Upper limb sites
Common. 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)
- 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
- 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
- Infection common (minor trauma).
- Aspirate if diagnosis unclear
Hip / Pelvis
- Ant to hip joint and lesser trochanter, and beneath iliopsoas tendon.
- 10% communicate with hip joint.
- Gradual onset medial thigh pain, worse with hip hip extension and int. rotation.
- Tenderness lateral to femoral artery
- Superficial and deep to tensor fascia lata - 40 - 60 yo women
- Aching pain over bursa radiating to TFL area (especially with walking up stairs)
- Gr. Trochanter tenderness and pain with resisted hip ab/adduction
- Patrick Fabere test painful, hip flex / ext normal
- Beware rheumatoid arthritis
- Buttock pain prolonged sitting and direct pressure ischeal tuberosity.
- DDx sciatica
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
- Inflammation after direct trauma (fall) or repeated friction (kneeling)
- Pain with palpation and knee flexion ---Knee joint must be normal
- Triggered by kneeling
- DDx Osgood Schlatter in teenager
- Around Achilles tendon insertion
- Poor footwear or overuse in athletes
- Beware sepsis