Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

Featured on Channel NewsAsia

Bursa Injuries

Bursae are small, fluid-filled sacs whose function is to reduce friction, distribute stress, and protect the underlying structures. They may be found between a bone and a tendon, between two tendons, or between a bone or tendon and the overlying skin. There are a number of permanent bursae around the hips, knees, feet, shoulders, and elbows, and some of these are linked with the adjacent joints. The bursa in the posterior aspect of the knee (popliteal or semimembranosus-gastrocnemius—‘Baker’—cyst), for
example, is connected with the knee joint, while that located beneath the iliopsoas muscle may be connected with the hip. Acquired bursae are found in areas subject to repeated stress, friction, or pressure, such as those over protruding bones or metallic implants.
Bursitis may be inflammatory, or caused by an impact with subsequent bleeding (hemorrhagic bursitis).

Inflammatory bursitis

Bursitis may be classified as frictional, chemical, or septic, according to its cause. It can occur in isolation or as part of a generalized inflammatory or infectious disease such as rheumatoid arthritis, tuberculosis, or ankylosing spondylitis (Bechterew’s disease).

Frictional bursitis

Frictional bursitis occurs when a tendon moves repeatedly over a bursa, often combined with external pressure. Frictional bursitis occurs in athletes who carry out repetitive movements, e.g. tennis players and runners training on one side of the road. It frequently affects bursae in the shoulder, elbow, hip, and knee, and around the heel and the big toe.

Symptoms and diagnosis

The mechanical irritation stimulates inflammation which in turn causes fluid to be secreted into the bursa with resultant swelling and tenderness. Fluctuation of the fluid can often be felt when the bursa is examined. If the inflammation is intense, and particularly when it is superficial, the overlying skin is red and hot.

Signs and symptoms include:
– swelling;
– local increase in temperature;
– redness;
– tenderness;
– pain on attempted movement.

Treatment

The athlete or trainer should:
– encourage rest until the pain has resolved completely;
– cool the injured area with an ice pack;
– apply a bandage to compress the bursa;
– relieve any external pressure on the bursa (e.g. by applying a ‘doughnut’ of plastic foam with the centre cut out);
– use a Neoprene sleeve for compression;
– consult a doctor if the swelling is extensive, the skin is red, or the pain is severe and persistent.

The doctor may:
– prescribe rest and sometimes a splint for a few days;
– aspirate the fluid from the bursa, sometimes in combination with compression;
– inject steroids locally;
– prescribe anti-inflammatory medication;
– remove the bursa by surgery; removal of an underlying bone spur may sometimes be necessary if it has been a factor in causing the bursitis;
– perform bursoscopy (inspection of the bursa using an arthroscope) and shaving if necessary.

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