Bursitis

What is Bursitis?

Bursitis refers to the inflammation of a bursa. A bursa is a fluid filled sac that prevents friction between bony surfaces and soft tissues in the body, especially in or around joints. When one of these bursae is inflamed, it becomes swollen and painful. The inflammation of a bursa may come about as a result of excessive movement or pressure on the bursa, infection or other diseases that may affect the joint and its environs (e.g. rheumatoid arthritis or gout).

The most common cases involve the knee, a condition colloquially referred to as "house-maid's knee". However, it can affect almost any joint in the body, such as the elbow, ankle or shoulder. It is more likely that a person will contract bursitis if they are involved in a job or a hobby that involves repetitive movement or constant pressure on a particular joint.

Statistics on Bursitis?

Anybody can get bursitis. It is more common among people who have jobs or hobbies that involve repetitive movement of a particular joint or groups of joints, or constant pressure on a particular area (e.g. playing lots of tennis or golf, sitting for long periods of time).

Risk Factors for Bursitis

Bursitis occurs most commonly in the shoulder, elbow, hip, and knee joints. Inflammation or degeneration seen in the bursae at these sites is usually the result of a repetitive movement injury. When bursitis occurs with repetitive movement disorders, inflammation is often limited to a portion of the bursa.

Things that may increase the possibility of bursitis include:

Trauma
Infection
Crystal deposits (gout)
Systemic disease (rheumatoid arthritis)
Sepsis

Progression of Bursitis

The first sign of bursitis is normally pain. This may get worse and may even be present when you are resting. This pain is often followed by a loss or restriction of movement about the joint. There is also tenderness and swelling.

Clinical Examination of Bursitis

In the absence of an infectious or systemic disease, physical examination is typically focussed on the painful region. Usually this will involve a detailed rheumatologic/musculoskeletal evaluation of the affected region.

Diagnosis is based on:

Pain on motion and at rest
Occasional loss of active movement in the area
Swelling (in foot, knee or elbow bursitis)
Tenderness

While these findings can also be consistent with tendonitis or muscle injury, loss of movement is more typical of synovitis, soft tissue contracture, or a structural abnormality of the joint.

How is Bursitis Diagnosed?

Diagnosis is usually based on signs of swelling, pain, loss of movement and a history of trauma, infection or repetitive movement about a particular joint.

Usually the only testing required may be a needle aspiration of fluid from the bursa to identify possible infections or systemic disease.

Imaging may be needed to guide aspiration of deep bursae (e.g. CT or ultrasound).

Prognosis of Bursitis

Most cases of bursitis will disappear with appropriate treatment in a matter of weeks. However, some may persist or reoccur. In these instances, surgery may be necessary to remove or repair the bursa. This only happens in a minority of cases.

How is Bursitis Treated?

Treatment involves:

Education to limit the amount of movement about the joint or to reduce the potential for trauma
Administration of anti-inflammatory drugs (NSAIDs) and/or steroid injections.

Occasionally, surgery may be needed to remove or repair the bursa.

Bursitis References

Ramzi S. Cotran VK, Tucker Collins , Stanley L. Robbins. Pathologic Basis of Disease. Seventh ed: W.B. Saunders Company; 2005.
Ishii H BJ, Welsh RP, Uhthoff HK. Bursal reactions in rotator cuff tearing, the impingement syndrome, and calcifying tendinitis. Journal of Elbow and Shoulder Surgery. 1997 March; 6(2): 131-6.
Stell IM GW. Simple tests for septic bursitis: comparative study. British Medical Journal. 1998 June; 316: 1877.
Kasper DL BE, Fauci A. Harrison's Principles of Internal Medicine. 16th ed: The McGraw-Hill Companies; 2005.
Buchbinder R GS, Youd JM. Corticosteroid injections for shoulder pain. Cochrane Database Systematic Reviews. 2003; CD004016(1).