Bursitis

Definition/diagnostic criteria Bursitis is an inflammation of the bursae, small fluid-filled sacs that cushion the bones, tendons and muscles near the joints. It most commonly affects the shoulder, elbow, hip and knee. Repetitive movements or positions that put pressure on the bursae around a joint tend to be a key factor in the condition.

Epidemiology The prevalence of bursitis in the UK is not precisely documented, but it is a common cause of musculoskeletal pain and disability. Risk factors include age (more common in adults over 40), certain occupations and sports, and pre-existing conditions such as rheumatoid arthritis, gout or diabetes.

Diagnosis
Clinical features: Patients typically present with pain, swelling, and tenderness in the affected area, worsened by movement or pressure. Specific types, like trochanteric bursitis (affecting the lateral hip), also cause pain when lying on the affected side.

Investigations: Diagnosis is usually clinical. Imaging tests, like ultrasound or MRI, are reserved for atypical cases or when other conditions need to be ruled out. Blood tests might be used to identify underlying rheumatic conditions or infection.

Typical abnormalities found: In cases where imaging is used, ultrasound may show bursal thickening and fluid accumulation, while MRI can provide detailed images of soft tissue changes around the bursa.

Treatment Initial treatment includes rest, ice, and over-the-counter pain relievers such as ibuprofen or paracetamol.

• In more severe or persistent cases, corticosteroid injections may be considered.
• Physiotherapy is recommended for improving joint function and strength.
• Refractory cases might require referral to a specialist for consideration of surgery, although this is rare.

Prognosis Most cases of bursitis improve with proper treatment and self-care. However, the condition can recur and, in some cases, become chronic. Long-term outcomes are generally good, especially with early intervention and adherence to recommended treatment and lifestyle modifications.