When, 2-3 days after an unsuccessful fall or intense physical activity, pain and a characteristic round swelling in the joint occur, there is reason to suspect bursitis. This condition requires special attention from the patient and the doctor - if not treated correctly, the inflammation can lead to the need to remove the joint capsule or become chronic. Need quick and competent medical care.
Bursitis is treated at the Kuntsevo Treatment and Rehabilitation Center - here there is everything necessary for this - from a high-tech diagnostic base to a modern exercise therapy room and experienced doctors.
What is acute bursitis
A person has about one hundred and sixty joint capsules (bursae). This is a special formation of strong connective tissue on the outside and a special layer of cells on the inside. Their task is to protect joints from external influences, injuries and friction of articular elements against each other. This is ensured with the help of a special synovial fluid, which is produced in the joint and improves gliding. In addition, it is this liquid that contains components that penetrate the cartilage tissue and provide its nutrition and hydration.
When the bursa becomes inflamed, the amount of fluid in it increases and its composition changes. Protein exudate, inflamed cells appear in the lubricating fluid, swelling of the joint capsule occurs - formation up to 5-10 cm in size. This leads to impaired mobility - any movement causes pain in the affected joint, and sometimes it bothers you even without physical activity.
The initial inflammation that occurs is acute bursitis. Typically, it occurs with severe symptoms that gradually decrease (with the exception of purulent bursitis). Untreated inflammation can lead to complications - the formation of purulent fistulas, phlegmon and tissue sepsis. Protracted acute bursitis becomes a chronic form of the disease. In this case, bursitis can worsen whenever immunity decreases or there are other risk factors for relapse. Chronic bursitis will be more difficult to cure.
Symptoms of bursitis
The following symptoms are reasons to think about treating bursitis:
- The appearance in the joint area of a round formation with liquid inside, elastic and painful to the touch.
- Sharp (with acute bursitis) or moderate (with chronic) pain when flexing/extending the joint or pressing on it (for example, when trying to lean on your arm). Characterized by morning stiffness and joint pain, which gradually decreases throughout the day.
- Limited range of motion in the inflamed joint.
- Redness and local increase in skin temperature in the joint area.
These are the main signs of bursitis, in which it is necessary to begin treatment of inflammation in order to avoid the disease becoming acute.
By the way! Bursitis does not always cause characteristic swelling and redness in the joint area. If the joint capsule is located deep in the soft tissues, swelling may not be visible. Since the symptoms of bursitis without characteristic external signs can resemble arthritis (which is treated differently), it is important to clarify the diagnosis using ultrasound, MRI and other examinations.
Types of acute bursitis
Inflammation of the bursa can occur in any of the joints. Bursitis most often occurs in large joints:
- Elbow.
- Shoulder.
- Hip.
- Knee.
- Radiocarpal.
The name also changes depending on the location of the inflammation: acute bursitis of the elbow joint, acute bursitis of the knee joint, and so on.
Another classification is based on the causes of inflammation:
- Septic bursitis occurs due to bacterial infection. Most often the cause is Staphylococcus aureus (about 80% of cases) and streptococci, but there may be other pathogens.
- Aseptic bursitis develops due to non-infectious causes - injuries, constant pressure or physical activity, existing joint diseases.
To predict the further course of the disease and select a treatment method, it is important to understand how the synovial fluid has changed. Bursitis is classified according to the nature of the exudate:
- Serous - plasma with an admixture of blood elements is formed in the bag.
- Hemorrhagic - a large number of red blood cells in the exudate.
- Purulent - an accumulation of microorganisms and destroyed cells. This is the most dangerous variant of acute bursitis with severe pain, rapid
- development and risk of complications - breakthrough of pus into the periarticular tissues and blood poisoning.
What is elbow bursitis?
The disease in question is one of the most common types of inflammation of the joint and the accumulation of serous or purulent exudate (effusion) inside its cavity.
The development of most diagnosed cases is provoked by overloads and numerous microtraumas of the elbow. Among the patients there are athletes, people working in conditions of increased complexity (hard work), as well as those who, due to some characteristics, often rest their elbows on the table.
The risk group includes people of different ages, mostly young and middle-aged men.
The treatment plan is determined individually, taking into account the degree of intensity of symptoms, as well as the type of disease and clinical picture of a particular patient.
Causes
There are factors that increase the risk of inflammation:
- Weakened immunity.
- Chronic infections in the body.
- Long-term treatment with antibiotics, corticosteroids and some other drugs.
- Incorrect shoes and poor posture.
- Excess weight.
- Diseases – diabetes, metabolic disorders and others.
- Professional or other activities that involve repetitive movements, pressure or joint injuries. For example, acute prepatellar bursitis (inflammation of one of the bursae of the knee joint) often occurs in those whose working position involves resting on their knees: gardeners, mechanics, plumbers and representatives of other professions. Elbow bursitis often occurs in those who work at a computer, play sports that place stress on the joint (tennis, baseball, weightlifting), or where the risk of falling on the elbow is high (football, basketball, and other sports).
