What is Bursitis?

Bursitis is an inflammation of the bursa. Our joints are composed of bones articulating with one another. To ensure that there is no friction between the bones and the ligaments connecting the bones, there are numerous fluid-filled sacs that act as a lubricating oil and shock absorber. These sacs are called bursa. If there were no bursa, movement across joints will be painful. Bursitis is one such painful condition.

Causes, Incidence and Risk Factors

Bursitis may occur because of irritation or infection. Bursitis caused by irritation occurs when a particular bursa is under constant pressure. For example, in the case of a housemaid involved in hard work, standing and kneeling throughout the day, the bursa of the knee becomes swollen giving rise to a Housemaid's Knee. Similarly, Clergyman's Knee, Tailor's Ankle and Weaver's Bottom are all caused by bursitis. A custodian using a vacuum cleaner uses his elbows extensively and repetitively. This leads to the development of olecranon bursitis (Student's Elbow). Bursitis also occurs with other underlying conditions like gout, when crystals collect within the bursa sac (joint space). These crystals reduce how easily the bones move across one another and cause further irritation.

Bursitis can also develop as a result of infection. Tuberculosis is an uncommon cause. Traumatic injury, such as a fall on a limb, can also produce bursitis. Systemic inflammatory conditions like rheumatoid arthritis increase the risk of developing a bursitis.

Risk factors:

• Trauma
• Repetitive work
• Infection
• Gout
• Rheumatoid arthritis
• Bony abnormalities

Signs and Symptoms

• Pain
• Swelling of joint spaces
• Pain and limitation of extremities of motion of the underlying joint
• Localized tenderness directly over the inflamed bursa

Screening and Diagnosis

Bursitis is usually diagnosed clinically, but further investigations are needed to ascertain the cause of bursitis and rule out any complications.

• An X-ray is taken to rule out other causes of pain like bone infection and fractures.
  
  
• Aspiration of the fluid within the bursa is done to look for any offending pathogens, gouty crystals and immune cells.
  
  
• A spinogram is done to know the state of the bursa and other structures nearby.

Treatment

• In acute cases, padding of the affected joint prevents excessive pressure and irritation.
  
  
• In the case of bursitis due to repetitive use, draining out the swollen, inflamed bursa and injecting steroids can alleviate pain. Removal of excessive fluid from the joint (joint aspiration) is done with a sterile needle and syringe and can be performed in the doctor's office.
  
  
• Antibiotics are used to treat bursitis caused by infection.
  
  
• Chronic, recurrent bursitis may require surgical removal of the bursa.

If a systemic cause is identified, steps should be taken to treat the underlying cause of bursitis first.

Outlook

Poorly treated bursitis can result in bone infection and joint erosion, resulting in increased pain and loss of movement. Acute bursitis resolves spontaneously whereas chronic slow-developing bursitis requires a physician's evaluation, treatment, and possible surgery.

Prevention

Avoid recurrent repetitive work. Shifting hands during work, changing postures and resting the affected joint adequately constitute some of the simple measures that can prevent bursitis from developing.

References

1. Affection of soft tissue, Outline of Orthopedics, 10th edition. John Crawford Adams Pages 113-114
   
   
2. Weinstein and Buckwalter, Turek's Orthopedics, principles and management, 5th edition. Pages 406-407, 586