Bursitis Disease

BASICS

DESCRIPTION

A bursa is a sac that is formed or found in areas subject to friction, such as locations where tendons pass over bony landmarks. Most common sites are subdeltoid, olecranon, prepatellar, trochanteric, radiohumeral. They essentially lubricate the region with synovial fluid. Large bursae usually communicate with joints and are responsible for retaining the synovial fluid in place. Bursae are fluid-filled sacs that serve as a cushion between tendons and bones. Bywaters, an English rheumatologist, found at least 78 bursae symmetrically placed on each side of the body.

System(s) affected: Musculoskeletal
Genetics: N/A
Incidence/Prevalence in USA: Common. Traumatic bursitis more likely in patients less than 35 years of age.
Predominant age: 15-50 years (most common in skeletally mature)
Predominant sex: Males > Females

SIGNS AND SYMPTOMS

Includes pain/tenderness
Decreased range of motion of affected region (rare except at shoulder)
Erythema if infection present
Swelling
Crepitus sometimes found

CAUSES

Bursitis may be acute or chronic, and its etiology is often unknown
There are many types of bursitis, including infectious, traumatic, inflammatory or gouty
Less often rheumatoid disease or TB as well as gout and pseudogout

RISK FACTORS

Individuals who engage in repetitive and vigorous training or others who suddenly increase their level of activity (e.g., "weekend warriors"). Also, improper or over-zealous stretching may lead to injury.

DIAGNOSIS

LABORATORY

Following will all help in differentiating soft tissue disease from rheumatic and connective tissue disease:

CBC
ESR
Serum protein electrophoresis
Rheumatoid factor (RF)
Serum uric acid
Calcium
Phosphorus
Alkaline phosphatase
VDRL
Joint fluid analysis (when available)

Drugs that may alter lab results:

ESR may be increased with coexistent use of dextran, methyldopa, methysergide, penicillamine, theophylline, vitamin A
ESR may be decreased with coexistent use of quinine, salicylates, and drugs which cause a high glucose level

Disorders that may alter lab results: Pre-existing cardiac disease

PATHOLOGICAL FINDINGS

Acute - with early inflammation, bursa is distended with watery or mucoid fluid
Chronic - bursal wall is thickened and inner surface is shaggy and trabeculated. The space is filled with granular, brown, inspissated blood admixed with gritty, calcific precipitations. Upper extremity tendonitis and bursitis are usually the result of repetitive microtrauma, probably resulting in disruption of fibers leading to pain, spasm and disability.

SPECIAL TESTS

ECG (if shoulder pain mimics cardiac pain)

IMAGING

CT or MRI
Calcific deposits may be seen on plain x-ray

DIAGNOSTIC PROCEDURES

Aspiration of swollen bursa and evaluation of synovial fluid
The clinician must differentiate infected from inflammatory bursitis. Fluid analysis and culture help make the diagnosis. If the gram stain and culture yield an infective cause, treat with appropriate antibiotics. If the etiology is inflammatory, give local care.

TREATMENT

APPROPRIATE HEALTH CARE

Outpatient; refer only difficult cases

GENERAL MEASURES

Conservative therapy consists of rest, ice and local care, elevation, gentle compression (often referred to as RICE therapy [rest-ice-compression-elevation])
Physical therapy/hydrocollator treatments
Invasive therapy would include aspiration of the bursa, injection of steroids
Have patient wear a triangular sling to protect arm and support shoulder
Treatment of any underlying infection

SURGICAL MEASURES

In severe cases, possibly surgical excision

ACTIVITY

Rest and elevation of affected extremity

DIET

Consider changes if bursitis directly related to obesity/crystalline deposition

PATIENT EDUCATION

Advice concerning prevention via appropriate warm-up and stretching and avoidance of repetitive injury
Possible life-style changes to prevent recurrent joint irritation

FOLLOW UP

PREVENTION/AVOIDANCE

Appropriate warm-up and cool-down maneuvers, avoidance of overuse or inadequate rest between workouts
Range of motion exercises
Maintain high level of fitness and general good health

POSSIBLE COMPLICATIONS

Acute bursitis may progress to chronic
Severe long-range limitation of motion

EXPECTED COURSE AND PROGNOSIS

Most bouts of bursitis heal without sequelae
Repetitive acute bouts may lead to chronic bursitis necessitating repeated joint/bursal aspirations or eventually surgical excision of involved bursa

MISCELLANEOUS

ASSOCIATED CONDITIONS

Tendinitis
Sprains, strains
Associated stress fractures

AGE-RELATED FACTORS

Pediatric: Look for other causes
Geriatric: More common
Others: N/A

PREGNANCY

N/A

OTHER NOTES

N/A

ABBREVIATIONS

N/A

Clinical Investigations

ROLE OF HOMOEOPATHY

Holistic healing that treats the person, not just the disease. Experience gentle, lasting wellness with expert constitutional care.