The main causes of acute bursitis:
- Injuries and microtraumas of the joint area.
- Infectious diseases.
- Allergies or autoimmune diseases.
How to deal with bursitis
Bursitis
(from Late Latin bursa - bursa) is
a painful inflammation of the joint capsule (a flat, fluid-filled sac used to protect when skin, muscles, tendons and ligaments rub against bone).
- Movement is usually accompanied by pain, and the joint capsule near the surface of the skin may swell and hurt.
- Pain around the joint capsules may prompt the diagnosis, but analysis of synovial fluid collected from the joint capsule or imaging studies are sometimes required.
- Rest, splinting, nonsteroidal anti-inflammatory drugs, and occasional corticosteroid injections help relieve symptoms.
Usually there is a small amount of fluid in the joint capsule that provides shock absorption. The bursa reduces friction and prevents wear and tear when structures move relative to each other. Some joint capsules are located directly under the skin (superficial joint capsules). Others are located under the muscles and tendons (deep joint capsules). In case of injury or high load, inflammation of the joint capsule may occur, which leads to the accumulation of excess fluid in it.
Inflammation can be caused by an infection, but more often it is a consequence of bruises or injuries, as well as constant friction of tendons and muscles against bones and ligaments. This is why bursitis is common among professional athletes, especially weightlifters and team sports players, skydivers, and anyone who lands hard or hits their knee.
The chronic form of the disease often occurs in those who, due to their occupation, spend a lot of time standing or crawling on their knees. The same maids used to often suffer from bursitis because they washed the floors with their hands. Today they use a vacuum cleaner more and more, so they take less risks. But roofers, parquet layers, gardeners, as well as overzealous housewives who care more about the cleanliness of the floors than about their health are in a particularly dangerous zone.
Bursitis usually occurs when:
- irritation from unusual or excessive exertion.
It can also result from injury, gout, pseudogout, rheumatoid arthritis, or certain infections, especially those caused by Staphylococcus aureus. The cause of bursitis is often unknown.
The shoulder joint is most vulnerable to bursitis, but the elbows, hips (acetabulum bursitis), pelvis, knees, toes and heels (Achilles bursitis) can also be affected. People with shoulder bursitis often develop inflammation of the tendons around the shoulder (rotator cuff tendonitis—the tendons and other structures involved in moving, rotating, and stabilizing the shoulder joint are called the rotator cuff).
SYMPTOMS OF BURSITIS
Bursitis is usually accompanied by pain and often limits freedom of movement, but specific symptoms depend on the location of the inflamed joint capsule. For example, when the joint capsule of the shoulder is inflamed, raising the arm to the side (for example, when putting on a jacket) is accompanied by pain and difficulty. However, elbow bursitis may be accompanied by swelling in the absence of significant discomfort (or its complete absence).
Acute bursitis develops over several hours or days. The inflamed area is usually characterized by pain when moving or touching. The skin over superficial joint capsules, such as near the knee and elbow joints, may become red and swollen. Acute bursitis, caused by infection or gout, may be partially painful and the affected area may become red and hot.
Chronic bursitis may develop due to repeated or persistent episodes of acute bursitis or repeated trauma. Occasionally, thinning of the walls of the joint capsule is observed. With unusual loading or stretching of the damaged joint capsule, the course of the inflammatory process may worsen. Prolonged pain and swelling can limit freedom of movement and lead to muscle weakness. Exacerbations of chronic bursitis can last several months and often recur.
DIAGNOSTICS
- Medical examination;
- Sometimes examination of the contents of the joint capsule;
- Sometimes imaging tests.
The doctor suspects bursitis if the area near the superficial joint capsule is painful to the touch, or if pain occurs during movements that lead to displacement or increased pressure on the deep joint capsule.
If the superficial joint bursa, especially near the knee or elbow joint, is noticeably swollen, the doctor may use a needle to remove a sample of synovial fluid from the bursa. The sample is then sent for analysis to determine the cause of inflammation, such as infection or gout.
An X-ray is usually done if the bursitis does not improve with treatment or continues to recur, or if the doctor suspects a problem in the joint, such as arthritis.
Magnetic resonance imaging (MRI) or ultrasound may be ordered to confirm deep bursitis.
TREATMENT OF BURSITIS
- Painkillers, anti-inflammatory drugs and rest;
- Treatment of gout or infection;
- Sometimes corticosteroid injections.
For the treatment of acute bursitis not caused by an infectious agent, the following is usually prescribed:
- Peace;
- Temporary immobilization (for example, using a splint) of the affected joint;
- Applying ice to the painful area;
- Nonsteroidal anti-inflammatory drugs (NSAIDs) in high doses.
Sometimes strong painkillers are required. Often, the doctor may inject a local anesthetic directly into the joint capsule, especially if the shoulder joint is affected. This treatment often provides symptom relief for several days after the injection. The injection can be repeated after a few months. Removing fluid with a needle may also help relieve pain.
Patients with acute bursitis are sometimes prescribed corticosteroids, such as prednisone, taken by mouth for several days. Once the pain has subsided, patients can do special exercises to increase the range of motion of the joint.
