How to distinguish bursitis from synovitis?

Bursitis and synovitis – these are inflammatory diseases that are accompanied by the accumulation of exudate.

Causes of disease development

• Traumatic impact.
• Infection.
• A complication of an allergic reaction in which the allergen penetrates into the joint capsule.
• Development of joint instability due to excess body weight.
• The presence of concomitant systemic diseases, for example, hemophilia, gout, arthritis, gonococcal infection.

Normally, the bursa should contain the optimal amount of fluid that lubricates the joint. This is required for shock absorption and to prevent damage to hard tissues, muscles, and fascia during movement. Pathologies are formed due to a combination of damaging factors:

• constant mechanical impact;
• decreased production of synovial fluid.

Typically, the pathology develops in athletes or other individuals whose professional activities involve increased stress on the musculoskeletal system. It often develops in the elbow or knee joints. An inflammatory process begins, which intensifies in the absence of timely treatment. An infectious agent can attach to the site of inflammation, causing suppuration.

Classification

For bursitis and synovitis, a detailed classification is distinguished. The pathology is divided depending on the area of ​​development of the damaging process: elbow, shoulder girdle, hip area, knee, ankle.

Division by type of course: acute, subacute, chronic.

Classification of pathogens in the presence of an infectious process:

• nonspecific form, that is, in the absence of identifying the exact type of pathogenic microorganism;
• a specific form formed as a complication of tuberculosis, syphilis, gonorrhea.

Division by type of exudate content:

• serous – there is no infection, fluid is released due to active inflammation, it contains formed elements;
• purulent – accumulation of fluid along with leukocytes and bacteria;
• hemorrhagic – release of copious amounts of red blood cells or whole blood;
• fibrous – release of fibrin threads.

Division depending on the presence or absence of infection:

• aseptic form – absence of bacterial infection;
• infectious form – the addition of bacteria with the formation of pus.

Synovitis has a separate allergic form. The reason is the accumulation of an allergen that affects the joints, causing inflammation.

Symptoms

Among the symptoms that are characteristic of the disease are:

• Pain syndrome, worsening during movement or after prolonged standing. At rest, the pain may be aching and not very pronounced.
• Swelling and redness of the joint, as well as surrounding tissues. The accumulation of fluid leads to the formation of fluid, irritation of the joint capsule and tendons with receptors, which triggers the inflammatory response. On palpation, a local increase in temperature is noted.
• Limitation of physical activity. Against the background of swelling and pain, there is a limitation in the range of motion. If a joint is involved in the pathological process, the patient may complain about the inability to support the affected limb.

Diagnostics

Making a diagnosis begins with clarifying the patient’s complaints, the conditions of their occurrence, the presence of concomitant diseases, heredity, as well as the effect of the therapy and the dynamics of the course.

The specialist performs an examination, assessing the condition of the skin, surrounding tissues, and the location of the lesion. Motor activity and palpable inflammation are determined.

Additional methods are prescribed:

• X-ray in two projections.
• Computed tomography.
• Joint puncture with laboratory testing of the resulting contents. In order to exclude resistance to therapy, antibiotic sensitivity testing is required.
• Biochemical и general clinical blood testsnecessary to assess the severity of the disease, and possibly identify an autoimmune cause.
• Blood test for the presence of antibodies to streptolysin if an infection caused by β-hemolytic streptococcus is suspected.

Complications

If the primary damaging factor persists, there are no timely treatment methods, various types of complications may develop:

• purulent arthritis – the formation of an infectious focus that emerges from the synovial membrane, moving around the joint;
• phlegmon – spread of the infectious focus into the fatty tissue with further suppuration of the surrounding soft tissues;
• panarthritis – purulent inflammation of the joint, ligaments and periarticular tissues together;
• sepsis – transition of an infectious focus into the systemic bloodstream;
• hydroarthrosis – accumulation of intra-articular fluid due to prolonged effusion, which becomes chronic;
• dislocation, subluxation – displacement of joint structures that develops as a result of excessive laxity during hydrothrosis.

All complications can be eliminated if you go through the stages of diagnosis and subsequent treatment in a timely manner. Therefore, when the first symptoms of the disease appear, they turn to an orthopedist.

