Bursitis is a disease of the musculoskeletal system, which is characterized by a lesion of the synovial sac (periarticular) with the accumulation of exudate (articular fluid). Most often it develops as a result of injuries, permanent mechanical irritation or has an infectious nature.
CAUSES OF BURSITIS
Injuries, hematomas
Purulent inflammatory processes – osteomyelitis, bedsores in severe patients, carbuncles, boils, erysipelas
Staphylococcus aureus and all diseases caused by it
Diabetes mellitus
Taking steroid medications
Gout
Scleroderma
Rheumatoid arthritis
Reactive arthritis
Constant mechanical irritation – professional features, athletes
CLASSIFICATION OF BURSITIS
Elbow, knee, shoulder, ankle – according to the localization of the process
Acute, subacute, reactive, chronic – along the course of the process
Specific and non–specific – according to the characteristics of the pathogen
Serous (fluid), purulent (accumulation of pus), hemorrhagic (accumulation of blood), fibrinous (accumulation of fibrin) – by the nature of the exudate
Aseptic, infected bursitis – by the presence or absence of the pathogen
symptoms
Localized swelling forms in the area of the affected joint, painful, local hyperemia occurs on palpation. The swelling is elastic. The patient complains of pain when moving in this joint, sometimes fever and malaise. During examination and palpation, a symptom of fluctuation is detected – the presence of excess fluid in the edema. Movements in the joint are limited. With the further development of bursitis, symptoms worsen, fever can reach critical figures (up to 40-41 degrees), pain is pronounced, movements in the joint are almost impossible. In the most severe cases, bursitis is complicated by a purulent lesion of the surrounding soft tissues – phlegmon. With adequate treatment, the symptoms quickly subside and complete recovery occurs, however, sometimes the process first turns into subacute bursitis, then takes on a chronic character. In chronic bursitis, the swelling is soft, has a rounded shape. Soreness and swelling of the affected joint are absent, and movements are not disturbed.
COMPLICATIONS
With purulent contents – the formation of fistulas
Osteomyelitis
Polyarthritis, arthritis
Sepsis
diagnostics
Interview and examination by a doctor
Infectious, family and somatic history
Puncture of an inflamed joint, taking fluid to determine the pathogen, as well as sensitivity to antibacterial drugs
Bacteriological studies, serological reactions in case of suspicion of specific bursitis (gonococcal, spirochete)
Differential diagnosis with arthritis – the presence of movement restriction in the joint significantly or completely
Radiography, magnetic resonance imaging – previously recognition of deep bursitis, auxiliary diagnostics, determination of the nature of damage in superficial bursitis
treatment
Aseptic bursitis – complete rest, cryopackage, an ice bubble on the affected joint. Anti–inflammatory drugs are prescribed, with pronounced pain syndrome – painkillers. In severe cases and with a large accumulation of fluid – puncture of the joint and removal of fluid, as well as intra-articular administration of glucocorticosteroids.
In the presence of infectious processes – antibacterial therapy, taking into account the sensitivity of the pathogen, drainage and washing of the joint bag with antibacterial solutions and antiseptics is possible.
In the most severe cases, surgical excision of the bursa is used, further PHO and treatment similar to treatment for purulent wounds.
Treatment of chronic bursitis largely depends on the localization. Surgical operation is most often indicated – excision of the synovial sac, removal of the affected tissues.
