Bursae are sacs of fluid which lie in proximity to tendons as they insert into bone.
The lining tissue of the bursa is similar to the synovial lining of the joint.
An inflammation of the bursa is called a bursitis, and in seen frequently in relationship to tendonitis itself.

The cause may be from repetitive strain and mechanical trauma, or may be part of an arthritis, both mechanical or even a generalized inflammatory arthritis. Therefore the condition may be isolated or part of an underlying disease process.
Diagnosis is therefore important, to exclude an underlying disease.

Examples of  common sites of bursitis:

Trochanteric bursitis: This causes pain on the outer aspect of the thigh and makes lying on the side painful, and frequently disturbs sleep. It is aggravated by walking and climbing stairs, and by abduction exercises of the thighs.

Subachromial bursitis: This is located at the shoulder and is involved with the rotator cuff of the shoulder, causing pain on lifting the arm. The test consists of getting the patient to push the shoulder out sideways - abduction against a resistance. This would be tender, whereas lifting the arm passively with the patient completely relaxed does not aggravate the pain.

Olecranon Bursitis: This is located at the elbow, and is a fairly common problem in Gout but may occur in autoimmune arthritis such as Rheumatoid arthritis. An enlarged sac of fluid on the extensor aspect of the elbow may be seen.

Popliteal bursa - Bakers cyst. This is a bursa, that is behind the knee and is associated with a swelling behind the knee. Sometimes it can rupture, and fluid leaks down into the calf - presenting frequently as a severe calf pain, and may be confused with a vein thrombosis.

Therapy of bursitis

The therapy is best either with local injection of corticosteroid and local anesthetic into the bursa, possibly in conjunction with physiotherapy (heat /laser and ultrasound).

Antiinflammatories may be useful, but I prefer using the local treatment as outlined above.


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