Treatment

In order to achieve an effect, it is recommended to select a comprehensive treatment. It includes the use of local and systemic medications, as well as surgical procedures and physiotherapeutic procedures.

Medicines are prescribed in injection, tablet and local forms. The most common groups of drugs include:

• Nonsteroidal anti-inflammatory, aimed at relieving swelling, redness, pain and effusion.
• Antibiotics, if a bacterial infection is suspected.
• Corticosteroids. These drugs are prescribed in the absence of effect from non-steroidal anti-inflammatory drugs.
• Chondroprotectors.

If a large amount of exudate accumulates, a puncture is indicated to remove the fluid and wash the inflamed cavity with antiseptics or antibiotics.

When synovitis or bursitis develops, there are two types of treatment.

1. Outpatient. It is carried out when there is a slight inflammatory process, the accumulation of a small volume of fluid.
2. Stationary. Hospitalization is required if there is an injury or excessive fluid accumulation with the development of severe inflammation. The patient is placed in different departments depending on the type of injury. For example, if an injury develops, he is sent to the trauma department. In the presence of a purulent process, hospitalization in surgery is indicated.

If there are no signs of infection, the following treatment is prescribed:

• bandaging the affected joint to immobilize and place the limb in the desired position;
• conducting physical therapy methods – electrophoresis with local anesthetic, ultraviolet irradiation, UHF;
• phonophoresis, in which different types of drugs are administered for rapid action (anti-inflammatory drugs, glucocorticosteroids, hyaluronidase, potassium iodite);
• therapeutic puncture, that is, the collection of excess fluid (later it can be submitted for analysis of the contents).

When inflammation of the aseptic type becomes chronic, additional therapy is prescribed:

• treatment of the primary disease that caused inflammation, which is prescribed individually depending on the severity of the pathology and changes in the articular cavity;
• periodic punctures to pump out fluid;
• oral or injection administration of non-steroidal anti-inflammatory drugs, glucocorticosteroids, enzymes, cartilage extracts;
• prescription of physiotherapeutic methods – heating with paraffin, UHF, phonophoresis (they have a warming effect, thereby increasing blood flow and the supply of nutrients along with oxygen);
• if previous treatment methods are ineffective, surgical intervention is performed in which the membranes are partially or completely removed.

If the condition is complicated by an infectious process, treatment methods change:

• preliminary immobilization of the limb, which is placed in an elevated position;
• performing a puncture to remove purulent contents;
• in severe cases, aspiration is prescribed with periodic washing of the joint cavity with an antiseptic and antibiotic;
• if previous methods do not help, surgery is prescribed, in which the joint is opened for antiseptic treatment and drainage.

If you had to resort to surgery, there is a recovery period after it. Prolonged immobilization, the use of antibiotics and physiotherapy are indicated.

Prevention

To the main eventsthat help reduce the risk of developing diseases include:

• Prevention of tissue trauma.
• Follow a diet containing foods rich in collagen.
• Timely treatment of metabolic disorders and systemic pathologies.

In case of joint diseases, it is necessary to be regularly observed by specialists for timely correction of possible therapy.

Forecast

If synovitis or bursitis is detected in a timely manner and the correct methods of therapy are used, the prognosis for the disease will be positive. Even in severe cases, surgery can be performed to remove the lesion and allow for further rehabilitation.

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The information and price list posted on the site are not a public offer.

Wherever bones, tendons, or ligaments move and rub against each other, especially in the joint area, the points of contact are cushioned by small fluid-filled sacs called bursas. The bursae are lined with special cells called synovial cells that produce a fluid rich in collagen and protein. By reducing friction, each of these bags (there are about 150 of them in the body) helps the joints work, smoothly providing the necessary range of motion. The bursa allows for multi-vector movements in joints such as the shoulder, elbow, knee, femur, and ankle. Inflammation and swelling of the bursa is called bursitis.

