Bursitis



Upper limb sites

SubAcromial BursaCommon. Remember to check a BM in all patients to help exclude diabetes

Beware the immunocompromised patient. Primary bursitis may originate from rheumatoid arthritis, gout or infections. Secondary bursitis may arise from inflamed nearby structures (e.g. subacromial bursitis from rotator cuff tendonitis)

Management

  • Request help from ED duty doc if needed
  • If grossly infected, treat like an abscess - incise and drain.
  • Send sample in blood culture bottle and copy results of culture to GP.
  • If pus aspirate refer orthopaedics on-call

If unsure of infection Olecranon bursitis

  • Aspirate
  • Send minimum 1ml of fluid in a "FBC" bottle for white cell analysis.
  • High neutrophil count probably indicates infection (BMJ article) for which a course of Flucloxacillin
  • Send sample in blood culture bottles and copy result to GP
  • Advise rest, give Ibuprofen and refer to the GP for follow up

See [BestBets] for further details on aspiration. 

Subacromial (subdeltoid) bursitis

  • Deep shoulder ache
  • Tenderness below acromion which eases with shoulder abduction

Olecranon bursitis

  • Infection common (minor trauma).
  • Aspirate if diagnosis unclear

Hip / Pelvis

Bursa around the hip region

Iliopsoas bursitis

Trochanteric bursitis

Ischial bursitis


Anserine bursitis diagramAnserine1

Anserine bursitis (goose foot)

  • Pain at insertion sartorious, gracilis and semitendinosus into prox. tibia
  • Women with OA knee (± NIDDM), pain inner knee / thigh climbing stairs
  • Tender bursa 5cm below med joint line knee
  • DDX MCL sprain
  • R. I. C. E ± steroid injection

Prepatellar bursitis

  • Inflammation after direct trauma (fall) or repeated friction (kneeling)
  • Pain with palpation and knee flexion ---Knee joint must be normal

Infrapatellar bursitisPre-patellar bursitis

Calcaneal bursitis

  • Around Achilles tendon insertion
  • Poor footwear or overuse in athletes
  • Beware sepsis

Content by Dr Íomhar O' Sullivan 23/06/2003. Reviewed by Dr ÍOS 30/07/2003, 18/09/2004, 02/02/2007. Last reviewed ÍOS 28/05/21.