Bursitis - Causes, Symptoms And Treatment

2024 Author: Josephine Shorter | [email protected]. Last modified: 2023-12-16 21:43

Causes, symptoms and complications of bursitis

Content:

• What is bursitis?
• Bursitis reasons
• Bursitis symptoms
• Types of bursitis
• Diagnosis of bursitis
• Complications of bursitis
• Bursitis treatment
• Prevention of bursitis

Diseases of the musculoskeletal system are among the most dangerous, because limit human motor activity. More often, the disease affects the junction of the bones - the joints.

What is bursitis?

Bursitis is an inflammatory disease of the synovial bursae, accompanied by increased formation and accumulation of exudate in their cavities. The causes of this disease are bruising, abrasion, minor wounds and secondary infection of the synovial bag with pyogenic microbes.

Most often occurs in the shoulder, elbow, or knee in men younger than 35, especially athletes. The hip, wrist, or ankle may also be affected. This is usually an occupational disease, but it also occurs in people who are overweight or wear the wrong shoes.

The swelling may be about 10 cm in diameter. It appears because the volume of the articular sac increases abnormally. Exceeding the normal size occurs, for example, due to blood. Vascular rupture and hemorrhage occur as a result of a strong blow. Gradually, the blood elements decompose and the blood turns into a yellowish liquid. Exudative effusion occurs. The resulting bag pulls the skin if the joint is shallow.

So exudate begins to accumulate in the cavity - a special liquid characteristic of inflammation foci. Then the adjacent tissues are squeezed, and the transudate is "squeezed out" into the intercellular space. Puffiness appears, pressure on the nerve endings causes painful sensations.

Edema can develop in a bursa located so deep that there are no visible changes. This applies, for example, to popliteal bursitis. In such "deep" cases, one cannot do without X-ray. Sometimes radiography is accompanied by contrasting - bursography. A special coloring agent is injected into the bursa using a needle.

Exudate from the bursa according to macroscopic features can be of the following types:

• serous;
• serous fibrinous;
• purulent;
• purulent hemorrhagic.

Some experts identify other varieties. The most severe form is accompanied by suppuration. Pus is a collection of leukocytes that have died in the fight against inflammation. They turn into purulent bodies. Hemorrhagic exudate has a reddish tint, because it is saturated with erythrocytes from destroyed vessels.

According to the cytological picture, i.e. cellular composition, this fluid has such forms as:

• neutrophilic in acute conditions;
• lymphocytic in the chronic course of the disease;
• eosinophilic for allergic inflammation;
• mononuclear in chronic form;
• mixed.

Neutrophils, lymphocytes, eosinophils and monocytes are types of leukocytes. At different stages of the disease, their proportion, i.e. leukocyte formula, in the cellular composition changes. The predominance of these very protective cells is associated with the presence of special receptors in them, the ability to synthesize toxic substances that accelerate the death of the pathogen. The exudation mechanism is triggered by the penetration of a pathogenic agent, it contributes to the process of phagocytosis.

Bursitis is characterized by the deposition of salts in the walls of the articular sac - calcification. Calcium salts should not be contained in them undissolved. This leads to dysfunction. Magnesium's ability to dissolve abnormal deposits is usually used to restore balance.

Bursa is a pocket located in the place of the greatest friction against bone protrusions. To soften this, the connective tissue sac is filled with a synovial fluid of a viscous consistency. It is a kind of motion damper, hydraulic cushion. There are more than 100 such "adaptations" in the human body, respectively, and the risk of developing bursitis when provoking factors appear is very high.

Bursitis reasons

The cause of bursitis is usually trauma, bruise or abrasion, that is, infection through the blood or damage to the affected area. It is also possible for pus to enter from erysipelas, this happens with osteomyelitis, bedsores, boils, carbuncles. This disease is more possible in people involved in traumatic sports: cyclists, football players, jumpers. The infection gets through abrasions or severe bruises. The chronic manifestation of this disease occurs due to constant irritation of the inflammation focus.

There are other reasons as well:

• mechanical overstrain of the joint due to its "curvature" (for example, hallux valgus, flat feet), damage or when lifting weights, wearing too narrow shoes and high heels, with excess weight;
• various diseases accompanied by inflammation, for example, arthritis (gout and scleroderma including), furunculosis with and without carbuncle, erysipelas, osteomyelitis, ARVI, influenza, tonsillitis, brucellosis, persecution, bronchitis, sinusitis, otitis media, abscess;
• metabolic disorders, for example, with bedsores;
• calcification of tendons and surrounding areas;
• injury to the bursa, patella, or adjacent tendons;
• damage or pathological changes in the skin in the joint area, leading to the penetration of infection into the bursa. This can happen with careless cutting of calluses and corns;
• an allergy causes an excess of antibodies. In the acute phase of the immune response, basophils secrete various inflammatory mediators;
• poisoning (toxins, getting into the blood, poison the tissues);
• autoimmune diseases. The immune system begins to produce antibodies against healthy tissues.

