Bursit – an acute, subacute or chronic inflammation of a sinovialny bag which is followed by plentiful education and accumulation of exudate (inflammatory liquid) in her cavity. Sharp bursit usually arises owing to a trauma, chronic – owing to constant mechanical irritation. Clinically bursit it is shown by rise in body temperature, an indisposition, pain, puffiness and reddening in the field of the struck sinovialny bag, moderate restriction of movements in a joint. The basis of diagnostics is made by survey of the struck area, a puncture and a bacteriological research of a punktat, MRT and a X-ray analysis of a joint. Treatment includes motive rest of the affected extremity, ice compresses, anesthetics and resolvents. Chronic bursit often is the indication to surgical treatment.
Bursitom is called sharp, subsharp or chronic inflammatory process in a sinovialny bag. The disease is followed by increase in a bag owing to accumulation of exudate in it. The sharp trauma, constant mechanical irritation or adjournment of salts at some rheumatoid diseases can become the reason of development. About 85% of all cases of a bursit are observed at men. First place on prevalence is won by elbow bursit.
Sinovialny bag is called the slit-like cavity covered by a cover and containing small amount of sinovialny liquid. Bags settle down about speakers of sites of bones and perform shock-absorbing function, protecting soft fabrics (muscles, sinews, skin and fastion) from excessive friction or pressure.
Allocate the following types of sinovialny bags: axillary (being under muscles), podfastsialny (located under fastion), subtendinous (lying under sinews) and hypodermic (being on the convex surface of joints, directly in hypodermic cellulose).
In traumatology and surgery there are several classifications of a bursit:
- Taking into account localization (an elbow, knee, shoulder joint etc.) and names of the struck Bursa.
- Taking into account a clinical current: sharp, subsharp and chronic bursit.
- Taking into account the activator: specific (bursit at syphilis, tuberculosis, a brucellosis, gonorrhea) and nonspecific bursit.
- Taking into account character of exudate: serous (plasma with impurity of a small amount of uniform elements of blood), purulent (microorganisms, the destroyed cages, the broken-up leukocytes), hemorrhagic (liquid with a large number of erythrocytes) and fibrinozny (with the high content of fibrin) bursit.
Besides, in clinical practice often allocate aseptic (not infected) and infected bursit.
Sharp infected bursit usually develops as a result of a small trauma (a small wound, a hematoma, a graze) or a purulent inflammation (decubitus, osteomyelitis, an anthrax, a furuncle, an erysipelatous inflammation). In the field of damage gnoyerodny microbes which then on lymphatic ways are carried to the area of a bag breed, infecting her contents.
Also transfer of an infection through blood or direct hit of microbes in a bag cavity at damage of soft fabrics is possible. Most often direct infection happens at cuts and grazes in an elbow (for example, as a result of falling from the bicycle). Epidermalny or golden staphylococcus becomes the reason of development of the infected bursit in this case usually.
The probability of emergence of bursit at direct hit of microorganisms increases at decrease in immunity, alcoholism, diabetes, reception of steroids, some diseases of kidneys. Besides, some diseases (a sklerodermiya, gout, rheumatoid arthritis) can be the cause of development of a bursit. In this case bursit arises owing to adjournment of salts in a sinovialny bag.
Chronic bursit arises owing to constant, enduring mechanical irritation of the respective area. Usually its emergence is caused by features of professional or sports activity. For example, at miners it is more often observed bursit an elbow joint, at housewives and housemaids – bursit a knee joint etc.
At a sharp bursit in the field of a bag the painful, limited, elastic swelling of rounded shape is formed. There is a reddening of skin and small hypostasis of soft fabrics. The patient is disturbed by pain in the struck area. Sometimes the patient complains of an indisposition and temperature increase. At a palpation the fluctuation confirming liquid availability is defined. The movements in a joint are moderately limited.
At further development of inflammatory process hypostasis and hyperaemia amplify, the considerable hyperthermia (to 39-40 °C) and the expressed pain syndrome is observed. In hard cases perhaps purulent defeat of soft fabrics with development of phlegmon. As a result of treatment sharp bursit disappears. Sometimes recovery does not manage to achieve, and sharp bursit passes in subsharp, and then into a chronic form.
