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Bursae are closed sacs, lined with a cellular membrane resembling synovium. They serve to facilitate motion of tendons and muscles over bony prominences. There are over 80 bursae on each side of the body. Excessive frictional forces or direct trauma may result in an inflammatory process in the bursal wall, with excessive vascularity, exudation of increased amounts of viscous bursal fluid, and fibrin-coating of the lining membrane. Only small numbers of inflammatory cells are found in bursal fluid in traumatic bursitis, but there may be a greater leukocyte response in bursitis secondary to other rheumatic diseases, such as rheumatoid arthritis or gout. Septic bursitis is usually caused by organisms introduced through punctures, wounds, or cellulitis in the overlying skin. Traumatic bursitis may be complicated by infection or hemorrhage. "Beat knee" and "beat shoulder" in miners are examples of this condition. Continuous abrasion of the skin with stone dust results in cellulitis, and repeated scraping of the bursa against rough stone surfaces leads to hemorrhage. With modification of occupations and habits, many of the classic forms of bursitis are encountered less frequently, e.g., "housemaid's knee," "weaver's bottom," and "policeman's heel." Sports-related bursitis (e.g., "wrestler's knee," a prepatellar bursitis found in 10% of college wrestlers) is receiving bursitis, bursitus.
Trochanteric bursitis is an inflammation of one or more of the bursae about the gluteal insertion on the femoral trochanter. This condition is most common in females and usually has insidious onset, preceded by apparent trauma in only about one-fourth of the cases. Aching pain on the lateral aspect of the hip
An inflammation with effusion at the point of the elbow occurs frequently with rheumatoid arthritis and gout as well as after trauma. Pain is usually minimal, except when pressure is applied to the swollen bursa. Elbow motion is unimpaired and usually painless. Fluid from the bursa is often serosanguineous
This type of bursitis is a swelling between the skin and lower patella or patellar tendon, resulting from
In general, therapy includes protection from irritation and trauma, either by modifying the patient's activities or by using appropriate padding. Anti-inflammatory drugs, heat, and ultrasound are also commonly employed. Local corticosteroid injections are usually successful, but there are occasional local complications such as infection and skin atrophy, particularly with olecranon bursitus . Surgical excision is reserved for refractory cases.