Bursitis

Definition

Bursitis is the inflammation of the fluid-filled sacs (bursae ~ plural / bursa ~ singular) in the body. These sacs are located at points where friction between the body parts would otherwise occur such as in the knees, ankles, shoulders and hips. Bursae act as cushion between two surfaces especially around the tendons, muscles and bones where sliding movement occurs. When inflamed, there is pain and swelling at the sites and also some restriction of movement.

Types

Specific types of bursitis are named according to the bursa affected and is usually a result of excessive use of the part where bursa is located or due to an injury. Some common types of bursitis include “

  • prepatellar bursitis also known as housemaid’s knee is inflammation of the bursa located above the patella (small bone in the knee).
  • infrapatellar bursitis known as clergyman’s knee, named so as it was commonly seen in them due to constant kneeling.
  • olecranon bursitis or students elbow as they usually leans on elbows while studying.
  • ischial bursitis or weavers bottom affecting the thigh due to prolonged sitting on the floor.
  • bunion bursitis on the side of the foot by the big toes due to poorly fitting footwear.

Causes

According to the cause there are two types of bursitis – irritative (non-infective) and infective bursitis.

  • Mechanical irritation is the cause of irritative bursitis and is more common than infective bursitis. Whenever there is an excessive pressure or friction on the bursa; usually due to a gouty deposit, it leads to inflammation of the bursa and results in accumulation of a clear fluid within the bursae. If inflammation persists for a long duration, then the sac becomes thickened and may cause pressure on the adjacent bone.
  • Infective bursitis occurs when the bursa becomes infected with bacteria. Most common sites include trochanteric bursa (upper end of thigh bone) and prepatellar bursa.

Symptoms

  • Swelling at the site of the affected bursa.
  • Difficulty in movement of the affected part and stiffness.
  • Pain which may be excruciating on movement of the affected part or when it is touched. For example in ischiogluteal bursitis is characterized by a sharp sudden onset of excruciating pain over the center of the buttock and down the leg
  • Fever may be present if infection is the cause.

Treatment

Diagnosis is made on physical examination and on evaluation of the signs and symptoms. Imaging studies like a CT scan and MRI may also be useful. When infective bursitis is suspected then fluid aspiration of the affected bursa may be performed to confirm the species of bacteria responsible for the infection.

  • Analgesics such as ibuprofen, naproxen are given to decrease the inflammation and for pain relief.
  • Rest and applying ice to the affected part and removal of the offending factor such as friction or constant pressure over the bursa helps in reducing the swelling.
  • In some cases not responding to aforementioned treatment, hydrocortisone (steroid) is injected into the bursal sac. Rarely, excision (removal) of the bursa may be required.
  • Infective bursitis needs to be treated with a bursotomy where an incision is made into the bursa and the infected fluid is drained. Antibiotics are also given to control the infection.

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