Bursitis: An overview of clinical manifestations, diagnosis, and management
- Derrick J Todd, MD, PhD
Derrick J Todd, MD, PhD
- Instructor of Medicine
- Harvard Medical School
INTRODUCTION AND DEFINITION
A bursa is a fluid-filled, saclike structure lined by synovial membrane which forms in clefts between mobile structures in the musculoskeletal system. From a simplistic point of view, the deeper bursae serve as “ball bearings,” allowing the muscles to glide over each other and over prominences of bone. The more superficial bursae, such as the olecranon, ischial, or prepatellar bursa, serve as “cushions” between the skin and the bone.
The term “bursitis” implies inflammation. In many clinical scenarios this is a misnomer, as many specific bursitis syndromes are associated only with tenderness over the bursal structure and not necessarily with overt inflammation that can be documented upon physical exam or imaging.
This topic will review the overall approach to the diagnosis and management of bursitis. A more detailed discussion on specific bursae and septic bursitis can be found elsewhere. (See "Greater trochanteric pain syndrome (formerly trochanteric bursitis)" and "Knee bursitis" and "Septic bursitis".)
Bursitis may result from any one or combination of the following causes:
●Direct injury or trauma.
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- INTRODUCTION AND DEFINITION
- CLINICAL PRESENTATION AND PHYSICAL EXAMINATION
- Clinical findings
- - Acute bursitis
- - Chronic bursitis
- DIAGNOSTIC TESTING
- Bursal fluid aspiration and analysis
- The need for imaging
- PRINCIPLES OF MANAGEMENT
- Joint protection
- Nonsteroidal antiinflammatory drugs (NSAIDs)
- Intrabursal injections of glucocorticoids
- SPECIFIC SYNDROMES
- Subacromial bursitis
- - Management
- Scapulothoracic bursitis
- - Management
- Olecranon bursitis
- - Management
- Ischial bursitis
- - Management
- Greater trochanteric pain syndrome (formerly trochanteric bursitis)
- Iliopsoas bursitis
- Prepatellar and infrapatellar bursitis
- Medial collateral ligament bursitis
- Pes anserinus pain syndrome (formerly anserine bursitis)
- Retrocalcaneal bursitis
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS