Where does bursitis hurt?
Bursitis is an inflammation of the joint capsule (from the Latin “bursa” – bag), which can be acute or chronic. The most commonly affected joints are the elbow and knee joints, as well as the ankles and wrists. Treatment is conservative; in case of suppuration, surgical treatment. This disease is treated by:
Description of the disease
Synovial bursae are small cavities, reminiscent of a collapsed pocket, in which each joint of the human body is “packed”. The joint capsules are formed by connective tissue, surrounded by a capsule, lined with special cells that produce synovial fluid – a gel-like lubricant that moisturizes the joint. Some bags are separated by partitions that form chambers. Each joint and the bursa surrounding it has its own limit of capabilities. When the joint is overloaded, infection occurs, or crystals form, the joint capsule becomes inflamed and excess pathological fluid forms in it. In this way, nature seeks to immobilize the affected joint to allow it to heal and recover. Bursitis can be acute or chronic. Depending on the pathogen, bursitis can be nonspecific (caused by various bacteria that also affect other organs) and specific – with tuberculosis, syphilis and gonorrhea. If it is possible to stop the inflammation with medications, then recovery occurs relatively quickly, and there is no restriction of movement in the future.
Symptoms of bursitis
- the skin over the joint is red and swollen;
- movements cause sharp pain;
- in the area of the joint, a round elastic formation is felt, inside of which liquid is felt (doctors say that a fluctuation occurs);
- local skin temperature rises.
If the inflammation is not treated, swelling, pain and redness increase. Body temperature can rise to very high values - 39 – 400C. This course indicates suppuration. If the body’s resistance is poor, limited suppuration can result in phlegmon or diffuse suppuration of the subcutaneous tissue.
With timely treatment, the inflammation quickly passes without leaving any consequences.
In some cases, it is not possible to quickly stop the inflammatory process, and the course of bursitis becomes chronic. In this case, there is no pain or limitation of movement, but the round swelling does not go away.
In people with reduced immunity or the presence of chronic diseases of internal organs, the course of bursitis is recurrent – exacerbations sometimes occur against the background of a chronic process.
Causes of bursitis
The main causes of bursitis are as follows:
- minor injury – cut, abrasion, bruise, sprain;
- inflammation of the soft tissues near the joint – boil, carbuncle, osteomyelitis, erysipelas;
- salt deposits;
- prolonged mechanical overload of the joint, constant similar movements.
The classic cause of elbow bursitis is a serious fall from a bicycle, when pyogenic microbes enter the joint cavity.
Bursitis can be complicated by any purulent process occurring in another organ. Bacteria enter the joint through the blood or lymph flow.
The development of bursitis is provoked by conditions and diseases in which metabolism or metabolism is disrupted. These are chronic alcoholism, diabetes mellitus, HIV, kidney disease, and taking steroid hormones.
With gout, uric acid salts are deposited in the synovial bursa, which also causes bursitis. In autoimmune diseases, the synovium is damaged by its own immune cells, and there is no infectious inflammation. This happens with rheumatoid arthritis, scleroderma and other pathologies.
With monotonous, monotonous overloads, chronic bursitis develops. Thus, golfers and miners suffer from elbow bursitis, housewives from knee bursitis. In the last century, this condition was called “maid’s knee” due to the fact that many types of cleaning had to be done while kneeling.
Diagnosis of bursitis
Diagnosis begins with a conversation with a doctor and an objective examination, during which characteristic clinical signs are detected. If a specific nature of the process is suspected, a puncture is performed; the resulting pathological fluid is sent for examination, and the blood is also examined for antibodies (serological reactions).
If inflammation of deep-seated bursae that cannot be felt during a routine examination is suspected, an X-ray examination or MRI of the joint is prescribed.
The doctor analyzes not only the specific clinical picture, but is also interested in all the medications the patient is taking. Some blood thinners, if taken in excess, cause bleeding into the joint (hemarthrosis), which looks similar to bursitis. A thorough differential diagnosis is required, which can only be carried out by a professional.
Treatment of bursitis
Treatment can be conservative or surgical.
The amount of treatment depends on the clinical picture.
For mild cases, local treatment is sufficient – rest, a restrictive bandage on the joint, compresses with anti-inflammatory drugs.
