Bursitis

term

A bursa (Bursa or bursa synovialis) is a sack-shaped structure that is filled with synovial fluid. These bursae are found in the musculoskeletal system primarily in places that are mechanically exposed to particularly high pressure loads. There they reduce the tensile and compressive forces and thus the friction between bones, skin, muscles and tendons.

Inflammation of the bursa (Bursitis) can result from injuries, permanent irritation (overload) or, less often, from an infection.

Bursitis often occurs in joints that are subject to high mechanical stress, such as the knee. But can also occur on the elbow, shoulder, hip or heel.

Read more information about this at: Bursitis on the heel, bursitis on the knee

Symptoms

With a bursitis there are typical signs of inflammation, mostly a strong one pain. Furthermore, it comes to over the affected area Redness, swelling, and overheating. If the inflammation is localized near a joint, one often occurs limited mobility. Only in rare cases the inflammation spreads to the entire body, causing general symptoms such as fever or lymph node swelling may occur.

root cause

Due to their function of absorbing pressure forces, the bursa become in a excessive stress first affected in the joint. On the one hand, this makes sense, as it e.g. the sensitive ones Joints against mechanical stress protect. By too big or permanent irritation the bursa can lead to bursitis (Bursitis) come.

Ask frequently Bad posture (e.g. on the hip) is the cause of such overload.

Another trigger of bursitis can be a accident be with a corresponding trauma. It comes here differently than with a permanent overload due to a bad posture due to a one-time violent event Destruction of various structures of soft tissue and boneswhich can cause inflammation of the bursa. A bursitis can also under certain circumstances rheumatic diseases occur. Here is the Rheumatoid arthritis (chronic polyarthritis), a systemic disease that affects the entire body. This disorder focuses on organs that are covered by the synovial membrane (Synovium) are coated. In addition to the joints and tendon sheaths, the bursa are also affected (Synovial bursa).

All the causes of bursitis mentioned so far cause the not septic form.

At the through Pathogens caused (septic) Form, however, the bursitis is usually caused by an infestation with pathogens bacteria caused. Often the causative bacterium is the Staphylococcus aureus, which is found in many people as otherwise peaceful residents of the skin or the upper respiratory tract. Often one will go septic Bursitis minor injuries or a bigger one trauma (see above), through which the pathogens enter the body and settle in the bursa, where they cause the typical signs of inflammation. The bacteria get into the whole from there blood circulation, so are systemic signs of disease like Fever or chills observed.

Diagnosis

The presence of bursitis can often be identified by an experienced doctor Eye diagnosis be asked. The appearance of Signs of inflammation how Redness, swelling, and pain The typical localizations of a bursitis (often hip, elbow, knee or shoulder) are groundbreaking.

In addition, in most cases the attending physician does one Ultrasound examination, where the inflammation-related Effusion visible and a reliable diagnosis can be made.

In some cases, a X-ray of the affected joint to exclude involvement of bony structures. However, this is the one caused by the X-ray device Radiation exposure should be noted, which is why children do not need an X-ray.

That is also becoming rarer blood examined when suspected bursitis. Above all, parameters that are unspecifically indicative of inflammation are checked here. This includes above all that C-reactive protein (CRP value) and the Sedimentation rate (BSG).

Is there any suspicion of a septic Bursitis, so can means of a Puncture of the Pathogen detected become. This is of great importance for the therapy so that a suitable antibiotic can be selected.

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treatment

Treatment of bursitis should be carried out as soon as possible after the doctor's diagnosis. The therapy options are diverse, although the decision should be based on the general condition of the patient, his preferences and the stage of the disease.

The therapy of aseptic and septic bursitis differs fundamentally in that with septic inflammation, in addition to treating the inflammation, the causative pathogen must also be combated.

In aseptic bursitis, where no pathogens are involved, protecting the affected joint is of great importance. The point here is to overload the bursa as the cause of its inflammation. By protecting the tissue, the inflammation can regress and the healing process can occur.

But even with a septic bursitis, the affected joint should be spared in order to avoid consequential damage after the inflammation has healed.

Another conservative method is the application of cold and warm compresses to stimulate blood circulation and thus speed up the healing process.

In terms of medication, NSAIDs (non-steroidal anti-inflammatory drugs) are the first choice because they fight both pain and inflammation. Frequently used representatives are aspirin (ASS), Ibuprofen or diclofenac. As these irritate the stomach lining, they should only be used in combination with stomach protection tablets in patients who have already suffered from a stomach ulcer. In any case, the drugs, even if they are over-the-counter, should only be taken on the advice of a doctor who is familiar with the appropriate dosage and duration of use.

If the bursitis is septic, the use of antibiotics is necessary. Choosing the right antibiotic can make it necessary to puncture the bursa. A puncture can also be used for therapeutic purposes: by draining purulent secretion, the joint is relieved and the patient feels an immediate improvement.

In the case of particularly resistant inflammation or a high level of suffering on the part of the patient, the bursa can also be rinsed with glucocorticoids (cortisone), which have a stronger anti-inflammatory effect than NSAIDs than ibuprofen.

