Bursitis
Bursitis is inflammation of a synovial bursa, most often the olecranon or prepatellar bursa, and the first task is distinguishing aseptic (traumatic or crystal) bursitis from septic bursitis before treating.
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What this article covers
- Overview
Bursitis is inflammation of a bursa, the fluid-filled synovial sac that cushions a tendon, ligament, or muscle as it glides over bone.
- Epidemiology
Superficial bursitis predominates: olecranon and prepatellar bursitis are the most common presentations, reflecting the exposed location of these bursae over bony prominences.
- Risk factors
Repetitive pressure or friction: sustained elbow leaning, repeated kneeling, or repetitive joint motion overlying a bursa.
- Pathophysiology
Mechanical/traumatic bursitis: repetitive friction or direct impact injures the synovial lining, triggering a sterile inflammatory response with increased synovial fluid and bursal wall thickening.
- Clinical features
Localized swelling over a bony prominence with normal joint range of motion: the hallmark finding; the elbow or knee can be fully flexed and extended without pain, because the bursa lies outside the joint capsule.
- Differential diagnosis
Septic arthritis of the adjacent joint: unlike bursitis, produces pain with passive range of motion and effusion within the joint capsule; requires joint aspiration if suspected.
- Diagnosis
Bursitis is a clinical diagnosis established by the combination of localized swelling over a known bursal landmark with a full, pain-free range of motion of the adjacent joint; this single bedside…
- Management
First, determine septic versus aseptic status before choosing therapy, since glucocorticoid injection is contraindicated in suspected infection and antibiotics are unnecessary in confirmed aseptic bursitis.
- Complications
Progression to sepsis: untreated septic bursitis can progress to bacteremia and sepsis if not recognized and drained promptly.
- Prognosis
Aseptic traumatic bursitis generally resolves with conservative care within days to a few weeks once the inciting activity is modified.
- Prevention
Protective padding for at-risk occupations: elbow pads for prolonged leaning, knee pads for frequent kneeling (carpet laying, gardening, plumbing), to prevent recurrent mechanical bursitis.
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