yogabook / pathologie / bursitis

Bursitis (inflammation of the bursa)

Definition of

Inflammation of a bursa( synovialbursa ) caused by trauma, infection or overuse. It often affects the

1. Bursasubcutanea praepatellaris „housemaid’s knee„, bursa subcutanea infrapatellaris due to frequent or prolonged kneeling „clergyman’s knee“,„priest’s knee“ and bursa subcutanea tuberositatis tibiae). These bursitis often occur in tradesmen, fitters, cleaners, interior decorators, roofers, pipe fitters, floor layers (parquet, tiles) and formerly also mine workers with kneeling activities. Decreasing pain when stretching. Bursitis praepatellaris is also described in surfers, caused by frequent climbing on the surfboard. The bursa under the medial collateral ligament can also be affected, usually as a result of sporting activities.
2. Bursitis olecrani: inflammation of the bursa olecrani is also known as „miner’s elbow“. It is characterized by pain caused by and when supporting the elbow, but not when stretching; it affects miners, glassblowers and glass grinders. Propping up the elbow can also affect students, especially if a lot of reading is done with the arms propped up in preparation for exams, and is then referred to as bursitis informaticus olecrani.
3. Bursitis iliopectinea affects the bursa behind the iliopsoas(bursa iliopectinea) and is caused by frequent bending of the hip, such as when climbing stairs, running and other sports.
4. Bursitis retrocalcanea: affects the bursa between the Achilles tendon and the calcaneus(bursa subtendinea tendinis calcanei) and is triggered by prolonged walking, running, dancing and jumping.
5. Bursitis trochanterica on the greater trochanter, possibly with restricted flexibility, severe pain that can persist even after rest, pressure pain, even when lying on the affected side; this also depends on which bursa is affected, which can be one of the regional bursae, depending on the trigger:
   • Bursa trochanterica musculi glutei maximi
   • Bursa trochanterica musculi glutei medii
   • Bursa trochanterica musculi glutei minimi
   • Bursa subcutanea trochanterica
   • Piriformbursa
     Bursitis trochanterica is often part of GTPS.
6. Subacromialbursitis: inflammation of the subacromialbursa is characterized by rapidly increasing, sometimes severe pain, especially at night.
7. Boxers are sometimes affected by metacarpophalangealbursitis, an inflammation of the dorsal subcutaneous metacarpophalangealbursae.
8. Bursitis serratus anterior inferior, i.e. inflammation of the serratus anterior inferiorbursa, is described in baseball players, triggered by the repetitive throwing motion.
9. In riders, bursitis epicondyli tibialis subcutanea, i.e. inflammation of the epicondyli tibialis subcutaneousbursa, can occur if the clothing does not sufficiently cushion the inner knee.
10. Wearing high heels can cause subcutaneous calcaneal bursitis, i.e. inflammation of the subcutaneous calcanealbursa.

The large joints shoulder joint, elbow joint, knee joint and hip joint are most frequently affected. Insertional tendinopathy is often found together with bursitis. The synovium is often irritated first and then becomes inflamed. Bursitis occurs not only as an overuse syndrome but also as a result of infections and metabolic diseases or autoimmunological diseases such as gout or RA. Chronic bursitis(bursitis chronica simplex), usually affecting the bursa olecrani or bursa praepatellaris subcutanea, usually develops from acute bursitis and mostly affects men between the ages of 30 and 60. Fibrin deposits and granulation tissue are then often seen, as well as sometimes (20%) calcium salt deposits, which can be traced back to calcifying tendinopathies.

Cause

1. Trauma; minor injuries with abrasions or cuts can lead to purulent bursitis. It is usually caused by streptococci or staphylococci.
2. Infection
3. Overuse
4. Gout
5. RA
6. Traumatic vascular ruptures can lead to a hematobursa

Predisposing

1. Wrestling due to increased pressure and friction
2. Ice hockey (falls, body checks)
3. Students (Burtisis informaticus olecrani, students elbow)
4. Craftsmen, mechanics and cleaners are predisposed to burtistis praepatellaris (housemaid’s knee)
5. People who are very active in sports
6. Shoulder (subcromial bursitis): sports that put strain on the shoulder such as badminton, basketball, swimming or volleyball

Diagnosis

1. Clinic
2. Medical history
3. Laboratory: CRP, rheumatoid factors, uric acid

Symptoms

1. Initially mild symptoms, rubbing, burning sensation
2. Pain that often occurs clearly at night after the overload
3. In the pronounced stage: marked tenderness, palpable swelling, rubbing-burning pain on exertion, calor, rubor
4. Painful movements
5. In the case of infectious purulent bursitis, an increase in temperature above 38° is also possible. Chills are also possible.

Complications

1. Reduced joint stability after prolonged rest

Therapy

1. Avoid the pain triggers, if necessary take a break from sport for 4 weeks
2. If necessary, immobilization, compression bandage, orthosis
3. Cooling the affected bursa
4. Analgesics/NSAIDs such as diclofenac, ibuprofen, ketoprofen
5. (Improved) padding of mechanically stressed areas, also as a recurrence prophylaxis
6. Strengthening and stretching training
7. Laser therapy
8. Ultrasound therapy
9. Shoulder, but also other localizations: local glucocorticoid infiltration into the bursa
10. Septic/purulent bursitis: antibiotics
11. If conservative therapy fails: bursectomy, if possible in an inflammation-free interval. Complications can occur in the inflamed state
12. If necessary: puncture (risk of infection)

DD

1. Knee: PFPS (chondropathia patellae), Osgood-Schlatter disease