Bursitis

Background

• Inflammation of a bursa (fluid-filled sac that reduces friction between tendons, bones, and skin)
• May be traumatic, overuse (repetitive microtrauma), infectious (septic bursitis), or inflammatory (gout, rheumatoid arthritis)
• Olecranon and prepatellar bursae are most commonly affected in the ED

Types by Location

• Shoulder: Subacromial bursitis
• Elbow: Olecranon bursitis
• Knee:
  • Prepatellar bursitis
  • Pes anserine bursitis
• Hip bursitis: Trochanteric, iliopsoas, ischial, iliopectineal
• Ankle: Retrocalcaneal bursitis

Clinical Features

• Localized swelling, warmth, tenderness over the affected bursa
• Pain with direct pressure or movement of adjacent joint
• May have limited range of motion
• Red flags for septic bursitis: fever, overlying cellulitis, significant erythema, history of penetrating trauma or immunocompromise

Evaluation

• Clinical diagnosis in most cases
• Aspiration (bursocentesis) if concern for septic bursitis:
  • Cell count, Gram stain, culture, crystal analysis
  • WBC >2,000/μL with >50% PMNs suggests infection (lower threshold than septic arthritis)
• X-ray to rule out fracture or foreign body if trauma history

Management

• Non-septic: Rest, ice, compression, NSAIDs, activity modification
• Septic: Antibiotics covering Staphylococcus aureus (most common organism), serial aspiration or surgical drainage
• Avoid corticosteroid injection until septic bursitis is ruled out

Disposition

• Discharge non-septic bursitis with RICE, NSAIDs, and PCP follow-up
• Septic bursitis: outpatient antibiotics if mild, admit if systemically ill or immunocompromised

See Also

• Septic bursitis
• Septic arthritis