Bursitis is an inflammation of the periarticular synovial sac with accumulation of effusion (exudate) in its cavity. The causes of bursitis are most often mechanical damage (bruises, chronic trauma), less often infections, metabolic disorders, intoxication, allergic reactions, and autoimmune processes.
Exudate (effusion), accumulating in the cavity of the periarticular synovial bag, with bursitis can have a serous, purulent or hemorrhagic nature.
The leading symptom of bursitis is the appearance of a local, rounded, flexible swelling in the area of the joint, often painful on palpation and movement, in the area of which the temperature is usually increased. Inflammation of the periarticular synovial bag can disrupt (limit) the motor function of the limb (it is difficult to bend and unbend the knee, etc.). In the course of the disease distinguish between "acute bursitis" and "chronic bursitis".
Symptoms of bursitis depend on the structure and function of the joint around which the bursae are located.
In the area of the shoulder joint, the subacromial and subdeltoid synovial bags are most often affected. With this localization, bursitis is accompanied by pain that increases with abduction and rotation of the shoulder, for example, when placing the hands behind the head. Sometimes these periarticular bags are calcified with calcium salts. The diagnosis in such cases is confirmed by X-ray examination of the joint. Bursitis of the shoulder joint can be one of the manifestations of humeroscapular periarthrosis.
Bursitis in the elbow joint most often develops as a result of chronic trauma in the course of professional activities or sports. Bursitis in the area of the elbow joint can also form as a result of a fall on the elbow with hemorrhage into the strip of the synovial bursa. The subcutaneous synovial bag of the olecranon is affected, less often the bursa at the lateral epicondyle.
Diagnosis of bursitis in case of inflammation of superficially located periarticular synovial bags does not cause difficulties - painful, well-mobile, clearly limited rounded tumor-like formations, hot to the touch, are found.
With serous inflammation, palpation of the periarticular bag causes moderate and purulent - sharp pain. When salts (calcium, urate, etc.) are deposited in the bursa cavity, uneven formations of bone density are felt. In chronic bursitis, as a result of prolonged inflammation, fibrosis of the capsule of the synovial bag develops, and on palpation, dense formations similar to a scar are determined.
Clinical diagnosis of bursitis of deeply located bursae is based on a clear knowledge of their location and accompanying bursitis dysfunction of the surrounding muscles. To diagnose bursitis of deeply located, especially intermuscular, synovial bursae, the additional instrumental examination is required (X-ray - arthrography, bursography).
In some cases, for differential diagnosis of bursitis, for example, hemangioma, lipoma, angiography, ultrasound, and radionuclide studies are performed.
To clarify the nature of the exudate with bursitis, a puncture of the synovial bag is performed, followed by microbiological and immunological studies of the obtained material (punctate).
Treatment of acute bursitis is conservative. As a rule, it is performed on an outpatient basis. In the first 5-7 days, rest is recommended, a splint limiting movement in the joint is applied, and anti-inflammatory drugs are prescribed. In some cases, hormonal drugs (Kenalog, Diprospan, Hydrocortisone) are injected into the joint capsule in combination with antibiotics. After eliminating the signs of acute inflammation, alcohol compresses are prescribed at night, phonophoresis of hydrocortisone, UHF therapy, UV irradiation is performed.
With purulent bursitis, patients are referred to a surgeon; a puncture or operation is shown - opening the synovial bag and removing pus, followed by treatment of the wound according to the general rules of surgery. Chronic post-traumatic bursitis is treated promptly in connection with the presence of blood in the cavity of the synovial bursa, which is a favorable environment for the development of infection. With chronic post-traumatic bursitis, relapses of the disease are also possible.