Bursitis pathophysiology
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Mehrsefat, M.D. [2]
Overview
Bursitis is characterized by acute or chronic inflammation of a bursa and buildup of fluid in the bursal sac. A bursa is a small, fluid-filled sac that acts as a cushion between a bone and other moving parts: muscles, tendons, or skin. Over 160 bursae are found throughout the body, though relatively few of them can cause bursitis. Aseptic bursitis can be caused by overuse and repetitive injuries to the joint, abnormal bony structure, and crystal deposit in the bursa. It commonly affects the knee or the elbow as a result of kneeling or leaning on the elbows for a longer period of time than usual. Moreover, septic bursitis can be caused by bacterial infection of the bursa through skin injury following repetitive trauma.[1][2][3]
Pathophysiology
Bursitis is characterized by acute or chronic inflammation of a bursa and buildup of fluid in the bursal sac. A bursa is a small, fluid-filled sac that acts as a cushion between a bone and other moving parts: muscles, tendons, or skin. Over 160 bursae are found throughout the body, though relatively few of them can cause bursitis.
Aseptic
- Bursitis commonly affects a knee or elbow, from kneeling or leaning on the elbows longer than usual on a hard surface.
- Aseptic bursitis can be caused by the following factors:[3]
- Injuries, overuse, and repetitive stress to the joint
- Abnormal bony structures or soft-tissue changes that affect the movement of the joint
- Crystal deposit in the bursa in patients with gout and pseudogout
Septic
- Septic bursitis can be caused by bacterial infection of the bursa via the following routes:[1][2][3]
- Through a skin injury following repetitive trauma
- Via fistula (vascular access) in chronic hemodialysis patients
- Bursa close to the surface of the skin are the most likely to become infected with bacteria. Common locations of septic bursitis include:
- Olecranon bursitis (in carpenters, athletes, or hemodialysis patients)
- Prepatellar or infrapatellar septic bursitis (in athletes and those whose occupations involve regular kneeling)
- Ischiogluteal bursitis (in weavers and patients with spinal cord injuries)
- A bursa on medial aspect of the first metatarsophalangeal joint (due to skin breakdown in patients with hallux valgus and inappropriate shoes)
Gross Pathology
On gross pathology, characteristic findings of bursitis include a thickened, erythematous, and shaggy bursal wall with fibrinous exudates.[4]
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Microscopic histopathological analysis
On microscopic histopathological analysis, chronic inflammation and scarring are characteristic findings of bursitis.
References
- ↑ 1.0 1.1 Fauci, Anthony S., and Carol Langford. Harrison's rheumatology. McGraw Hill Professional, 2010.
- ↑ 2.0 2.1 Hellmann DB, Imboden JB., Jr. Musculoskeletal and immunologic disorders. In: McPhee SJ, Papadakis MA, editors. Current Medical Diagnosis & Treatment. McGraw-Hill Lange; 2010. pp. 2056–2061.
- ↑ 3.0 3.1 3.2 García-Porrúa C, González-Gay MA, Ibañez D, García-País MJ (1999). "The clinical spectrum of severe septic bursitis in northwestern Spain: a 10 year study". J Rheumatol. 26 (3): 663–7. PMID 10090179.
- ↑ Wikimedia Commons. Bursitis. (2012) https://commons.wikimedia.org/wiki/Category:Bursitis Accessed on August 31, 2016