Bursitis in Emergency Medicine Workup

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

Laboratory Studies

  • Routine laboratory blood work is generally not helpful in the diagnosis of noninfectious bursitis. In cases of septic bursitis, however, leukocyte count and erythrocyte sedimentation rate may be mildly to moderately elevated. Blood cultures may be drawn if infection of deep bursae is a concern.
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Imaging Studies

  • Plain film radiography is usually not helpful in the diagnosis of bursitis but may be helpful to exclude other suspected pathologies (eg, fractures, dislocations). Of note, the bursal walls or nearby tendons may be calcified and radiopaque in chronic bursitis.
  • For diagnostic aspiration or treatment injections, ultrasonography may be used to elucidate the structures and to guide procedures.
  • If needed, MRI helps depict bursal/prebursal fluid, associated abscesses, and adjacent soft tissue structures.[2]
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Procedures

  • Aspiration and analysis of bursal fluid distinguishes septic bursitis from aseptic bursitis and may also be therapeutic.
    • Physicians should be more inclined to perform bursal fluid aspiration in the most frequently infected bursae, which are the olecranon, prepatellar, and infrapatellar bursae.
    • The septic bursitis white blood cell count (WBC) is lower than that of septic arthritis. A WBC count from 5,000/mm3 to 20,000/mm3 or higher may be considered indicative of infection. Gram stain accuracy varies considerably, with sensitivities between 15% and 100%. Therefore, fluid with a high WBC count but negative for Gram stain is still considered suspicious for infection. Elevated protein level and reduced glucose level are associated with infection but are not a sufficiently sensitive or specific finding to be used in isolation. Bursal fluid culture is the conclusive test for diagnosis. Culture in liquid medium has been shown to be superior to culture on solid medium. Chronic or recurrent bursitis should be sent for acid-fast staining and cultured on special media for mycobacteria, Brucella, and algae.
    • Fluid should also be examined for crystals. Monosodium urate crystals are seen in gout; calcium pyrophosphate crystals are seen in pseudogout; cholesterol crystals are seen in rheumatoid chylous bursitis.
    • Arthrocentesis should be performed if joint involvement is suspected.
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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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