Last updated: February 9, 2023

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Bursitis is the inflammation of a bursa and is typically triggered by acute trauma, overuse, or an underlying inflammatory joint disease, such as rheumatoid arthritis or gout. Bursitis most commonly affects the olecranon, prepatellar, subacromial, or anserine bursae. Depending on which bursa is involved, the clinical presentation may include localized swelling, fluctuance, and/or pain with passive range of motion of the adjacent joint. Bursitis that is complicated by infection is referred to as septic bursitis and should be ruled out in patients with significant tenderness, erythema, and/or warmth of the inflamed bursa. Although bursitis is primarily a clinical diagnosis, imaging modalities such as x-ray, ultrasound, and/or MRI may be used to evaluate for alternative diagnoses or underlying joint disease. In patients with signs of acute inflammation, bursal aspiration with fluid analysis is indicated to rule out septic bursitis or gout. Conservative management (including rest, compression, and NSAIDs) is the mainstay of treatment for patients with nonseptic bursitis; intrabursal glucocorticoid injections may be used in refractory cases. Septic bursitis requires systemic antibiotic therapy and bursal drainage; surgical intervention is considered for patients with severe, recurrent, or refractory purulent effusions.

Pes anserine bursitis and trochanteric bursitis can occasionally contribute to pain syndromes that are primarily caused by tendinopathies; see “Pes anserinus pain syndrome” and “Greater trochanteric pain syndrome.”

General joint swelling and significant pain with passive range of motion of the elbow or knee should raise concern for arthritis rather than bursitis. [1]

Fever, signs of acute inflammation, and/or overlying cellulitis suggest septic bursitis. [1]

Bursitis is primarily a clinical diagnosis. [1][2]

Identification of monosodium urate crystals in bursal fluid indicates gout but does not rule out concurrent septic bursitis. [3]

Nonseptic bursitis [1][2]

  • Rest, ice or heat, elevation, and NSAIDs
  • Bursal aspiration for significant swelling
  • Compression to prevent fluid reaccumulation
  • Consider intrabursal glucocorticoid injection with specialist guidance. [1]

Septic bursitis [1][3]

Oral antibiotic therapy for septic bursitis may fail in up to 50% of patients. Maintain a low threshold for admission and inpatient IV antibiotic therapy. [1][5]

  1. Walls R, Hockberger R, Gausche-Hill M, Erickson TB, Wilcox SR. Rosen's Emergency Medicine 10th edition- Concepts and Clinical Practice E-Book. Elsevier Health Sciences ; 2022
  2. Sherman SC. Simon's Emergency Orthopedics, 8th edition. McGraw Hill Professional ; 2018
  3. Lormeau C, Cormier G, Sigaux J, Arvieux C, Semerano L. Management of septic bursitis. Joint Bone Spine. 2019; 86 (5): p.583-588. doi: 10.1016/j.jbspin.2018.10.006 . | Open in Read by QxMD
  4. Umer M, Qadir I, Azam M. Subacromial impingement syndrome. Orthop Rev (Pavia). 2012; 4 (2): p.18. doi: 10.4081/or.2012.e18 . | Open in Read by QxMD
  5. Khodaee M. Common Superficial Bursitis.. Am Fam Physician. 2017; 95 (4): p.224-231.

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