Wikis > Orthopaedics > Bursitis


Inflammation of bursa – can be in deeper tissue or more superficially in subcutaneous tissues.
Bursa are formed at areas of friction or impingement to facilitate movement – they are closed, self contained, round, flattened sacs lined by synovium – contain small amount of synovial fluid. Can be classified as deep or superficial.

Bursa may become inflamed due to traumatic, inflammatory or infective processes. Traumatic causes include tissue damage from excessive shearing stress; trauma; chronic overuse; pressure over a bony prominence. Bursitis may also develop beneath a heloma durum. Inflammatory causes include rheumatoid arthritis and gout. Infections may also develop in bursa.

At sites of bursa, there is a loosening of the interposed fibroareolar tissue. The resulting ‘clefts’ in the tissues are filled with tissue fluid, forming small cavities that eventually organise to be surrounded by synovial tissue.
In acute cases trauma to the bursal wall result in the synovial membrane secreting a serous fluid when damaged. In chronic cases the bursal wall will thicken with proliferation of the synovium.
Infective bursitis develops following the introduction of microorganisms into the bursa --. increase in amount of synovial fluid.

Clinical Features
Inflammation, heat and redness (less pronounced in chronic case); localised pain; Swelling and tenderness; Direct and lateral palpation will be tender; An infective bursitis will be much redder, swollen and painful – lymphangitis may be present.

Differential diagnosis:
Periarticular tendonitis; muscle tears; synovitis; osteomyelitis; cellulitis

A fistula between the bursa and the surface may develop, allowing fluid to be released from the bursa.

Common sites for traumatic bursitis:
Site Common Name
Medial aspect of first MPJ Bunion
Lateral aspect of fifth MPJ Tailors bunion
Superficial retrocalcaneal Pump bump; Haglunds, winter heel
Plantar calcaneal
Deep retrocalcaneal
Dorsal IPJ’s
Tuberosity of navicular
Pre or suprapatellar Housemaids knee

Acute case will need rest, ice, compressions, immobilisations and possibly NSAID’s. Corticosteroids are sometimes used.

For chronic cases and after the acute phase is over:
Identify cause
Pressure relief/accommodative padding
Change mechanics

An infective bursitis will need draining, possibly antibiotics and rest.

Plantar calcaneal bursitis (Policeman’s heel)

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