BURSITIS


Inflammation of the synovium-like cellular membrane overlying bony prominences may be secondary to trauma, infection, or arthritic conditions such as gout, rheumatoid arthritis, or osteoarthritis. The most common locations are the subdeltoid, olecranon, ischial, trochanteric, semimembranous-gastrocnemius (Baker's cyst), and prepatellar bursae.

There are several ways to distinguish bursitis from arthritis. Bursitis is more likely than arthritis to begin abruptly and cause focal tenderness and swelling. Olecranon bursitis, for example, causes an oval (or, if chronic, bulbous) swelling at the tip of the elbow, whereas elbow joint inflammation produces more diffuse swelling. Similarly, a patient with prepatellar bursitis has a small focus of swelling over the kneecap but no distention of the knee joint itself. Active and passive ranges of motion are usually much more limited in arthritis than in bursitis. A patient with trochanteric bursitis will have normal internal rotation of the hip, whereas a patient with hip arthritis will not. Bursitis caused by trauma responds to local heat, rest, NSAIDs, and local corticosteroid injections.
Bursitis can result from infection. The two most common sites are the olecranon and prepatellar bursae. Acute swelling and redness at either of these two sites calls for aspiration to rule out infection. The absence of fever does not exclude infection; and onethird of those with septic olecranon bursitis are afebrile. A bursal fluid white blood cell count of greater than 1000/mcL indicates inflammation from infection, rheumatoid arthritis, or gout. In septic bursitis, the white cell count averages over 50,000/mcL. Most cases are caused by Staphylococcus aureus; the Gram stain is positive in two-thirds. Treatment involves antibiotics and repeated aspiration for tense effusions.

Chronic, stable olecranon bursa swelling unaccompanied by erythema or other signs of inflammation does not suggest infection and does not require aspiration. Aspiration of the olecranon bursa in rheumatoid arthritis and in gout runs the risk of creating a chronic drainage site, which can be reduced by using a small needle (25-gauge if possible) and pulling the skin over the bursa before introducing it. Applying a pressure bandage may also help prevent chronic drainage. Surgical removal of the bursa is indicated only for cases in which repeated infections occur. Repetitive minor trauma to the olecranon bursa should be eliminated by avoiding resting the elbow on a hard surface or by wearing an elbow pad.

A bursa can also become symptomatic when it ruptures. This is particularly true for Baker's cyst, whose rupture can cause calf pain and swelling that mimic thrombophlebitis. Ruptured Baker's cysts are imaged easily by sonography or MRI. In most cases, imaging is unnecessary because the cyst and an associated knee effusion are detectable on physical examination. It may be important to exclude a deep venous thrombosis, which can be mimicked by a ruptured Baker's cyst. Treatment of a ruptured cyst includes rest, leg elevation, and injection of triamcinolone, 20–40 mg into the knee (which communicates with the cyst). Rarely, Baker's cyst can compress vascular structures and cause leg edema and true thrombophlebitis.

1 comment:

  1. To learn more about Wrinkles Treatment in Delhi, please visit website at http://skindelhi.com/wrinkles.html

    ReplyDelete