The acute or chronic inflammation of a bursa.
A bursa is a sac containing a small amount of synovial fluid that lies between a tendon and either skin or bone to act as a friction buffer. There are >150 bursae in the body and these can be deep (e.g., the subacromial bursa) or superficial (e.g., the olecranon bursa).
In bursitis there is thickening and proliferation of the synovial lining, bursal adhesions, villus formation, tags, and deposition of chalky deposits. This may result from repetitive stress, infection, autoimmune disease, or trauma.
Key diagnostic findings are localised pain and tenderness over a bursa and swelling if superficially sited.
Treatment for non-septic bursitis involves modified physical activity, rest, and analgesia. Corticosteroid injections are reserved for those cases that do not respond to conservative management. Bursal excision is a last resort.
The first-line treatment for septic bursitis is aspiration and antibiotic therapy. Surgical debridement and lavage may be required.
Bursitis is an acute or chronic inflammatory condition of a bursa. A bursa is a jelly-like sac that usually contains a small amount of synovial fluid. A bursa lies between a tendon and either bone or skin to act as a friction buffer and facilitate movement of adjacent structures. Over 150 bursae are located throughout the human body. Some are superficial and more vulnerable; others are deeper and better protected. In primary care, bursitis most commonly presents in the knee, subacromial (subdeltoid), trochanteric, retrocalcaneal, and olecranon bursae.
History and exam
Key diagnostic factors
- pain at site of bursa
- tenderness to palpation at site of bursa
- decreased active range of motion
Other diagnostic factors
- presence of risk factors
- low-grade temperature (septic bursitis)
- erythema (septic bursitis)
- warmth of overlying skin (septic bursitis)
- painful arc on shoulder abduction (subacromial)
- lateral hip pain (trochanteric)
- pain at the extremes of hip rotation, abduction, or adduction (trochanteric)
- pain of contraction of the hip abductors against resistance (trochanteric)
- pseudoradiculopathy: pain radiating down the lateral aspect of the thigh (trochanteric)
- impalpable patella (prepatellar)
- palpable bump over heel (retrocalcaneal)
- occupation that causes mechanical stress on bursa
- rheumatoid arthritis
- gout or pseudogout
- penetrating injury
- osteoarthritis of the hip
- infection in a nearby joint
- lower limb length discrepancy
- iliotibial band contracture
- lumbar spondylosis
- valgus knee deformity
- low-riding shoes
- anatomical or functional impingement within the coracoacromial arch
1st investigations to order
- clinical diagnosis
Investigations to consider
- Gram stain and culture of fluid aspirate
- crystal analysis
- x-ray of affected region
Nicola Maffulli, MD, MS, PhD, FRCS(Orth)
Centre Lead and Professor of Sports and Exercise Medicine
Consultant Trauma and Orthopaedic Surgeon
Queen Mary University of London
Barts and The London School of Medicine and Dentistry
William Harvey Research Institute
Centre for Sports and Exercise Medicine
Mile End Hospital
NM is an author of a number of references cited in this topic.
Umile Giuseppe Longo, MD, MSc
Specialist in Orthopaedic and Trauma Surgery
Department of Orthopaedic and Trauma Surgery
Campus Bio-Medico University
UGL is an author of a number of references cited in this topic.
Vincenzo Denaro, MD
Professor and Head of Orthopaedic and Trauma Surgery
Dean of the Faculty of Medicine
Campus Bio-Medico University
VD declares that he has no competing interests.
Kelton Burbank, MD
University of Massachusetts Medical School
KB declares that he has no competing interests.
Franceso Oliva, MD, PhD
Specialist in Orthopedics and Trauma
Studi di Roma "Tor Vergata
FO declares that he has no competing interests.
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