Causes of bursitis

Excessive stress on the joint or injury, as well as prolonged stress, can cause inflammation of the periarticular bursa. The bag fills with excess fluid, which causes pressure on the surrounding tissue. The immediate first sign of bursitis is pain, often accompanied by redness, swelling and tenderness. This is a distinguishing feature of bursitis in contrast to tendinitis, which is inflammation of the tendon where the muscle tendon attaches to the bone. Age plays a certain role in the occurrence of bursitis, and the shoulder joint, which has the greatest range of motion among all joints, is most often susceptible to bursitis in older age. As a rule, pain from bursitis in the shoulder occurs after sleep and gradually regresses during the day (pain is usually localized in the upper part of the shoulder). Other areas where bursitis most often occurs are the area of ​​the elbow joints, the femoral joints of the knees and the area of ​​the thumb.

The main causes of bursitis are trauma, infections and rheumatological diseases.

Injury

Trauma can be both a provoking factor and directly lead to the development of bursitis.

Bursitis often develops due to the characteristics of a person’s work. Heavy physical work involving prolonged, repetitive, heavy work. The most common cause of chronic bursitis is a minor injury, such as to the shoulder when throwing a ball. Or, for example, prepatellar bursitis occurs from prolonged kneeling while washing floors.

It is also possible to develop acute bursitis from a blow, for example to the knee, which leads to the accumulation of blood in the bursa.

Infections

The bursae are located close to the surface of the skin and are often susceptible to infection as a result – such bursitis is called infected. The most common microorganism that causes bursitis is staphylococcus. People with weakened immune systems (diabetes patients, chronic alcoholics, patients taking corticosteroids for a long time) are most susceptible to infected bursitis. In 85% of cases, infected bursitis occurs in men. Rheumatological conditions.

Rheumatological diseases

In various rheumatological conditions, secondary inflammation of the bursae is possible. In addition, diseases such as gout or pseudogout due to the deposition of salts in the bursa can cause the development of bursitis.

Symptoms

Common symptoms of bursitis include:

• Pain, inflammation, and swelling in the shoulder, elbow, hip, or knee, especially noticeable when straightening the joints.
• Stiffness or decreased range of motion in a joint with or without pain.
• Muscle weakness due to pain. Bursitis may cause pain and tenderness in the area of ​​the affected bone or tendon. The bags may increase in size, which may cause difficulty in movement. As a rule, bursitis occurs in the area of ​​the shoulder, elbow, knee and hip.

Shoulder

In the shoulder, the subacromial bursa (subdeltoid bursa) separates the supraspinatus tendon from the underlying bone and deltoid muscle. Inflammation of this bursa is usually the result of injury to surrounding structures, usually the rotator cuff. This condition limits the range of motion of the shoulder, resulting in “impingement syndrome” and is characterized by pain in the front and side of the shoulder. Discomfort is caused by raising the arm above the head and putting pressure on the shoulder.

The pain intensifies at night, the range of motion in the shoulder decreases and pain appears in certain areas.

Cubit

Bursitis at the tip of the elbow (olecranon) is the most common form of bursitis.

• Pain may increase in a bent elbow as pressure on the bursa increases.
• This type of bursitis most often has a post-traumatic nature and can be associated with both direct trauma and excessive rotation and flexion of the elbow (for example, when painting).
• Infection also occurs quite often with this type of bursitis.

Knee

• Prepatellar bursitis anterior kneecap. Swelling on the front of the kneecap can be caused by chronic trauma (such as from kneeling) or a blow to the knee. The swelling may appear within 7-10 days after a single blow to the area, usually from a fall. Prepatellar bursitis is also called priest’s knee or carpet cleaner’s knee.
• Popliteal bursitis located in the area where the three main tendons of the inner part of the knee are located. This type of bursitis occurs most often in patients with arthritis and these are usually middle-aged and overweight women. Popliteal bursitis manifests itself as pain when bending the knee and at night. Moreover, pain at night forces patients to sleep in certain positions in which the pain becomes less. In addition, this bursitis is characterized by an increase in pain when climbing stairs, possibly radiating along the inner surface of the thigh. Popliteal bursitis is also common among athletes, especially long-distance runners.

Ankle

Ankle bursitis occurs when the bursa under the Achilles tendon behind the heel becomes inflamed. Most often caused by local trauma associated with wearing ill-fitting shoes (often high heels) or prolonged walking

This bursitis can also be a consequence of Achilles tendonitis.

Bursitis in this part of the body often occurs as a consequence of excessive stress in young athletes, speed skaters, and in female teenagers who begin to wear high-heeled shoes. The pain is usually localized at the end of the heel and increases with movement of the foot.

