What is Bursitis?
Written by Braden Womack with Dr. Nabil
Ebraheim
Bursas are synovium-lined, sac-like
structures located throughout the body between skin and tendon or tendon and
bone (1,2). The main function of bursa is to reduce the friction between areas
of movement and some common locations are the shoulder, knee, hip, and elbow
(1). When these areas become swollen or inflamed it is known as bursitis.
During this abnormality the bursa will enlarge with fluid causing any movement
against or direct pressure upon the area to produce pain for the patient (2).
Bursitis can be broken up further to
acute bursitis and chronic bursitis. Acute bursitis is typically caused by trauma,
infection, or crystalline joint disease resulting in pain on palpation of the
bursa as well as a decrease in range of motion that is secondary to pain. Whereas
chronic bursitis is typically caused by inflammatory arthropathies, repetitive
motions, or microtraumas most often causing painless swelling and thickening of
the bursa. Examination of the skin is an important distinguishing factor for
acute and chronic bursitis as trauma, erythema, and warmth should all be
evaluated to make a proper diagnosis (2).
Diagnosis of many types of bursitis
can be made clinically without further studies, however in the case of trauma,
concern for foreign bodies, or fractures imaging can play an important role in
diagnosis. Basic plain film imaging can be used when evaluating a superficial
bursa however, for a deeper bursa MRI and ultrasound can be used (1).
Ultrasound will also provide the added benefit of showing real-time images to
observe changes in active and passive movements (2). When evaluating an
inflamed bursa, aspiration is a critical tool to distinguish between septic and
aseptic bursitis as the aspirated fluid should be sent for a basic cell count
and cell cultures (3).
Treatment for bursitis depends on the
type and causative agent as most bursitis will heal on their own without
intervention. To combat the patient’s pain, bursitis can be treated with a
conservative treatment plan involving rest, ice, compression, and elevation as
well as NSAIDS and/or acetaminophen for pain (2). With deeper bursitis
corticosteroid injections can provide symptomatic relief however, this course
of treatment is not recommended for superficial bursa and can delay the
diagnosis of another condition such as a tear. Physical therapy is another
important treatment method to strengthen the muscles that support the area
around the bursa (2). For septic bursitis the typical course of treatment is oral
antibiotics as an outpatient but systemic IV antibiotics may be needed if signs
of widespread sepsis are present (4). The last line of treatment is surgery
which is most often used only as a last resort when all other conservative
treatment methods fail (2).
