Bursitis

The term bursitis refers to any acute or chronic inflammatory process involving one of the more than 150 bursae identified throughout the human body. 17 Bursitis is classified by etiology, body location, and presence of infection. Etiologic entities include trauma, crystal-induced, rheumatoid, and idiopathic forms. Presence of infection is noted by classification as septic or nonseptic. Staphylococcus aureus accounts for the majority of identified infectious agents, but Staphylococcus epidermis and Streptococcus species are also encountered.

Bursitis is a relatively common condition, due to the number of bursae and the minimal trauma required to initiate a clinically evident process. The affected site is determined by the activity precipitating the event and/or the relatively superficial location of many bursae. Certain entities are frequently associated with occupations or activities that precipitate their occurrence: "carpet layer's knee" (prepatellar bursitis) or "student's elbow" (olecranon bursitis).

General principles of management include restraint from further trauma/injury, elevation, and a compressive dressing. Drug therapy with NSAIDs is the primary pharmacotherapeutic intervention. Injection of the affected bursa with steroids is controversial and should be avoided when septic bursitis cannot be excluded. Specifically, olecranon and prepatellar bursitis are not uncommonly complicated by infection.

Septic bursitis generally responds well to oral antibiotics, with emphasis on coverage of Staphylococcus and Streptococcus species. Selected patients will require more aggressive interventions, including admission to hospital, administration of parenteral antibiotics, incision and debridement, and open irrigation. These patients typically have more advanced, purulent infection within the bursa, extensive spread of infection/cellulitis to surrounding soft tissues, suspected joint involvement, or failure to respond to oral antibiotics and outpatient interventions.

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