Excessive stress on the joints is common. They are typical for women who love to walk on stiletto heels, men who carry weights, and all fat people. If bursitis develops as a complication of another disease, the treatment is complex. In arthritis, inflammation on the periarticular bursa spreads from the joint, in osteomyelitis - from the bone marrow.

Any inflammation takes place in 3 stages:

1. Alteration - cell damage (including pathogens);
2. Exudation - fluid secretion;
3. Proliferation - restoration of integrity.

The second stage is fraught with "infection" of other organs. The causative agents of the inflammatory process are quickly spread throughout the body with the blood.

Bursitis symptoms

The main symptom of bursitis is the appearance of swelling in the area of the injured area of the body.

The symptoms of bursitis include the definition of a rounded, limited patient swelling, elastic consistency, fluctuating, at the site of the anatomical location of the bag. This swelling can be about eight or ten centimeters in diameter.

There are symptoms of bursitis such as:

• accumulation of excess fluid in the bursa - exudate
• pain syndrome - aching, shooting, strong, throbbing pains radiating to the limb. They get worse at night. This happens because there are much fewer irritants at night that can distract the patient. When a person is immobile for a long time, the swelling increases, and so does the pain.
• joint contracture. Restriction of movement appears due to the resulting pain, edema and deposits of calcareous salts in the walls of the bag.
• edema - accumulation of fluid in the intercellular space as a result of hyperosmia
• redness of the skin - hyperemia. It occurs due to the tension of the skin, its thinning, rush of blood to the inflamed area.
• increase in local or general body temperature up to 40
• general malaise, weakness
• nausea
• enlargement of the surrounding lymph nodes

If the disease is phlegmatic, then the body temperature will be from thirty-nine to forty degrees. With bursitis, swelling of some skin tissues occurs, while the person will feel increased pain, and the body temperature will rise up to forty degrees.

Chronic bursitis is characterized by a round, limited swelling of a soft consistency, it occurs at the site of the bursa. The skin over the swelling is mobile, not changed, the function of the limb is not impaired.

Chronic bursitis can turn into a hygroma, this is due to the appearance of a large amount of fluid in the edema cavity.

Types of bursitis

Experts use several grounds for classifying the types of this disease. According to the nature of the course of the disease, acute and chronic bursitis are distinguished. The acute form develops in a couple of days, the chronic one can proceed with periodic exacerbations. These forms differ in the nature of the pain.

Types of bursitis for reasons of occurrence:

• infectious or septic;
• aseptic, including traumatic.

The infection enters from the outside or from the inside: directly through the damaged skin, blood (hematogenous infection with pyogenic microbes) or lymph (lymphogenous). By the nature of the pathogen, nonspecific and specific bursitis are distinguished.

The latter are caused by the following pathogens:

• gonococci;
• brucellosis;
• staphylococci;
• streptococci;
• pneumococci;
• tuberculous or Escherichia coli.
• The type of pathogen determines what the exudate will be, how the disease will proceed.

Types of bursitis depending on the location of the lesion:

• brachial;
• elbow;
• hip;
• knee: sub- (infrapatellar), patellar (prepatellar) or Baker's cyst on the inner side - hygroma;
• ankle;
• heel or Achilles bursitis;
• wrist.

The bursae are located in various locations. In accordance with their position, the types of bursitis are also differentiated:

• subcutaneous develops in the subcutaneous tissue on the convex surface of the joint;
• subfascial;
• dry tendon;
• axillary.

Varieties of inflammation of the bursa by the nature of the exudate:

• serous;
• purulent;
• hemorrhagic.

The type of illness is usually caused by the type of infection, sport, or profession. Bursitis caused by overstraining the legs when kneeling for a long time is called “water in the knee”, “roofer knee”, “parquet flooring knee”, “tiler's knee” or “maid / housewife's knee”. There is also a footballer's knee caused by frequent injuries. Occupational hand diseases are called "watchmaker's elbow", "jeweler / engraver's elbow", "miner's elbow", tennis players' bursitis, etc. There is also a "loader's shoulder". The form and number of bursitis relapses depend on the patient's profession and working conditions.

Diagnosis of bursitis

Different types of bursitis differ slightly in symptoms. The chronic form can be virtually asymptomatic. At different stages of the disease, the swelling changes its size and density. Signs of bursitis appear in stages.

In acute form, the patient may find a painful swelling in the morning. The skin in this place is reddened, hot to the touch, mobile. Over time, the limb will become more difficult to act. When pus appears in the focus of inflammation, fever will begin. If a focal change in the organ of the musculoskeletal system is a complication of another disease, then its manifestations will progress.