As a rule, no surgical intervention is necessary for bursitis. This will only be considered if the mentioned conservative methods fail or if the inflammation is peracute (extremely rapid). In this case there is a risk of pathogens being washed out into the entire body circulation (sepsis), which can be life-threatening. Fortunately, such a course is rarely observed.

Even if the bursitis developed after an operation, surgical treatment is often recommended, as otherwise it may develop into a chronic course. In surgical therapy, on the one hand, endoscopic mirroring (similar to a joint mirroring) is used. The surgeon works in a minimally invasive manner, leaving the bursa in the joint. A clear advantage of this method is that by leaving the bursa in place, it can continue to fulfill its function and cushions the joint from excessive stress.

Another option is to cut out the entire inflamed bursa. By completely removing the inflammation, complete healing occurs quickly. However, the absence of the bursa can severely restrict joint function and make it more prone to wear and tear (osteoarthritis).

Read more on the topic: Bursitis surgery

You might also be interested in: Home remedies for bursitis

Healing and course

As a rule, bursitis heals relatively quickly and without complications with care and drug therapy. Dangerous, peracute courses with threatening sepsis are extremely rare. However, it is important to protect the structures around the inflamed bursa sufficiently, as otherwise it can become chronic, which can usually only be corrected surgically.

You might also be interested in: Duration of bursitis

Elbow

Bursitis occurs often on the elbow on and then will Olecranon bursitis called. The bursa on the elbow, which is just below the skin is located. The eponymous Olecranon it is the back of the ulna (Ulna), this protruding bone corresponds to the colloquial elbow. This bone lies just under the skin and is surrounded by little protective fat, which is why the Bursa (Bursa olecrani) this cushioning Should take over the task.

To Olecranon bursitis can it through for example mechanical overload come. This is how bursitis on the elbow becomes too "Student's elbow" called because the elbow is often supported on the table top when working at a desk. Also a Fall can lead to inflammation of the bursa in the elbow due to the formation of effusion and irritation of the surrounding structures.

It can also be used in the elbow septic bursitis come through, for example Cuts Pathogens get into the bursa and cause inflammation there. An olecranon bursitis is particularly noticeable through one painful swelling above the elbow (Olecranon) that very sensitive to touch is. Through the Effusion (Fluid build-up in the bursa) can swell up to a hen's egg. In most cases, olecranon bursitis can be resolved without any complications treat with the above therapy options.

knee

Bursitis occurs primarily in heavily stressed joints, including the knee joint. The bursae of the knee are particularly prone to inflammation due to their location just under the skin, similar to those in the elbow. There are three different bursae in the knee, all of which can be affected by inflammation. In prepatellar bursitis, the bursa that lies directly on the kneecap is affected. It acts as a buffer between the skin and the kneecap. In infrapatellar bursitis, the bursa just below the kneecap is inflamed. The pes anserinus burstis affects a bursa that is located just below the pes anserinus (goose foot). It is a common starting point for several thigh muscles on the inside of the knee.

Bursitis on the knee often occurs when there is strong mechanical stress, for example when kneeling down for a long time. This clinical picture is often found in certain occupational groups such as Encountered by tilers.

Furthermore, penetration of bacteria in the context of open injuries can lead to septic inflammation of a bursa in the knee.

Similar to the shoulder, chronic joint diseases can also lead to inflammation of a bursa on the knee. In addition to a resilient swelling (effusion), patients report rubbing pain, especially when moving the knee joint. Here, too, rest and rest (e.g. by elevating the affected leg) is of great importance for the success of the therapy.

Also read more on the topic: Bursitis on the knee and duration of bursitis on the knee

Bursitis of the shoulder

The bursitis in the shoulder will also be Subacromial bursitis and is a common clinical picture, especially in middle age. The bursa (Subacromial bursa) forms a Sliding layer for the shoulder muscles and separates it from the surface of the hard bone. If it comes to bursitis, it can no longer adequately fulfill its tasks, so that the muscles slide against each other, especially when moving the shoulder strong pain triggers.

In addition to a Swelling and redness is the so-called "Painful Arc" typical of subacromial bursitis. The patient feels here strong pain at the Raise the affected arm to 90 °In addition, the movement is painless again. The severe pain often leads to it Restrictions on movement.

There are many causes of subacromial bursitis. By many small traumas can it through one Tear of the bursa to inflammation come. It can go through less often open injuries come to septic bursitis. Also the so-called Impingement Syndrome can be causative by the Entrapment of the supraspinatus muscle for permanent irritation and inflammation of the neighboring bursa leads. Micro-scale depositsthat every person has at an advanced age can lead to inflammation of the bursa due to permanent irritation. Subacromial bursitis can also occur in the frame chronic joint diseases how arthrosis, rheumatoid arthritis or gout occur.

The bursitis in the shoulder can, insofar recognized early, good with conservative therapeutic measures be treated. Of the Immobilization The shoulder is of great importance here, as otherwise the constant straining of the bursa by the muscles prevents healing and threatens to become chronic.