Bursitis
Overview
A bursitis is an inflamed (itis) bursa. It often appears as a swollen fluid filled sac. It can cause chronic discomfort, or be a source of acute discomfort in the case of a sudden flareup. A bursitis originates from irritation or inflammation of a normal bursa.
Bursae (plural of bursa) are normal fluid filled sacs found commonly throughout the body. Bursae are non-painful and very thin –usually only a few cell layers thick. Typically, a bursa occurs anywhere two structures rub across each other. So, a bursa will often be present when a tendon or muscle rubs across another structure such as a bone. Bursae seems to exist to make the movement of the two structures smoother with less friction. The lining of the bursa contains synovial cells that secrete lubricating fluid into the bursa.
A bursitis occurs when the thin bursa becomes irritated, enlarges, and becomes painful. Bursitis usually form secondary to some irritation. This can be from a localized trauma, repetitive irritation, or even an infection. When a bursitis develops the lining of the bursa thickens, and a much greater volume of synovial fluid is secreted into the bursal sack. The bursitis is essentially a painful spongy bag of fluid surrounded by a thickened synovial lining. The increase in size and associated inflammation often creates localized discomfort.
Examples of How a Bursitis can Develop
- Traumatic bursitis: If someone bangs their elbow on a table the olecranon bursa will be traumatized and may respond by thickening and secreting more fluid into the bursa, creating a painful olecranon bursitis.
- Bursitis from repetitive irritation: Repetitive movement of soft tissue over the outside of the hip bone (greater trochanter) can lead to a painful greater trochanteric bursitis.
- Infected (septic) Bursitis: Sometimes an existing bursitis becomes infected. For example, a bursitis can form where the soft tissue runs over the kneecap (pre-patellar bursitis) and certain situations may become infected. This would be an example of a septic bursitis. Fortunately, an infected bursitis is much less common than a regular bursitis that is painful and inflamed for other reasons.
Treatment of Bursitis
Non-Operative Treatment
Most bursitis can be treated conservatively by relieving the trauma or local irritation. The specific treatment depends on the location of the bursitis. Modifying activities, physical therapy, anti-inflammatory medication, and a possible cortical steroid injection are all potential treatment options.
Surgical Treatment
Most cases of bursitis will not require surgery. Indications for surgery may include:
- A chronic painful bursitis that does not respond to conservative treatment: In this situation respecting the bursa may be beneficial. This can occur in a variety of areas, particularly with olecranon bursitis and pre-patellar bursitis.
- Removing the bursitis as part of a larger operation: Another indication for surgery on a bursitis is when cleaning out (debriding) a bursa is performed as part of bigger operation. For example, if surgery is performed to address a painful insertional Achilles tendonitis, the associated bursa that forms between the Achilles insertion and the nearby heel bone (retrocalcaneal bursitis) is often removed.
- An infected bursitis: An infected bursa can create the equivalent of an abscess where the infected area does not have an adequate blood supply. In this case surgery is required in order to remove this infected tissue.
July 12th, 2024