At a chronic bursit in the field of a bag the soft, limited swelling of rounded shape is defined. Reddening, hypostasis of surrounding fabrics and morbidity at a palpation are absent. The movements in a joint are kept in full. At a secondary chronic bursit perhaps recidivous current. In this case in a cavity of a bag there are isolated sites of the destroyed fabrics which at decrease in immunity or a small trauma can become favorable circumstances for repeated development of inflammatory process.
The diagnosis is exposed on the basis of a clinical picture. For specification of character of inflammatory liquid and definition of sensitivity of microorganisms to antibiotics the puncture is carried out. In the course of diagnostics it is necessary to exclude specific infections (spirokheta, gonokokk etc.) therefore at suspicion on the specific nature of a disease bacteriological researches and serological reactions are carried out.
Differential diagnostics with arthritis is performed on the basis of clinical signs: at a bursita, unlike arthritis, the volume of movements in a joint is slightly reduced or kept. Radiodiagnosis and MRT of joints are an auxiliary method of diagnostics at superficial bursita and gain bigger practical value at recognition of the deep bursit less available to direct clinical trial.
treatment should be carried out only under the supervision of a doctor. Self-treatment is unacceptable!!!
At sharp aseptic bursita provide rest of an extremity, appoint ice compresses, the anti-inflammatory and anesthetizing medicines. In certain cases carry out a puncture of Bursa for removal of liquid and/or introduction of corticosteroids.
At accession of an infection carry out antibiotic treatment, if necessary carry out repeated removals of inflammatory liquid or drainage with washing of a cavity of Bursa solutions of antibiotics and anti-septic tanks. In hard cases expeditious excision of Bursa sometimes is required. Further treatment is carried out as usual at purulent wounds, healing can take the long period of time.
Treatment of chronic aseptic bursit depends on localization. In many cases the most reliable way forever to get rid of a bursit is surgery – excision of a bag. Removal of not infected Bursa is carried out in a planned order, in the conditions of the pure operating room. The wound heals primary tension within 10 days. A recurrence of a bursit when using this method of treatment is observed at 2-2,5% of patients. Purulent bursit can be complicated by fistulas, osteomyelitis, arthritis or sepsis.
Bursita of an elbow joint
As it was already told above, the most widespread type of a bursit is bursit an elbow joint, more precisely – the elbow hypodermic bag located in the field of an elbow shoot. Sharp elbow bursit develops owing to a trauma, a drift of an infection or a metabolic disorder. Features of work or sports loading (except miners this disease the people forced to lean constantly elbows on a table in operating time and also fighters – sometimes have because of pressure and friction of elbows about a carpet) can be the reason of development of a sharp and chronic bursit.
In the beginning in the field of an elbow shoot there is a small swelling which often remains unnoticed. At a sharp bursit the swelling increases, skin over it reddens, the movements in a joint become painful. Perhaps local temperature increase. At a palpation elastic flyuktuiruyushchy education is defined. At further development of an infection weakness, symptoms of the general intoxication appears.
Surgeons are engaged in treatment of a sharp bursit. Therapy includes the standard methods used for all types of bursit: rest, compresses, anti-inflammatory and anesthetics, sometimes – punctures and introduction of corticosteroids. At purulent bursita antibiotics are appointed, removal of liquid through a small section with the subsequent washing and drainage of a cavity is carried out. In the started cases carry out surgical intervention – opening with the subsequent drainage.
At a chronic bursit the swelling also continues to increase, however, in this case neither the redness, nor temperature increase is observed. Can be the only unpleasant symptoms feeling of awkwardness in an elbow and the pain when bending caused by a tension of Bursa.
For lack of treatment Bursa can reach the considerable sizes and is considerable limit mobility of a joint. When performing any work the patient is forced to do breaks because of pains during movements. The swelling can be both elastic and intense, and flabby, soft. Sometimes at a palpation consolidations of cartilaginous density and cicatricial tyazh are defined.
Chronic aseptic bursit is under authority of traumatologists and orthopedists. Bag punctures in this case are not shown as after removal liquid usually collects again. Operation is recommended. Surgical intervention is carried out in the conditions of a hospital. The bag is otslaivat from skin and a bone, and then deleted, the wound is drained, apply a hard bandage area of a joint. The graduate delete for the 2 or 3 day, usually remove seams in 10 days after operation.