If the patient has diseases leading to salt deposition in the joints, then treatment is aimed at improving the general condition. Additionally, various non-steroidal anti-inflammatory drugs are prescribed to help relieve pain and resolve pathological fluid.
Treatment of specific bursitis – tuberculous, syphilitic – is carried out in a hospital of the appropriate profile.
Surgical treatment of bursitis
If a large amount of fluid accumulates, there is no point in waiting for it to resolve. The joint is punctured (the bursa is pierced) and the inflammatory fluid is sucked out. At the same time, through the same needle, the cavity is washed with disinfectant solutions, which are also removed. Finally, a hormonal anti-inflammatory agent is injected into the cavity, and the puncture is covered with a sterile bandage. Before puncture, the skin over the joint is moved and then returned to its place to stop the outflow of fluid from the joint cavity.
In severe cases with suppuration, arthrotomy or opening of the joint cavity is performed. Today, such manipulation is performed using endoscopic instruments. Microscopic instruments equipped with a backlit video camera are inserted into the joint. The surgeon sees the internal cavities and removes crystals, pus or blood. This is the most reliable method of treating severe bursitis, which allows you to achieve good results.
In case of phlegmon, the affected tissue is excised.
The best prevention of bursitis is a timely visit to a doctor, when it is possible to stop the inflammation at an early stage and avoid surgical treatment.
At SM-Clinic, a comprehensive diagnosis of the condition of the musculoskeletal system is carried out and the most adequate therapy is selected.
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If bursitis is not treated, the disease will become purulent. This threatens the appearance of external fistulas and subcutaneous phlegmons.
Bursitis of the joint.
Bursitis is an acute, subacute or chronic inflammation of the synovial bursa, which is accompanied by abundant formation and accumulation of exudate (inflammatory fluid) in its cavity. The cause of the pathology can be heavy loads, open and closed injuries. It is important to start treatment on time to avoid dangerous complications.
Synovial bursa (or bursa) is a small cavity filled with fluid. Bursae are located in places of greatest friction of various tissues: tendons, muscles and bone protrusions. Due to the normal functioning of the joint capsules, friction during movement is reduced. The wall of the bursa is two-layered: the outer layer consists of dense connective tissue; the inner one is called the synovium and normally produces a small amount of fluid. If the synovial bursae are malfunctioning, joint movement is impossible.
If left untreated, purulent bursitis can lead to intoxication and sepsis
Joint bursitis occurs for the following reasons:
✓ joint injury from a blow, fall or bruise;
✓ excessive physical activity leading to sprained ligaments and tendons, damage to the joint capsule and synovial membrane. Often found in athletes;
✓ infectious inflammation of the joint capsule;
✓ gout;
✓ autoimmune disorders with damage to the synovial membrane;
✓ arthritis;
✓ entry into the body of streptococci and staphylococci;
✓ microtraumas.
Bursitis reasons:
If you notice the following symptoms, make an appointment for a consultation
✓ pain syndrome;
✓ edema (swelling) in the area of the bursa or the entire joint;
✓ redness in the area of the bag;
✓ increased temperature in the area of inflammation, in some cases – a general increase in body temperature;
✓ limitation of movements in the joint of varying degrees of severity, ranging from a slight limitation of flexion and extension to the complete inability to make movements, the inability to stand on the affected leg;
✓ symptoms of intoxication (weakness, headaches, nausea) appear when an infection attaches and the inflamed bursa suppurates.
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In the case of a bacterial infection and suppuration of the synovial bursa, the purulent process may spread to both the surrounding tissues and the joint. In the first case, they are formed abscesses and phlegmons, in the second it develops purulent arthritis. As a result, after suffering phlegmon or purulent arthritis, it is possible to limit the range of movements in the joint up to complete absence of movements.
Another possible scenario is the spread of the purulent process to the bone. In this case, bone tissue is destroyed and osteomyelitis. This condition can ultimately lead not only to limited movement in the joint, but also to disruption of the supporting function of the limb. The patient will not be able to move without the help of supporting devices.
Symptoms of joint bursitis.
К general symptoms for bursitis of any localization include
The risk of purulent bursitis increases if:
✓ weakening of immune defense;
✓ excessive passion for alcoholic beverages;
✓ diabetes;
✓ kidney diseases;
✓ deep cuts of soft tissues.
