Bursitis in Emergency Medicine 

  • Author: Eileen Chang, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Jan 13, 2010
 

Background

Bursitis is inflammation of a bursa caused by repetitive use, trauma, infection, or systemic inflammatory disease. Bursae are flattened sacs that serve as a protective buffer between bones and overlapping muscles (deep bursae) or between bones and tendons/skin (superficial bursae). These synovial-lined sacs are filled with minimal amounts of fluid to facilitate movement during muscle contraction. Deep bursae, such as the subacromial and iliopsoas bursae, are located in the fascia. Superficial bursae, such as the olecranon and prepatellar bursae, are located in the subcutaneous tissue. Humans have approximately 160 bursae. Bursitis most commonly affects the subacromial, olecranon, trochanteric, prepatellar, and infrapatellar bursae. Symptoms of bursitis may include localized tenderness, edema, erythema, and/or reduced movement.

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Pathophysiology

Inflammation causes synovial cells to multiply and thereby increases collagen formation and fluid production. A more permeable capillary membrane allows entrance of high protein fluid. The bursal lining may be replaced by granulation tissue followed by fibrous tissue. Hemorrhage may occur. One study suggests this process may be mediated by cytokines, metalloproteases, and cyclooxygenases. In septic arthritis, local trauma usually causes inoculation of bacteria into the bursa, which triggers the inflammatory process.

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Contributor Information and Disclosures
Author

Eileen Chang, MD  Attending, Department of Emergency Medicine, North Shore Medical Center

Disclosure: Nothing to disclose.

Coauthor(s)

Janet Kay Talbot-Stern, MD, FACEM, FCEM  Emergency Medicine VMO, Ryde and Bankstown Hospitals, Australia

Disclosure: Nothing to disclose.

Specialty Editor Board

Mark Louden, MD, FACEP  Assistant Medical Director, Emergency Department, Duke Raleigh Hospital

Mark Louden, MD, FACEP is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Gino A Farina, MD, FACEP, FAAEM  Associate Professor of Clinical Emergency Medicine, Albert Einstein College of Medicine; Program Director, Department of Emergency Medicine, Long Island Jewish Medical Center

Gino A Farina, MD, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD 

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

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Acute infectious bursitis upon presentation to an emergency department. Image courtesy of Christopher Kabrhel, MD.
Infectious bursitis. Image courtesy of Christopher Kabrhel, MD.
 
 
 
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