Bursitis overview

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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 Classification

Based on the nature of inflammation bursitis may classified into 2 subtypes: septic and aseptic. Common anatomic location include shoulder, elbow, hip, knee, and ankle. Most common bursitis subtypes include subacromial, olecranon, trochanteric, prepatellar, and retrocalcaneal. Moreover, based on the location of the bursa from the skin, bursitis may be classified into 2 subtyopes: superficial and deep. Superficial bursa are more prone to get infected with bacteria and develop septic bursitis. common location of septic bursitis include knee (prepatellar bursitis), and elbow (olecranon bursitis).

Bursitis Pathophysiology

Bursitis is characterized by acute or chronic inflammation of a bursa and buildup of fluid in the bursa 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 bursa are found throughout the body and only few of them can cause bursitis. Aseptic bursitis can be caused by overused and repetitive injuries to the joint, abdominal bony structure and crystal deposit in the bursa. It commonly affects knee or elbow, from kneeling or leaning on the elbows longer than usual. Moreover, septic bursitis can be caused by bacterial infection of the bursa through the skin injury following repetitive trauma.

Images

The following are gross and microscopic images associated with bursitis:

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  Prepatellar bursitis<ref> Wikipedia.Prepatellar bursitis. https://en.wikipedia.org/wiki/Prepatellar_bursitis#/media/File:Prepatellar_bursitis.JPG Accessed on August 25, 2016</red>

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  Olecranon bursitis<ref> Wikipedia.Prepatellar bursitis. https://en.wikipedia.org/wiki/Bursitis#/media/File:Bursitis_Elbow_WC.JPG Accessed on August 25, 2016</red>

Bursitis Cause

Aseptic bursitis is commonly caused by prolonged pressure, overuse, or strenuous activity. Elbows and knees are the most commonly affected because they are rested upon more than many parts of the body with bursae and they also get the most repetitive use. Shoulder bursitis is more commonly due to overuse of the shoulder joint and muscles. Inflammation of bursae can also be caused by other inflammatory conditions such as rheumatoid arthritis and Spondyloarthritis. Gout and pseudogoutcan also be a cause of bursitis. Common causes of septic bursitis include Staphylococcus aureus, Staphylococcus epidermidis, and Streptococcus spp.

Bursitis Differential Diagnosis

Bursitis symptoms and signs are relatively non-specific. Even after detailed history and physical examination, imaging studies are often necessary to rule out other musculoskeletal conditions. Bursitis must be differentiated from tendonitis, cellulitis, osteoarthritis, ligamentous injuries, and septic arthritis.

Bursitis Epidemiology and Demographics

Bursitis accounts for 400 visits per 100,000 visits to primary care clinic. The exact prevalence and incidence of bursitis is unknown.

Bursitis Risk Factors

Common risk factors in the development of aseptic bursitis include diabetes, rheumatoid arthritis, osteoarthritis, gout, and pseudogout. Additionally, having a hobby or job that involves repetitive motions such as bicycling, playing baseball, gardening, or setting tiles may lead to bursitis.

Bursitis Screening

Screening for bursitis is not recommended.

Bursitis Natural History, Complications, and Prognosis

Bursitis is often caused by recurrent micro-trauma and overuse. Symptoms of bursitis may develop rapidly within 2 to 3 days in an acute form. It usually presents with edema, erythema, and tenderness over the involved joint. In most cases after adjustment of activities, bursitis will gradually clear within few days to weeks without. If left untreated, acute bursitis may lead to chronic bursitis which may result in cicatricial adhesions, reduced mobility, and progressive pain. With treatment and activities adjustment, septic and aseptic bursitis are associated with excellent prognosis.

Bursitis History

Complete history will help determine whether the bursitis is associated with any specific activities.

Bursitis Symptoms and Physical Examination

Type of Bursitis	Symptoms	Physical examination
Subacromial bursitis	Mid shoulder pain pain often worse at night Pain after repetitive activity (painting and throwing a ball) Popping sensation with shoulder movements	Redness, swelling, and warmth over the shoulder Shoulder stiffness Lateral or anterior shoulder tenderness on palpation Reduced active range of motion (ROM) with decreased elevation, internal rotation and abduction
Olecranon bursitis	Painful or painless focal swelling at the posterior elbow	Abrasion or contusion of skin (in a case of trauma) Swelling, at the posterior elbow Goose egg appearance over the olecranon process Tenderness for palpation at the affected site Systematic inflammatory processes Fever Rheumatoid nodules
Trochanteric bursitis	Pain in the lateral side of the hip with walking, running or stair-climbing Lower extremities weakness Pain with active and passive motion	Tenderness at lateral hip, aggravated by active and passive external rotation and abduction Lateral hip pain on direct palpation Weakness of the hip-abductors
Prepatellar bursitis	Reduced range of motion at the knee Focal swelling, pain, and redness Difficulty kneeling and walking	Erythema at the affected site (knee) Ususally very large swelling over the knee Tenderness aggravated by bending and stretching the knee Reduced active range of motion (ROM)
Retrocalcaneal bursitis	Swelling at the back of heel Pain at the back of the heel, especially when running uphill Pain while standing on tiptoes	Swelling at the back of heel Tenderness at the back of heel Painful ankle dorsiflexion

Bursitis laboratory findings

The diagnosis of bursitis is usually made clinically. There are no diagnostic lab findings associated with bursitis. However, patients with septic bursitis may have elevated ESR, CRP, and white blood cells.

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References

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