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 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, abnormal 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.[1][2][3]
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 commonly affect knee or elbow, from kneeling or leaning on the elbows longer than usual on a hard surface.
- Aseptic bursitis can be caused by following mechanism:[3]
- Injuries, overuse, and repetitive stress to the joint
- Abnormal bony structures or soft-tissue changes that affect the movement of the joint.
- Bursitis commonly affect knee or elbow, from kneeling or leaning on the elbows longer than usual on a hard surface.
- Crystal deposit in the bursa in patient with gout and pseudogout
Septic
- Septic bursitis can be caused by bacterial infection of the bursa by following routes:
- Through the 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 get infected with bacteria. Common location of septic bursitis include:
- Olecranon bursitis (in carpenters, athletes, or hemodialysis patients)
- Prepatellar or infrapatellar septic bursitis (in athletes and those with kneeling occupations)
- Ischiogluteal bursitis (in weavers and patients with spinal cord injury)
- 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, bursitis is characterized by edema, erythema in the area over the bursa.
- On gross pathology, thickened, erythematous and shaggy bursal wall with fibrinous exudates are characteristic finding of bursitis.
Microscopic histopathological analysis
- On microscopic histopathological analysis, chronic inflammation and scarring are characteristic findings of 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>
References
- ↑ Fauci, Anthony S., and Carol Langford. Harrison's rheumatology. McGraw Hill Professional, 2010.
- ↑ 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 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.