It is necessary to remember that at an elbow bursit there is rather high risk of secondary infection. Besides, at old chronic bursita in a bag and around it there are cicatricial changes that complicates performing surgery. Therefore it is necessary to see a doctor in early terms, without waiting for complications.
Bursita of a knee joint
Most often are surprised the hypodermic bag located on the forward surface of a joint (the first place on prevalence), and the infrapatellyarny bag which is under a patella and a large sinew. Prepatellyarny bursit – an inflammation of the hypodermic bag located on the forward surface of a knee. Wins first place on prevalence among bursit of a knee joint.
The disease usually arises after a trauma (falling on a patella, a bruise or blow) or after the long standing on a lap which is usually caused by professional activity (the roofer's knee, the housewife's knee). Besides, adjournment of salts at pseudo-gout, gouty arthritis or rheumatoid arthritis can become the reason of development of a bursit.
There is hypostasis, reddening of skin, unpleasant feelings in a knee. Pains are usually less expressed, than at arthritis, the movements are slightly limited or kept in full. Some constraint when walking can be observed. At infection of liquid in a cavity of Bursa pains amplify, the volume of movements decreases, noted increase in regionarny lymph nodes and temperature increase of a body. Treatment – as at other types of bursit.
Infrapatellyarny bursit develops as a result of an inflammation of infrapatellyarny Bursa located under a large sinew which, in turn, lies under a patella. Usually the trauma at a jump (the jumper's knee) becomes the reason of a bursit. Treatment includes rest of the affected extremity, ice compresses, and also reception of anesthetics and resolvents.
Goose bursit – an inflammation of goose Bursa located on the zadnevnutrenny surface of a knee joint. Develops at women with an excess weight more often. Is followed by the pains amplifying at rise and descent on a ladder.
Conservative treatment standard, is carried out by surgeons. At a chronic aseptic bursit of a goose bag which also carries the name of a cyst of Becker surgery – excision of Bursa is recommended. Operation is carried out by traumatologists or orthopedists in the conditions of a hospital. As well as in case of an elbow bursit, in a postoperative wound for 1-2 days put the rubber graduate. Seams are removed for the tenth days.
Bursita of a shoulder joint
The inflammation of the bags which are not connected with a cavity of a shoulder joint – subakromialny, subdeltoid and hypodermic akromialny is most often observed. There is a pain amplifying at rotation assignment of an extremity. The pain syndrome is especially pronounced at a bursita of a subdeltoid bag.
The area of a shoulder joint increases in volume a little, contours of muscles smooth out. At defeat of a subdeltoid bag the deltoid muscle looks increased, the swelling on the external surface of a joint in certain cases appears.
Bursita of a coxofemoral joint
Most often the podvzdoshno-grebeshkovy bag, deep and superficial bags of a big spit are surprised. The heavy current is characteristic of these kinds of a bursit.
Sharp bursit is followed by substantial increase of temperature and the expressed pains which sharply amplify at rotation, extension and assignment of a hip. The compelled position of an extremity is observed: the hip is taken away, bent and a little turned knaruzh. Over an inguinal sheaf the painful swelling is determined by the front and internal surface of a hip.
In certain cases bursita of a coxofemoral joint need to be differentiated with purulent arthritis. Unlike arthritis existence of a local swelling, absence of pain at axial load of an extremity, reduction and bending of a hip is characteristic of bursit.
Bursita of an ankle joint
Most often in this area arises bursit the hypodermic calcaneal bag located between an Achilles sinew and a calcaneal hillock. The trauma (for example, the rubbing footwear) or transfer of an infection on lymphatic or blood vessels is the reason of emergence. Sometimes in cases of an akhillobursit it is necessary to carry out differential diagnostics with the inflammatory process caused by a travmatization of fabrics a calcaneal spur.
Miners and people of other professions interfaced to the increased danger of development of a bursit should protect whenever possible sinovialny bags from a constant travmatization (for example, using protective bandages). For prevention of development of a sharp bursit it is necessary to process carefully wounds in joints, to treat correctly and in due time pustulous diseases.