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Bursitus

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.

Only small numbers of inflammatory cells are found in bursal fluid in traumatic bursitus, but there may be a greater leukocyte response in bursitus secondary to other rheumatic diseases, such as rheumatoid arthritis or gout. Septic bursitus is usually caused by organisms introduced through punctures, wounds, or cellulitis in the overlying skin.

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 bursitus found in 10% of college wrestlers) is receiving greater emphasis.

TROCHANTERIC BURSITUS

Trochanteric bursitus 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 and thigh is aggravated by lying on the affected side. The patient experiences tenderness posterior to the

OLECRANON BURSITUS

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

PREPATELLAR BURSITUS

This type of bursitus is a swelling between the skin and lower patella or patellar tendon, resulting from frequent kneeling. Pain is usually slight unless there is direct pressure on the swollen area.

ILIOPECTINEAL OR ILIOPSOAS BURSITUS

With this inflammation of a bursa between the iliopsoas and inguinal ligament, the patient complains of groin pain radiating to the knee, and often adopts a shortened stride to prevent hyperextension of the hip

OBTURATOR INTERNUS BURSITUS

This may result in low back pain. There is local buttock tenderness just below the posterior inferior iliac

Treatment

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.