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Bursitis

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Bursitis

  • Definition
  1. Bursa
    1. Fluid-filled sac between adjacent musculoskeletal structures (e.g. tendon over bone, skin over bone) to reduce friction
  2. Bursitis
    1. Inflammation or injury involving bursa
  • Mechanisms
  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
  • Differential Diagnosis
  • 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
  • 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
  • Management
  1. Exclude Septic Bursitis and inflammatory Bursitis
  2. Conservative management
    1. RICE-M
    2. Padding (to prevent recurrent Trauma, such as knee pads)
    3. Compression wraps
  3. 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 (but risk of fistula)
  4. Refractory, recurrent or persistent Bursitis that interferes with function
    1. Endoscopic bursectomy