Chronic bursitis, if it is not caused by an infectious agent, is treated in a similar way, although rest and immobilization are not as effective. In rare cases, surgery is performed to remove the joint capsule.
It is often possible to restore function with physical therapy. Exercises can strengthen weakened muscles and restore the full range of motion of the joint.
It is necessary to drain the infected joint capsule and prescribe appropriate antibiotics, often active against Staphylococcus aureus.
If the cause of bursitis, such as gout, rheumatoid arthritis or chronic overuse, is not treated or corrected, relapses of bursitis are common.
AT-RISK GROUPS
Athletes whose activities involve lifting weights, as well as track and field athletes and runners are most likely to develop bursitis.
The risk of developing bursitis is also increased by monotonous physical activity, which can be experienced by people whose professional activities require long stays in one position (roofers, parquet layers and other professions with monotonous physical activity).
Also at risk for developing bursitis are patients suffering from alcoholism, diabetes, and kidney disease.
In addition, gout, arthritis, rheumatoid arthritis, scleroderma, and erysipelas can trigger the development of bursitis.
Diagnostics
Acute bursitis is usually visible to the naked eye due to reddened skin and swelling of the joint. For more accurate diagnosis, use:
- Palpation (feeling) of the joint.
- X-ray - the study will show not only inflammation, but also pathologies of bone and cartilage tissue in the joint, salt deposits, thickening of the synovial bursa.
- Ultrasound or MRI - for diagnosing soft tissues.
- Laboratory tests - blood, PCR diagnostics for the analysis of inflammatory pathogens.
Pathological anatomy of the disease
The cause of exacerbation of the symptomatic picture and the need for a therapeutic complex is inflammation of the bursa.
A bursa is a slit-type formation located relatively close to protruding bony areas, within which there is a relatively small amount of fluid.
The key function of the bursa is to cushion and protect the periarticular tissues from excessive pressure or excessive friction.
With systematic microtraumas, as well as increased pressure inside the joint, aseptic inflammation may occur, which will result in the active release of fluid from the bursa membrane. Depending on the amount of fluid produced, local swelling appears, caused by protrusion of the filled cavity.
Treatment
Treatment is carried out by a traumatologist-orthopedist or surgeon (for acute purulent bursitis). In case of acute inflammatory process it is necessary:
- Rest - reduce or completely eliminate movements in the joint, minimize the load. For this, you can use orthoses, bandages and other fixing devices.
- Cold – Periodic cold compresses reduce inflammation.
- Compression – compressing the joint with elastic bandages or other devices reduces pain.
Conservative treatment is used to treat acute elbow bursitis and others:
- Medicines - the doctor will prescribe painkillers, local anti-inflammatory drugs, hormonal agents with anti-inflammatory effects and intra-articular injections.
- Physiotherapeutic procedures - cryotherapy, procedures using electrical currents with different parameters and other procedures. They improve the penetration of drugs into the affected tissues, reduce swelling, improve blood circulation and reduce pain.
The goals of conservative therapy are to stop inflammation, relieve pain, restore joint mobility and prevent complications.
For the purulent form of acute bursitis, conservative therapy is ineffective; surgical treatment is recommended. An opening is performed and the inflamed bursa is drained, the pus is pumped out and the joint cavity is washed with antibiotics and antiseptics. In severe cases, surgery may be performed to remove the bursa.
Diagnostic features
The diagnostic process is based on a patient interview, clinical assessment of existing symptoms and, of course, direct examination. To clarify the suspected diagnosis, instrumental research methods are additionally used, including:
- radiographic examination
– the examination results allow us to exclude the possibility of a bone fracture or the presence of foreign bodies, salt deposits, etc.;
- ultrasonography
– forms an overall picture for visualizing the situation, allowing you to fully assess the condition of the walls and the volume of inflammatory fluid;
- magnetic resonance imaging (MRI)
– detailing the results obtained provides the opportunity to confirm/refute the diagnosis and exclude other assumptions;
- puncture
– sampling the contents of the cavity allows you to determine the type of fluid, which is of particular importance when making a diagnosis. It is important to note that during the collection of material for research, therapeutic manipulations may be carried out.
In addition, a number of additional laboratory tests are carried out (clinical and biochemical blood tests, detection of C-reactive protein and rheumatological tests), which makes it possible to verify the accuracy of the diagnosis and makes it possible to assess the severity of the existing pathological process.
Possible complications and prognosis of patients with diagnosed bursitis of the elbow joint
Like any other disease, ulnar bursitis has certain prognoses, which were formed thanks to a large number of cases of medical practice.
In the vast majority of cases, the development of pathology does not lead to serious restrictions on the mobility of the arms (mostly the joint).
In the absence of an infectious lesion, positive dynamics are observed in the near future after the start of complex treatment (in conjunction with a system of anti-inflammatory drug therapy).
However, it is important to say that in rare cases, a relapse may occur, in which even minor swelling and mild pain can trigger the release of a large amount of fluid.
Refusal of treatment or untimely assistance may aggravate the situation and complicate the treatment process.