Bursitis

Definition:
A bursa is a fluid-filled sac that usually overlays a bone or a joint and acts as a shock absorber. There are two types:

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Anatomical bursae normally occur around the body where tendons cross bones or joints. The complex knee joint has 15 bursae, for example.

•Adventitious bursae are not part of the normal body structure but develop when the soft tissue overlying a bone suffers repeated friction or trauma. An example of this type is over the pelvic bone in the buttock muscles because someone has been sitting on a hard chair for several hours a day.

Bursitis is inflammation of the fluid-filled sac (bursa) that lies between a tendon and skin, or between a tendon and bone. Certain occupations predispose people to this. The condition may be acute or chronic.
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Causes:
The most common causes of bursitis are trauma, infection, and crystal deposits.

Trauma
Trauma causes inflammatory bursitis from repetitive injury, which results in widening of the blood vessels. This allows proteins and extracellular fluid into the bursae and the bursae react against these “foreign” substances by becoming swollen.

•Chronic: The most common cause of chronic bursitis is minor trauma that may occur to the shoulder (subdeltoid) bursa from repetitive motion, for example, throwing a baseball. Another example is prepatellar bursitis (in front of the knee) from prolonged or repetitive kneeling on a hard surface to scrub a floor or lay carpet.

Acute brusits: A direct blow (let’s say you accidentally bang your knee into a table) can cause blood to leak into the bursa. This rapid collection usually causes marked pain and swelling, most often in the knee.

Infections:
Bursae close to the surface of the skin are the most likely to get infected with common organisms; this is called septic bursitis. These bursitis-causing bacteria are normally found on the skin: Staphylococcus aureus or Staphylococcus epidermis. People with diabetes or alcoholism and those undergoing steroid treatments or with certain kidney conditions, or who may have experienced trauma may be higher risks for this type of bursitis. About 85% of septic bursitis occurs in men.

Crystal deposits
People with certain diseases such as gout, rheumato:id arthritis, or scleroderma, for example, may develop bursitis from crystal deposits. Little is known about how this process happens. Uric acid is a normal byproduct of daily metabolism. People who have gout are unable to properly break down the uric acid, which crystalizes and deposits in joints-a mechanism for causing bursitis.
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Symptoms:
Bursitis causes pain and tenderness around the affected bone or tendon. The bursae sacs may swell, often making movement difficult. The most commonly affected joints are the shoulder, elbow, wrist and hand, knee, and foot.

Shoulder…...click & see

The subacromial (subdeltoid bursa) separates the major tendon (known as the supraspinatus tendon) from the overlying bone and deltoid muscle. Inflammation of this bursa is usually a result of injury to surrounding structures-most commonly the rotator cuff. This is often referred to as “impingement syndrome.” It is often difficult to tell the difference between this type of bursitis pain and a rotator cuff injury. Both cause pain in the side or front of the shoulder.

•Overhead lifting or reaching activities are uncomfortable.

•Pain is often worse at night.

•The shoulder will usually have decreased range of active motion and be tender at specific spots.

Elbow. click & see

Olecranon bursitis is the most common form of bursitis. Goose-egg-like, tender red swelling may appears just behind the elbow. This area is at the top of one of the forearm bones called the ulna and is known as the olecranon process.

•The pain may increase if the elbow is bent because tension increases over the bursa.

•This bursa is frequently exposed to direct trauma (bumping your arm) or repeated motions from bending and extending the elbow (while painting, for example).

•Infection is common in this bursa.

Knee....click & see

•Kneecap (prepatellar) bursitis: Swelling on the front of the kneecap is usually associated with either chronic trauma (from kneeling) or an acute blow to the knee. Swelling may occur as late as 7-10 days after a single blow to the area, usually from a fall.

•Anserine bursitis: The anserine bursa is fan shaped and lies among 3 of the major tendons at the knee. The name anserine (gooselike) comes from the shape of the swollen bursa. When restrained by the 3 tendons, the bursa looks like a goose’s foot.

This type of bursitis is most often seen in people with arthritis, especially overweight middle-aged women with osteoarthritis.

*The pain is typically produced when the knee is bent and is particularly troublesome at night. People often seek comfort by sleeping with a pillow between their thighs.

*The pain can radiate to the inner thigh and midcalf and usually increases on climbing stairs and at extremes of bending and extending.

*The area of tenderness is on the middle part of the knee.

*Anserine bursitis also occurs as an overuse or traumatic injury among athletes, particularly long-distance runners.
Ankle.click & see

Retrocalcaneal bursitis occurs when the bursa near the Achilles tendon in the ankle becomes inflamed. This is commonly caused by local trauma associated with wearing a poorly designed shoe (often high heels) or prolonged walking. It can also occur with Achilles tendonitis.

