Chapter 158 Bursitis

Question 1

What is the definition of a bursa?

Answer 1

A sac lined with a membrane that produces and contains synovial fluid

The viscous fluid provides lubrication and facilitates smooth movement between tissues of an extremity.

Question 2

What is bursitis?

Answer 2

A pathologic inflammatory disorder of the bursa

It may be caused by trauma, repetitive injury, autoimmune diseases, crystal deposition, and infection.

Question 3

Which areas of the body are most commonly affected by bursitis?

Answer 3

• Shoulder
• Elbow
• Hip
• Knee
• Heel

Swelling and pain are the most common reasons for seeking medical care.

Question 4

What are the risk factors for the development of bursitis?

Answer 4

• Acute trauma
• Repetitive injury
• Infections
• Gout
• Pseudogout
• Uremia
• Rheumatoid arthritis
• Tuberculosis
• Diabetes mellitus
• Immunosuppression

Septic bursitis is often seen in the olecranon and prepatellar bursa.

Question 5

What are the four major bursae around the shoulder?

Answer 5

• Subacromial (subdeltoid)
• Subcoracoid
• Subscapular
• Scapular

Subacromial bursitis is the most common type of upper extremity bursitis.

Question 6

What is the most common presenting complaint of patients with shoulder bursitis?

Answer 6

Anterior or lateral shoulder pain

Pain is exacerbated by overhead activities and may interrupt sleep.

Question 7

What are the Neer and Hawkins impingement signs used for?

Answer 7

To indicate impingement or inflammation of the subacromial bursa and potentially the rotator cuff

These signs are the most sensitive and specific for subacromial bursitis.

Question 8

What is the location of the olecranon bursa?

Answer 8

On the extensor aspect of the elbow, overlying the olecranon process and triceps tendon

Visible posterior elbow swelling is easily recognized because the bursa is very superficial.

Question 9

What are the common features of septic olecranon bursitis?

Answer 9

• Tenderness
• Erythema
• Warmth

One-third of all cases of olecranon bursitis are septic.

Question 10

What is the most common type of hip bursitis?

Answer 10

Trochanteric bursitis

It affects females more than males and is common in running athletes.

Question 11

What are the major structures of bursae around the hip?

Answer 11

• Trochanteric
• Iliopsoas
• Ischiogluteal

Hip bursitis can result from trauma, muscle and tendon overuse, degenerative changes, or systemic disease.

Question 12

What is the common cause of prepatellar bursitis?

Answer 12

Activities that require excessive kneeling

It is also known as ‘housemaid’s knee’.

Question 13

What are the two clinically significant bursae in the posterior heel?

Answer 13

• Retrocalcaneal bursa
• Posterior calcaneal bursa

Calcaneal bursitis is often seen in ice skaters and long-distance runners.

Question 14

What is the usual presentation of calcaneal bursitis?

Answer 14

History of new or poorly fitting shoes causing heel pain

Patients may report limping.

Question 15

What is the initial diagnostic testing for bursitis?

Answer 15

Plain radiography

It is used to exclude the presence of arthritis, foreign body, soft tissue abnormalities, or underlying bony pathology.

Question 16

What is the essential diagnostic procedure if septic bursitis is suspected?

Answer 16

Bursal fluid aspiration

A white blood cell count, crystal analysis, and glucose should be evaluated.

Question 17

What is the initial diagnostic imaging for bursitis?

Answer 17

• X-ray studies
• Ultrasound

Initial diagnostics may include plain radiography to exclude various conditions.

Question 18

What laboratory tests may be performed on bursal fluid?

Answer 18

• White blood cell count
• Crystal analysis
• Glucose
• Gram stain
• Culture

These tests are essential in patients with systemic symptoms or suspected septic bursitis.

Question 19

What are the priority differential diagnoses for bursitis?

Answer 19

• Septic bursitis
• Fracture
• Trauma
• Arthritis
• Neoplasm

Consideration of patient age and symptoms can help narrow these differentials.

Question 20

True or false: Bursal aspiration should be performed after starting antibiotics for septic bursitis.

Answer 20

FALSE

Aspiration should ideally be completed before antibiotics are started to improve symptoms and reduce bacterial load.

Question 21

What are the nonpharmacologic management strategies for bursitis?

Answer 21

• Aspiration
• Cold and heat therapy
• Activity modification
• Joint protection

These strategies aim to alleviate pain and reduce inflammation.

Question 22

What medications are commonly used for pharmacologic management of bursitis?

Answer 22

• Nonsteroidal antiinflammatory drugs (NSAIDs)
• Antibiotics (for septic bursitis)
• Local corticosteroid injections

NSAIDs help manage pain and inflammation, while antibiotics target infections.

Question 23

What are the contraindications for bursa aspiration and injection?

Answer 23

• Cellulitis at the injection site
• Primary coagulopathy
• Septic effusion
• More than three previous injections at the same site
• Suspected bacteremia

These contraindications help prevent complications during the procedure.

Question 24

What are the potential complications of corticosteroid therapy?

Answer 24

• Postinjection flare
• Arthropathy
• Tendon rupture
• Skin atrophy
• Transient elevations in blood sugar

Patients should be informed about these risks before treatment.

Question 25

What is the purpose of **bursa aspiration and injection**?

Answer 25

* Obtain bursal fluid for evaluation * Drain abnormal fluid accumulation * Manage inflammation with local anesthetics and corticosteroids ## Footnote These procedures help relieve pain and determine the cause of inflammation.

Question 26

What should be included in **patient education** regarding bursitis?

Answer 26

* Modify or avoid exacerbating activities * Use protective pads for joints * Rest during acute processes * Start gentle stretching and range-of-motion exercises ## Footnote Education is crucial to prevent recurrence and manage symptoms effectively.

Question 27

What is the **role of ultrasonography** in diagnosing bursitis?

Answer 27

Determine if the bursa is involved in significant swelling ## Footnote Ultrasound is operator dependent and useful for identifying related pathologies.