Regional lymph nodes near the affected joint enlarge when inflammation products enter them. This is a reaction of the immune system. Lymphadenitis may begin. With shoulder bursitis, the lymph nodes are enlarged in the neck and in the armpits, with the hip and knee - in the groin.

The reason for going to the clinic is usually pain and limited body movements. Bursitis diagnostic methods:

• conversation;
• inspection;
• radiography;
• Ultrasound;
• CT scan;
• Magnetic resonance imaging;
• puncture with laboratory tests of the extracted fluid;
• arthrography - knee endoscopy;
• Complete blood count to detect signs of inflammation;
• angiography of blood vessels to determine the boundaries of inflammation.

The diagnosis of some types of bursitis is complicated by the fact that their symptoms are similar to other inflammatory diseases. An example is arthritis - inflammation of the joint and synovitis - its lining. In addition, these pathologies can occur simultaneously. In this case, it is quite difficult to identify the root cause.

Depending on the test results, the orthopedist prescribes treatment. But most often, only visual methods and palpation are enough to make a diagnosis.

Simple tests can help diagnose bursitis:

1. The doctor asks the patient to try putting his hand behind his head as if brushing hair.
2. The patient should squat a little.

If soreness and limited movement is found, then the likelihood of illness increases. The further from the surface of the body the inflamed bursa is located, the more difficult it is for a specialist to diagnose. But no matter how deeply the focus is hidden, when pressed, the patient will definitely feel pain.

The general symptoms of inflammation of the bursae are little different from those of other similar diseases. It is all the more important to be examined by a specialist in order to differentiate this ailment in time and begin treatment.

Complications of bursitis

• cicatricial adhesions - seals that cause immobility of the limb - contracture
• calcification
• infection of other organs, for example, tendobursitis and tendon rupture, abscess, osteomyelitis, subcutaneous and intermuscular cellulitis, arthritis, including purulent (when pus breaks into the joint) and coxarthritis
• fistula - a fistula with the formation of pus
• bag wall necrosis
• sepsis

The adhesion process sometimes proceeds pathologically. The healing of the walls of the mucous bags of the joints damaged by bursitis proceeds abnormally, extra "threads" - adhesions are formed. They create unnecessary connections that interfere with normal organ movements.

The unpleasant thing is that such growths often occur imperceptibly. It is not always possible to see them even with the help of ultrasound. Over time, pains appear, adhesive disease progresses. If this process is triggered by hip bursitis, abnormal scarring can also invade the woman's genitals, causing infertility.

The inflammation spreads easily from the joint capsule to the tendons. Their fibers are closely intertwined with the outer fibrous sheath of the bursa. So muscles can more effectively perform motor function, activate the process of movement of articular surfaces.

The most severe purulent bursitis. Suppuration spreads to nearby soft tissues and bones. It melts the connective tissue of phlegmon. It differs from an abscess in that it has no clear boundaries. These are the unfavorable outcomes of necrosis. Sometimes there is a spontaneous opening of abscesses. Fistulas appear.

Fixing bandages can increase the pressure inside the bursa so much that pus gets into other tissues, blood. It contains a large amount of proteolytic enzymes that melt proteins. So necrotic destruction of cells begins in other parts of the body.

Lymphoid tissue is almost always involved in inflammatory processes. The immune system must respond to infection. During the next examination, the orthopedist palpates those lymph nodes to which lymph flows from the affected area. Soreness indicates the progression of the pathological condition.

Necrosis of the inner lining of the bursa will lead to the cessation of the secretion of synovial fluid.

The synovial fluid performs very important functions for joint health:

• nourishes,
• moisturizes,
• helps to slip.

Complicated bursitis increases pain. All parts of the joint, except for the hyaline cartilage, are perfectly innervated. Simultaneously developing pathologies increase the number of foci of inflammation. Strengthening the inflammatory process of pressure on numerous nerve endings exacerbates the pain syndrome.

If left untreated, the patient may become disabled or die. Self-medication is dangerous and can lead to tragic consequences. According to the surgeon D. S. Thevs: "Better to overestimate the severity of your symptoms than to seek medical attention late."

Bursitis treatment

Conservative treatment of acute bursitis

In acute bursitis, the most important thing for the patient is rest and immobility. If bursitis occurs on the joints of the shoulder or elbow, then the joint must be fixed with a plaster cast. If the person is in severe pain, give them aspirin or some pain reliever, sometimes the pain will go away on its own. In some cases, in order for the exudate to dissolve better, use heat or apply Vishnevsky ointment.

Modern methods allow patients to undergo a therapeutic course on an outpatient basis. Rest, diet is required. Specific measures depend on the causes of the disease. They usually include suppressing the inflammatory process with intravenous antibiotics, anesthesia, and strengthening the immune system.

