Where does bursitis most often develop?
There are more than a hundred synovial bursae in the body, but mainly those that lie under the skin near the bony protrusions become inflamed. On the elbow, the bag suffers for those who lean on the table for a long time, on the knee - for people who work on their knees. The deep subdeltoid bursa becomes inflamed at the shoulder, and then the pain intensifies when raising the arm. In the hip and heel area, bursitis often accompanies tendon overuse in runners and overweight people.
- Elbow bursitis - "student's elbow", a soft lump on the extensor side
- Prepatellar bursitis - "housewife's knee", swelling above the kneecap
- Subdeltoid bursitis of the shoulder - pain when abducting the arm
- Trochanteric bursitis of the thigh - pain on the outer surface, worse when lying on your side
- Heel bursitis - pain at the insertion of the Achilles tendon
Causes and risk factors
Most often, the bag is damaged by mechanical pressure or monotonous movements: repairs, masonry, kneeling, rowing, tennis. Less commonly, bursitis becomes part of a systemic disease - gout, rheumatoid arthritis, psoriatic arthritis. Infectious bursitis occurs when germs enter the bursa through an abrasion or puncture of the skin; it develops quickly, with redness and fever. Diabetes mellitus, taking glucocorticoids and reduced immunity increase the risk of the purulent form.
- Prolonged pressure on the elbow, knee, heel
- One-time severe injury
- Overload in sports and at work
- Gout and Crystal Deposition
- Rheumatoid and psoriatic arthritis
- Infection through broken skin
Symptoms
The main symptom is a limited swelling of a soft or elastic consistency directly above the joint. It is mobile, painful when pressed, and the skin may be slightly warm. Unlike arthritis, the joint itself bends almost to its full extent, and pain appears when pushing or extreme movements. Chronic bursitis is manifested by a thickened, painless bursa, which periodically fills up after exercise.
- Round swelling over a bony prominence
- Pain with support and pressure
- Local warmth and slight redness
- Feeling of iridescent liquid
- Moderate limitation of movement
- In the purulent form - sharp pain, fever, chills
Diagnostics
In most cases, the diagnosis is made during examination. Ultrasound shows how much fluid is in the bursa, whether there is thickening of the walls and calcifications, and helps to distinguish bursitis from a cyst or tumor. X-rays are prescribed for injury and suspected bony prominence or salt deposits. Blood tests are needed when there are signs of inflammation or systemic disease. If the doctor suspects pus or gout, a puncture is performed: the fluid is sent for culture and examination for crystals.
- Inspection and functional tests
- Ultrasound of the joint capsule
- X-ray of a joint in case of injury and chronicity
- Complete blood count and C-reactive protein
- Uric acid for suspected gout
- Puncture of the bursa with culture if infection is suspected
- MRI in difficult cases
Treatment and prevention
Non-infectious bursitis is treated conservatively: the joint is unloaded, cold is applied in the first days, and soft protective pads are used. The doctor may prescribe anti-inflammatory drugs, and if there is a large volume of fluid, remove it by puncture and, if necessary, administer a glucocorticoid. Physiotherapy and exercise therapy speed up recovery and reduce the risk of recurrence. Purulent bursitis requires drainage and antibiotics. A chronic thickened bursa that interferes with work is sometimes removed surgically. Any injections and antibiotics are prescribed only by a doctor.
- Unloading the joint and refusing to rely on the sore spot
- Cold for the first 48 hours, then warm
- Knee pads and elbow pads when working
- Anti-inflammatory drugs as prescribed by a doctor
- Puncture and fluid evacuation
- Physiotherapy, shock wave therapy, physical therapy
- Bursectomy for persistent chronic bursitis