Bursitis

Presentation

Following minimal trauma or repetitive motion, a nonarticular synovial sac or bursa protecting a tendon or prominent bone becomes swollen and possibly painful, inflamed, and fluctuant. It may be nontender or tender. The elbow, hip, knee, and shoulder are most commonly involved unilaterally.

Olecranon bursitis of the elbow can be caused by trauma from a direct blow (often only causing acute hemorrhage into the bursa), chronic crushing friction from prolonged leaning on the elbows, crystal deposition (gout), systemic diseases (rheumatoid arthritis, diabetes, systemic lupus erythematosus [SLE], alcoholism, uremia), or infection (usually from an overlying skin lesion or wound).

Trochanteric bursitis causes pain and tenderness that is greatest over the lateral hip. Active resistance to abduction of the hip may increase the pain.

Ischial bursitis can result from trauma or prolonged sitting on a hard surface. This causes buttock pain that may radiate down the back of the thigh. Palpation will reveal point tenderness over the ischial tuberosity.

Prepatellar bursitis , also known as housemaid’s knee, is caused by frequent or prolonged kneeling on hard surfaces. There may be marked swelling and tenderness over the anterior surface of the patella.

Pes anserine bursitis is located on the medial inferior aspect of the knee on the anterior medial aspect of the knee about 4 to 5 cm below the joint margin and just superior to the pes anserinus tendon. Inflammation of this bursa is common in overweight middle-aged and elderly women with knee pain. It is also seen in those people beginning an exercise program, distance runners, and individuals with osteoarthritis of the knee. The knee pain is worsened when climbing stairs, and there is tenderness to direct palpation over the area of the bursa.

Subdeltoid (or subacromial) bursitis can be the result of traumatic injury or chronic overuse of the shoulder, and it frequently accompanies other shoulder problems. A history of pain in the lateral shoulder, which can be severe with acute onset, and tenderness to palpation along the acromial border help make the diagnosis. Shoulder strength should be intact, although active strength testing may be limited due to pain.

Because there is no joint involved, there is usually little decreased range of motion, except in the shoulder, where bursitis can produce dramatic limitation. If the tendon sheath is involved, there may be some stiffness and pain with motion. Swelling is less evident when the bursa is deep, such as in the case of ischial bursitis.