Bursitis of the Knee, Hip, Elbow and Shoulder

Courtesy: Prof Nabil Ebraheim, University of Toledo, Ohio, USA

BURSITIS:
The bursa is a thin sac containing minimal fluid that lubricates the tissue to decrease friction.
These bursa are present where friction normally occurs between bones, muscles and tendons.
When the bursa is irritated, inflamed and painful, the condition is called bursitis.

Types of bursitis::
I. Prepatellar knee bursitis
II. Trochanteric hip bursitis
III. Olecranon bursitis
IV. Subacromial shoulder bursitis

KNEE BURSITIS

• The knee has a small bursa in front of the patella and when the bursa becomes inflammed, it is called bursitis, which causes pain, swelling, tenderness and a lump in the area on the top of the knee cap.
• It may be difficult to kneel down due to the tenderness and swelling.
• Sometimes knee bursitis can occur from occupational kneeling, like carpet layers, tilers and wrestlers.
• Try to look into any break in the skin in the area of the bursa -A red, hot, painful, swollen bursa is a sign of possible infection.
• Wrestlers can have abrasion of the knee and this can lead to knee bursitis that may be infected.

Treatment:
•Anti-inflammatory medications
• Ice therapy
• Aspiration
-If infection is suspected or confirmed.
– Aspirate first before you give antibiotics and send the fluid for culture and crystals.
• Surgery
– Debridement and excision of the bursa may be needed.

 

HIP BURSITIS

• Hip bursitis is called trochanteric bursitis.
• it is lateral hip pain over the greater trochanter, which is aggravated by direct pressure or movement of the hip.
• The patient can identify the exact location of the pain outside the hip area.
• Examination will show tenderness over the greater trochanter.
• Trochanteric bursitis could be associated with iliotibial band syndrome.
• Rule out gluteus medius tear.
• Pain from a gluteus medius tear can mimic pain from greater trochanter bursitis.

OLECRANON BURSITIS

• Elbow bursitis is sometimes called olecranon bursitis, which can cause pain, swelling, tenderness and a lump in the area at the tip of the elbow.
• It may be difficult to put the elbow down onto a surface due to the tenderness and the inflammation.
• Bursitis of the elbow can occur due to many factors including inflammation, trauma, infection, or medical conditions such as gout and rheumatoid arthritis.
• The normal olecranon bursa provides protection and decreased friction to the elbow area.It contains a little fluid, and when this fluid increases it can be painful and this is called bursitis.

Treatment:
• Anti-inflammatory medication
• Ice
• Aspiration- Send the fluid for cultures and for crystals.
• Antibiotics- If infection is suspected.
• Surgery
– Debridement and excision of the bursa.

SHOULDER BURSITIS (subacromial bursitis)

• Shoulder bursitis is also called subacromial bursitis.
• It is a condition caused by inflammation of the subacromial bursa.
• This bursa separates the supraspinatus tendon (rotator cuff muscle) from the acromion.
• This bursa aids in the motion of the supraspinatus tendon of the rotator cuff in overhead activities.
• The patient with bursitis will complain of decreased motion and painful overhead activities.
• Shoulder bursitis is a common source of pain in the shoulder.
• You will find it in about 50% of all patients who come to the doctor with a complaint of a shoulder problem.
• It is really an irritation of the rotator cuff and it can lead to break down and tear of the tendon (could be an overuse syndrome).

Treatment:
• Therapy
• Anti-inflammatory medication
• Injection
– Either blind injection or ultrasound guided injection.