borsite
Japanese 滑液包滑膜炎, カツエキホウエン, カツエキホウカツマクエン, 滑液のう炎, 関節包炎-癒着性, 粘液嚢炎, 癒着性関節包炎, 粘液包炎, 滑液嚢炎, 滑液包炎
Swedish Slemsäcksinflammation
Czech bursitida, burzitida, Burzitida, Synovitida tíhového váčku
Finnish Bursiitti
Polish Zapalenie kaletki maziowej
Hungarian Nyálkatömlő-gyulladás, Bursitis
Norwegian Slimposebetennelse, Bursitt
Derived from the NIH UMLS (Unified Medical Language System)

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