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 the inflammation of a bursa and buildup of fluid in the bursa sac.
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
The exact pathogenesis of aseptic bursitis is not fully understood. Bursitis commonly affect knee or elbow, from kneeling or leaning on the elbows longer than usual on a hard surface. The inflammation of bursa can be the result of following mechanisem:
- 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 is the result of 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. The most common bacteria to cause septic bursitis are Staphylococcus aureus and Staphylococcus epidermidis. 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.