In addition to drug treatment, massage and physiotherapy are prescribed:

• ultraviolet irradiation;
• shock wave therapy;
• inductotherapy;
• paraffin or ozokerite applications;
• electrophoresis with various drugs.

Physiotherapy procedures should activate metabolic processes, prevent stagnation. They help relieve swelling and reduce muscle tension in the affected area. Strongly resorbing effect of physiotherapy. Specific procedures are prescribed depending on the stage of the disease and the patient's well-being.

The movement of the diseased limb is limited with elastic bandages and a special fixator: bandage, splint, etc. Massage is carried out with an ice pack through the clothes. These measures can help reduce pain. The painful joint is lifted to prevent the development of edema.

After the inflammation is removed, physical activity is increased gradually. The leg or arm is developed using special exercises. The complex of physiotherapy exercises is selected individually. With a favorable course of the disease, it is possible to suppress it in a week, otherwise - in 3 months. After healing, it is important not to forget about preventive measures.

Surgical treatment of chronic post-traumatic bursitis

With chronic bursitis, surgical intervention is also possible, since the patient will complain of calcium deposits - provided that they are quite large, create long-term discomfort or interfere with movement.

In case of calcium deposits, they are removed with a needle or by surgery. Sometimes, with complete immobility of the joint, it is developed under anesthesia.

Bursa can be opened, cleaned, cut adhesions and calcium deposits, treated with antiseptics. With purulent bursitis, extirpation of the periarticular bursa is sometimes required. Only part of it is surgically removed, for example, mucous membrane. Modern methods allow minimizing the recovery period. With a favorable outcome, the operated person can return home in a couple of hours. The last resort is bursectomy - complete removal of the bursa. A special type of surgical intervention - osteotomy, is accompanied by the movement of bones, and even their fixation in the correct position with special metal rods.

In the media, there are recommendations for aspiration of exudate at home. Doing so is deadly! This procedure is carried out only by a specialist, under sterile conditions. “Well-wishers”, giving such advice, forget how fast disease-causing microbes can spread. Sepsis is fatal within a few days.

Prevention of bursitis

• disinfection of scratches, abrasions, small wounds, abrasions with antiseptics;
• timely suppression of inflammation;
• avoidance of overload;
• correction of deformed joints;
• diet food.
• playing sports, taking into account the individual health index.

By immediately treating wounds with disinfecting compounds, you can significantly reduce the risk of an infectious disease. If there is a focus of inflammation, there is a high probability that it will spread further with lymph and blood. By suppressing the disease in time, many complications can be avoided.

People who are prescribed to wear special models of shoes, the use of special insoles or inlays should not neglect the recommendations of specialists.

There are the following types of orthopedic products for various activities:

• orthoses for adjustable fixation of the hip and knee joints;
• bandage and sports orthosis for the knee joint and the cup;
• compression and anti-varicose jersey with devices to facilitate putting on / taking off;
• hip bandage;
• bandage for fixing the Achilles tendon;
• ankle bandage and sports orthosis;
• abduction bandage for the first toe in case of non-fixed hallux valgus;
• under - and heel;
• pelot, lining and liner under the forefoot;
• instep support;
• insoles and half insoles;
• interdigital insert;
• bursoprotector;
• interdigital corrector;
• metatarsal and support-corrective linings;
• interdigital septum and insert;
• protective cap and toe ring;
• pelot-fixer;
• protective liner against corns;
• interdigital separator;
• elastic brace and forefoot cuffs;
• metatarsal pad;
• a protector to protect the joint of the big toe and little toe;
• heel and toe pad;
• anti-ash ring;
• protective socks;
• corrector and padding between the toes;
• metatarsal roller;
• orthosis for the big toe.

Here are listed not only products useful for professional athletes, but also remedies for the correction of deformed joints. Orthopedic treatment is always a complex and time-consuming process. In severe cases, surgery is required.

Those whose profession is associated with constant stress on the joints should be protected as much as possible. Place soft pillows under your knees or elbows, wear special protective bandages, take breaks with a little warm-up. Before heavy loads, be sure to "warm up" the joints with a special set of exercises. Stretching should be done before any exercise: light - moderate - full. Walking, jogging, dumbbell work, and swimming are recommended.

It is not uncommon for a patient to do nothing after discovering swelling and continues to live according to the principle "it will pass by itself." The tumor subsides. But usually this is only an indicator of the onset of the chronic stage of the disease. Neglecting treatment can provoke the spread of infection throughout the body.

Author of the article: Kaplan Alexander Sergeevich | Orthopedist

Education: diploma in the specialty "General Medicine" received in 2009 at the Medical Academy. I. M. Sechenov. In 2012 completed postgraduate studies in Traumatology and Orthopedics at the City Clinical Hospital named after Botkin at the Department of Traumatology, Orthopedics and Disaster Surgery.