Bursitis
(Redirected from Bursitits)
Background
- Inflammation of a bursa (fluid-filled sac that reduces friction between tendons, bones, and skin)
- May be traumatic, overuse (repetitive microtrauma), infectious (septic bursitis), or inflammatory (gout, rheumatoid arthritis)
- Olecranon and prepatellar bursae are most commonly affected in the ED
Types by Location
- Shoulder: Subacromial bursitis
- Elbow: Olecranon bursitis
- Knee:
- Hip bursitis: Trochanteric, iliopsoas, ischial, iliopectineal
- Ankle: Retrocalcaneal bursitis
Clinical Features
- Localized swelling, warmth, tenderness over the affected bursa
- Pain with direct pressure or movement of adjacent joint
- May have limited range of motion
- Red flags for septic bursitis: fever, overlying cellulitis, significant erythema, history of penetrating trauma or immunocompromise
Evaluation
- Clinical diagnosis in most cases
- Aspiration (bursocentesis) if concern for septic bursitis:
- Cell count, Gram stain, culture, crystal analysis
- WBC >2,000/μL with >50% PMNs suggests infection (lower threshold than septic arthritis)
- X-ray to rule out fracture or foreign body if trauma history
Management
- Non-septic: Rest, ice, compression, NSAIDs, activity modification
- Septic: Antibiotics covering Staphylococcus aureus (most common organism), serial aspiration or surgical drainage
- Avoid corticosteroid injection until septic bursitis is ruled out
Disposition
- Discharge non-septic bursitis with RICE, NSAIDs, and PCP follow-up
- Septic bursitis: outpatient antibiotics if mild, admit if systemically ill or immunocompromised