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When inflammation of a bursa is superficial, such as of the shoulder, knee, elbow, or Achilles tendon, the diagnosis of bursitis is easily accomplished. Deep bursae, such as those around the hip joint and the ischial tuberosity, do not present with obvious swelling; a diagnosis must be inferred from local tenderness and exacerbation of pain by activation of the associated muscles. In difficult cases, the temporary elimination of pain after the local instillation of an anesthetic is a useful diagnostic tool. Bursitis seldom

Noninfective bursitis is treated as follows. The involved areas should be rested (e.g., the provision of a sling for subdeltoid bursitis or instruction in the use of a cane in the

After the bursa is aspirated, a mixture of 1% procaine (about 3 mL) containing 1 to 2 mL of a long-acting corticosteroid preparation, bursitus such as

Prompt amelioration of discomfort within about 5 minutes of giving this injection (due to the effect of the local anesthetic) gives some reassurance that the injection has

In some cases, the injection of a long-acting corticosteroid preparation, which is usually microcrystalline, provokes an acute inflammatory response akin to gout. This is almost always averted if the patient is bersitis, borsitis, AIDS

A recurrence of the bursitis within 7 days of injection should arouse concern regarding possible septic bursitis, and a

Patients who have a serious underlying illness should be treated more vigorously with intravenous antibiotics, such as oxacillin (Prostaphlin), 2 grams four times a day for

In those rare cases in which reaccumulation of infected bursal fluid is recurrent, despite appropriate antibiotics, the possibility of open surgical drainage should be discussed with an