Buttocks

Ischiogluteal bursitis (Ischiogluteal) is caused by inflammation of the ischial bursa, which is located between the base of the pelvic bone and the large buttock muscle (musculus gluteus maximus). Inflammation may be due to prolonged sitting on a hard surface or cycling. Ischiogluteal bursitis is also called weaver’s disease. Pain occurs when sitting and walking.

• There may be soreness in the pubic bone area, which gets worse when bending and stretching the leg.
• The pain may radiate down the back of the thigh.
• When pressure is applied to the area of ​​the inflamed bursa, acute pain appears.
• The pain is worse when lying down with the hips passively flexed.
• It may be difficult to stand on tiptoes on the affected side.

Hip

Iliopsoas muscle bursitis. This bursa is the largest and is located deep in the tissues of the hip near the joint. Bursitis in this location is usually associated with problems in the hip such as arthritis or hip injury

Pain from iliopsoas bursitis is localized in the anterior thigh, radiating to the knee and increasing with hip extension and rotation. ?Extension of the hip while walking causes pain so much that you have to shorten your step and limit the load on the leg. Possible pain in the groin area. Sometimes an enlarged bursa may resemble a hernia. Sensations such as tingling or numbness are also possible if sensory nerves are compressed by an enlarged bursa.

Acetabular bursitis (bursitis trochanteric) is located in the upper part of the femur and occurs, as a rule, in overweight, middle-aged women. Acetabular bursitis manifests itself as pain in the lateral thigh radiating to the buttocks or knee. The pain intensifies when moving local pressure or stretching the leg. The pain gets worse at night and prevents you from sleeping on the affected side. Considering that bursitis can be infectious and treatment with antibiotics or puncture of the bursa will be necessary, it is necessary to seek medical help in the following cases.

• Presence of pain in the joint for more than a few days.
• Limitation of mobility in the charter.
• The presence of swelling that does not disappear after taking NSAIDs.
• Increased temperature in the presence of pain in the joint.
• Areas around the joint that are hotter to the touch or red.
• Areas of pain in the joint area.

Diagnostics

The diagnosis of bursitis is made based on a combination of symptoms, clinical manifestations, medical history and instrumental diagnostic methods. The medical history allows us to determine the presence of concomitant somatic pathology.

Certain diagnostic procedures may be prescribed to rule out other causes of pain. They include the following diagnostic procedures:

• Radiography allows visualization of the presence of osteophytes or arthritis.
• Analysis of the punctate (microscopy), which was obtained as a result of puncture of the enlarged bursa, allows us to exclude gout and the presence of infection. Bursitis in the knee and elbow are most likely to become infected.
• Blood tests can help rule out rheumatologic diseases (such as rheumatoid arthritis) and metabolic diseases (diabetes mellitus).
• MRI may be prescribed if detailed visualization of the morphological picture is necessary.

Treatment

Although bursitis is usually self-limiting and disappears after a few days or weeks, steps should be taken to reduce stress or trauma. There are patients who prefer to endure pain, but this can lead to the development of chronic bursitis and the formation of calcium deposits in the soft tissues, which ultimately leads to limited mobility in the joint.

The first step is usually medication. NSAIDs can reduce pain and inflammation. It is also possible to use steroids for a short course (taking into account the presence of somatic diseases). For infected bursitis, a course of antibiotics is necessarily prescribed.

Puncture of the inflamed bursa allows you to aspirate excess fluid and reduce pressure on surrounding tissues. Injecting anesthetics along with steroids into the inflamed bursa helps reduce the inflammation.

Physical therapy (ultrasound or diathermy) can not only reduce the discomfort and inflammation of bursitis, but can also relax tight muscles and relieve stress on the nerves and tendons. In addition, it is possible to use local cold exposure or modern cryotherapy techniques.

Sometimes, with persistent bursitis and pain, surgical removal of the inflamed bursa is recommended.

Prevention of bursitis is the elimination of stress that led to the development of bursitis. Wearing orthopedic devices is often recommended, especially if the work involves a certain risk of traumatic movements. Exercise therapy also allows you to optimize the functioning of muscles and ligaments.

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