Bursitis in this part of the body often occurs as an overuse injury in young athletes, ice skaters, and female adolescents transitioning to higher heels. The pain is usually on the back of the heel and increases with passive extension or resisted flexion.

Buttocks....click & see

Ischiogluteal bursitis causes inflammation of the ischial bursa, which lies between the bottom of the pelvic bone and the overlying gluteus maximus muscle (one side of the buttocks). Inflammation can come from sitting for a long time on a hard surface or from bicycling.

•The pain occurs when sitting and walking.

•There will be tenderness over the pubic bone, which may be made worse by bending and extending the leg.

•The pain may radiate down the back of the thigh.

•Direct pressure over the area causes sharp pain.

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•The person may hold the painful buttock elevated when sitting.

•The pain is worse when person is lying down and the hip is passively bent.

•The person may have difficulty standing on tiptoe on the affected side.

Hip click & see

The iliopsoas bursa is the largest in the body and lies in front of, and deep to, the hip joint. Bursitis here is usually associated with hip problems such as arthritis or injury (especially from running).

•The pain of iliopsoas bursitis radiates down the front and middle areas of the thigh to the knee and is increased when the hip is extended and rotated.

•Extension of the hip during walking causes pain so the person may limit the stride on the affected side and take a shorter step.

•There may be tenderness in the groin area.

•Sometimes a mass may be felt resembling a hernia. The person may also feel numbness or tingling if adjacent nerves are compressed by the inflamed bursa.

Thigh click & see

The trochanteric bursa, part of the thigh, can be associated trochanteric bursitis, which occurs most frequently in overweight, middle-aged women.

•It causes deep, aching hip pain along the side of the hip that may extend into the buttocks or to the side of the knee.

•Pain is aggravated by activity, local pressure, or stretching.

•Pain is often worse at night.
Diagnosis:
Exams and Tests:

•History: The doctor will usually take a detailed history about the onset of symptoms and will want to know what movement or activity makes you feel more or less pain. You will need to report other medical problems you may have.

•Fluid removal: The doctor may remove synovial fluid from the joint with a needle (aspiration) and send it to the lab for analysis for possible infection. Bursitis in the knee and elbow are especially prone to infection.

•X-rays: They are usually not helpful, but the doctor may get them if any other disease process is suspected such as a fracture or dislocation. MRI and CT scans are obtained only to exclude other causes.

•Blood testing: The doctor may take blood from your arm for lab testing to rule out infection or other conditions such as rheumatoid arthritis or hyperthyroidism.
Treatment:
The doctor will probably recommend home care with P-R-I-C-E-M: protection, rest, ice, compression, elevation, and medications .

At first  doctor may recommend temporary rest or immobilization of the affected joint.

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen may relieve pain and inflammation. Formal physical therapy may be helpful as well.

If the inflammation does not respond to the initial treatment, it may be necessary to draw out fluid from the bursa and inject corticosteroids. Surgery is rarely required….

Exercises for the affected area should be started as the pain resolves. If muscle atrophy (weakness or decrease in size) has occurred. Your health care provider may suggest exercises to build strength and increase mobility.

Bursitis caused by infection is treated with antibiotics. Sometimes the infected bursa must be drained surgically.

Prognosis:
The condition may respond well to treatment, or it may develop into a chronic condition if the underlying cause cannot be corrected.

Complications:
Chronic bursitis may occur.
Too many steroid injections over a short period of time can cause injury to the surrounding tendons.

Prevention:
Avoid activities that include repetitive movements of any body parts whenever possible.

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Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.bbc.co.uk/health/physical_health/conditions/bursitis.shtml
http://healthtools.aarp.org/adamcontent/bursitis?CMP=KNC-360I-GOOGLE-HEA&HBX_PK=bursitis&utm_source=Google&utm_medium=cpc&utm_term=bursitis&utm_campaign=G_Diseases%2Band%2BConditions&360cid=SI_148893841_6495451981_1
http://www.emedicinehealth.com/bursitis/article_em.htm
http://www.medicalook.com/Joint_pain/Bursitis.html
http://activemotionphysio.ca/article.php?aid=246
http://www.bursitisinshoulder.com/
http://www.bursitis.ws/Knee-Bursitis.html

http://www.aidmybursa.com/foot-ankle-bursitis.php

http://www.sportlink.co.uk/hip_bursitis.php

http://www.bursitistreatment.info/ischial-bursitis_8.html

http://www.steadyhealth.com/articles/Hip_Bursitis___Trochanteric_Bursitis_a246.html

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