Bursitis Workup

  • Author: Alita Gonsalves, MD; Chief Editor: Harris Gellman, MD   more...
 
Updated: Feb 7, 2012
 

Laboratory Studies

  • Erythrocyte sedimentation rate (ESR), antinuclear antibody (ANA), rheumatoid factor (RF)
    • The ESR, ANA, and RF tests should all be ordered in cases in which autoimmune disease is suspected, because these inflammatory disorders can trigger bursitis.
  • Fluid analysis
    • The joint should be aspirated and fluid sent for analysis to rule out infectious or rheumatic causes. Bursal fluid should be drawn for uric acid crystal determination, cell count with differential, Gram stain, and culture. Nonseptic bursitis has cell counts less than 2000, with a predominance of mononuclear cells. Septic bursitis has cell counts greater than 70,000, with a predominance of polymorphonuclear cells. Gram stain and culture are done to identify any pathogens.
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Imaging Studies

  • Radiographs
    • Plain radiographs may be useful in identifying osteophytes or other underlying bony pathology that may be triggering the bursal inflammation. They may also show joint effusions.
  • Bone scan
    • Bone scan is not a sensitive test of bursitis, but it may be done in cases in which the diagnosis is unclear, to rule out other causes of pain.
  • MRI and CT scan
    • MRI and CT are usually not necessary because of the common clinical presentation of bursitis. MRI is useful to delineate the anatomy of the entire joint and is a very sensitive test for identification of bursitis. MRI is also helpful in ruling out suspected solid tumors and defining pathology for possible surgical excision.
  • Ultrasonography
    • Ultrasonography is a useful modality to obtain further imaging of the bursa when the diagnosis is uncertain, and it is often used to obtain images of popliteal cysts. These bursae are often discovered incidentally when lower-extremity Doppler studies are done to rule out deep vein thrombosis. Ultrasound studies distinguish solid from cystic masses and are helpful in detecting Baker's cysts (popliteal bursitis) when there are extensive joint deformities.[11, 24]
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Contributor Information and Disclosures
Author

Alita Gonsalves, MD  Physiatry, Private Practice, Vero Orthopaedics and Neurology; Former Staff Physician, Department of Physical Medicine and Rehabilitation, New York Presbyterian Hospital-Columbia and Cornell

Alita Gonsalves, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation and Physiatric Association of Spine, Sports and Occupational Rehabilitation

Disclosure: Nothing to disclose.

Coauthor(s)

Leon Root, MD  Professor of Clinical Surgery, Department of Orthopedics, Weill Medical College of Cornell University; Founder and Director, Pediatric Outreach Program; Emeritus Chief of Osteogenesis Imperfecta Clinic, Attending Orthopaedic Surgeon, Medical Director of Rehabilitation , Emeritus Chief of Pediatric Orthopaedics at The Hospital for Special Surgery

Leon Root, MD is a member of the following medical societies: American Academy of Cerebral Palsy and Developmental Medicine, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, New York Academy of Medicine, and Pediatric Orthopaedic Society of North America

Disclosure: Nothing to disclose.

Specialty Editor Board

Heidi M Stephens, MD, MBA  Associate Professor, Department of Surgery, Division of Orthopedic Surgery, University of South Florida College of Medicine; Courtesy Joint Associate Professor, Department of Environmental and Occupational Health, University of South Florida College of Public Health

Heidi M Stephens, MD, MBA is a member of the following medical societies: Alpha Omega Alpha, American Academy of Orthopaedic Surgeons, American Medical Association, American Orthopaedic Foot and Ankle Society, and Florida Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Ian D Dickey, MD, FRCSC  Adjunct Professor, Department of Chemical and Biological Engineering, University of Maine; Consulting Staff, Adult Reconstruction, Orthopedic Oncology, Department of Orthopedics, Eastern Maine Medical Center

Ian D Dickey, MD, FRCSC is a member of the following medical societies: American Academy of Orthopaedic Surgeons, British Columbia Medical Association, Canadian Medical Association, and Royal College of Physicians and Surgeons of Canada

Disclosure: Stryker Orthopaedics Consulting fee Consulting; Cadence Honoraria Speaking and teaching

Dinesh Patel, MD, FACS  Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital

Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Harris Gellman, MD  Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami, Leonard M Miller School of Medicine

Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, and Arkansas Medical Society

Disclosure: Nothing to disclose.

References

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Olecranon bursitis, shown here with the elbow flexed. Image courtesy of UMDNJ-New Jersey Medical School, www.DoctorFoye.com, and www.TailboneDoctor.com.
Olecranon bursitis aspiration of a hemorrhagic effusion. Image courtesy of UMDNJ-New Jersey Medical School, www.DoctorFoye.com, and www.TailboneDoctor.com.
Location of pes anserine bursa on the medial knee. MCL is medial collateral ligament.
 
 
 
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