Risk factors:
Classification of bursitis
Due to the occurrence:
• aseptic, including traumatic bursitis. The cause may be a variety of factors, autoimmune, dysmetabolic, such as gout and other crystal arthropathies;
• infectious, or septic, bursitis. Depending on the pathogen that caused the inflammation, septic bursitis is divided into nonspecific (caused by staphylococcus, streptococcus and other bacteria) and specific (tuberculosis, gonococcal, brucellosis, syphilitic).
According to the clinical course: acute, subacute, chronic, recurrent.
Based on the nature of inflammation, they distinguish serous bursitis, serous-fibrinous, purulent and purulent-hemorrhagic.
Types of bursitis
Elbow bursitis
The most common type of bursitis is bursitis of the elbow joint, or more precisely, the ulnar subcutaneous bursa located in the area of the olecranon. Acute elbow bursitis develops as a result of injury, infection or metabolic disorders. The cause of the development of acute and chronic bursitis can be the characteristics of work or sports activity (in addition to miners, this disease sometimes affects people who are forced to constantly lean their elbows on the table while working, as well as wrestlers – due to pressure and friction of the elbows on the carpet).
Bursitis of the knee joint
The disease usually occurs after an injury (fall on the kneecap, bruise or blow) or after prolonged kneeling, usually due to professional activity (roofer’s knee, housewife’s knee). In addition, the development of bursitis can be caused by salt deposition due to pseudogout, gouty arthritis or rheumatoid arthritis.
Bursitis of the shoulder joint
Most often, inflammation of the bursae not associated with the cavity of the shoulder joint is observed – subacromial, subdeltoid and subcutaneous acromial. Pain occurs, which intensifies when the limb is abducted.
Bursitis of the hip joint
The most commonly affected areas are the iliopectineal bursa and the deep and superficial bursae of the greater trochanter. These types of bursitis are characterized by a severe course. Acute bursitis is accompanied by a significant increase in temperature and severe pain, which sharply intensifies with rotation, extension and abduction of the hip.
Ankle bursitis
Most often in this area, bursitis occurs in the subcutaneous heel bursa, located between the Achilles tendon and the heel tubercle. The cause of the appearance is injury (for example, rubbing shoes) or transmission of infection through the lymphatic or blood vessels.
Diagnosis of bursitis
The equipment of the operating room and the clinic as a whole, as well as the professionalism of the specialists, allows us to treat even the most complex patients, and in case of adverse reactions or complications, provide all the necessary assistance, which also guarantees you maximum safety!
The main way to identify pathology and assess the degree of its development is radiography. The image clearly shows the bone growth, its shape, location and size.
✓ palpation (palpation), during which the area of greatest pain, the temperature of the skin in the affected area for local hyperthermia, the presence/absence of space-occupying formations are determined;
✓ Ultrasound allows you to evaluate the structure of periarticular tissues (tendons, ligaments, muscles) and menisci, the presence or absence of excess fluid in the joint cavity and periarticular bags, determine the nature of the fluid and its approximate volume.
✓ MRI allows you to obtain a holistic picture of the joint, assess in detail the condition of the periarticular and intra-articular structures;
✓ X-ray or CT to assess the condition of bone tissue. Allows you to determine the presence or absence of foci of destruction (destruction) of bone, degenerative-dystrophic changes;
✓ Diagnostic puncture – exudate (inflammatory fluid) is removed from the joint capsule, the nature and volume of the fluid is determined. Subsequently, it is sent for laboratory analysis.
Bursitis treatment
Treatment of bursitis requires an integrated approach using:
• antibiotic therapy, pumping out accumulated effusion, washing the bursa with antiseptic solutions, administering corticosteroids (to eliminate inflammation);
• physiotherapy;
Operative therapy
If conservative treatment does not help to cope with the pathology, then surgical intervention will be required. The doctor performs aspiration, during which the contents of the joint capsule are sucked out and corticosteroids are injected into it. This measure is necessary to relieve the inflammatory process. The patient then continues to wear the elastic bandage to keep the leg immobilized and rested. With the development of a purulent process, the formation of an abscess or phlegmon, a bursectomy is prescribed – the abscess is opened under local or general anesthesia. If there is no effect, they resort to excision of the affected bursa.
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