BURSITIS - Disease Management

Bursitis is defined as an inflammation of bursae. Bursae are closed, round, flattened sacs that are lined by synovium, and separate the bare areas of hone from overlapping muscles (deep bursae), or skin and tendons (Superficial bursae). They occur in areas of friction or possible impingement. When inflammed, the synovial cells increase in thickness and may show villous hyperplasia. Bursal lining eventually may be replaced by granulation tissue prior to fibrous tissue formation. The bursa becomes filled with fluid, which is often rich in fibrin.

Classification

• Subacromial (subdeltoid) bursitis
• Olecranon bursitis
• Iliopsoas bursitis
• Trochanteric bursitis
• Ischial bursitis
• Prepatellar bursitis
• Infrapatellar bursitis
• Anserine bursitis
• Calcaneal bursitis

Causes

General bursitis

• Acute trauma
• Chronic friction
• Crystal deposition (gout, pseudogout)
• Systemic diseases such as rheumatoid arthritis,ankylosing spondylitis, psoriatic arthritis,Scleroderma, systemic lupus erythematosus,pancreatitis, Whipple disease, oxalosis, uremia,hypertrophic pulmonary osteoarthropathy, and idiopathic hypereosinophilic syndrome

Infective and septic bursitis

• Bacteria
• Staphylococcus aureus most common
• Mycobacterium (both tuberculous and non tuberculous strains)
• Fungi-Candida species

Risk Factors

• .History of inflammatory disease (s)
• History of repetitive motion
• Diabetes
• Steroid therapy
• Uremia
• Alcoholism
• .Traumatic injury
• Cellulitis in the overlying skin

Signs and Symptoms

• Pain upon motion
• Decreased range of motion
• Edema
• Localized tenderness
• Warmth
• Erythema of the skin (if superficial)
• Loss of function

DIAGNOSIS

• Differential Diagnosis
• Abdominal Trauma
• Rheumatoid Arthritis
• Cellulitis
• Costochondritis
• Tendonitis strain and sprain

Investigations

• X-ray
• Bursograpny
• .Ultrasound
• CT scan
• MRI
• Bursal fluid white blood cell count

TREATMENT

Goal

• To reduce morbidity
• .To prevent complications

Pharmacological Treatment

Classes of drugs used are:

• Nonsteroidal anti-inflammatory agents (NSAIDS)
• Antibiotics
• Penicillins
• Cephalosporin
• Others - Vancomycin
• Corticosteroids

For details, refer chart on bone and joint infections

PATIENT EDUCATION

• Advice pertaining to prevention via appropriate warm-up, stretching, and avoidance of repetitive injury
• Lifestyle changes to prevent recurrent joint irritation

Complications

• Acute bursitis may progress to chronic bursitis
• Severe long-range limitation of motion

Prognosis

• Generally good as most bouts of bursitis heal without sequelae
• Repetitive acute bouts may lead to chronic bursitis necessitating repeated joint/bursal aspirations or eventually surgical excision of involved bursa.