| ICD-9-CM: |
| 095.7 - | Syphilis of Synovium, Tendon, and Bursa; Syphilitic: Bursitis, Synovitis |
| 098.52 - | Gonococcal Bursitis |
| 726 - | Peripheral Enthesopathies and Allied Syndromes |
| 726.3 - | Enthesopathy of Elbow Region |
| 726.33 - | Olecranon Bursitis; Bursitis of Elbow |
| 726.4 - | Enthesopathy of Wrist and Carpus; Bursitis of Hand and Wrist; Periarthritis of Wrist |
| 726.5 - | Enthesopathy of Hip Region; Bursitis of Hip; Gluteal Tendinitis; Iliac Crest Spur; Psoas Tendinitis; Trochanteric Tendinitis |
| 726.6 - | Enthesopathy of Knee, Unspecified |
| 726.60 - | Enthesopathy of knee, Unspecified; Bursitis of Knee NOS |
| 726.61 - | Pes Anserinus Tendinitis or Bursitis |
| 726.62 - | Tibial Collateral Ligament Bursitis; Pellegrini-Stieda Syndrome |
| 726.63 - | Fibular Collateral Ligament Bursitis |
| 726.65 - | Prepatellar Bursitis |
| 726.69 - | Enthesopathy of Knee, Other; Bursitis: Infrapatellar, Subpatellar |
| 726.71 - | Achilles Bursitis or Tendinitis |
| 727.2 - | Specific Bursitides Often of Occupational Origin; Beat: Elbow, Hand, Knee; Chronic Crepitant Synovitis of Wrist; Miners Elbow, Knee |
| 727.3 - | Other Bursitis Disorders; Bursitis NOS |
| | | |  | | © Reed Group | | |
Bursitis is the painful inflammation of any of the 150 to 160 fluid-filled sacs (bursae) that cushion the movement between the bones, muscles, and tendons near the body’s joints. In addition to cushioning pressure points, the bursae are lined with synovial cells that secrete a fluid rich in collagen and proteins. The synovial fluid acts as a lubricant when body parts move. When this fluid becomes infected with bacteria or when the bursa becomes irritated because of excessive pressure or unusual movement, bursitis results. Bursitis also occurs as part of systemic inflammatory diseases such as rheumatoid arthritis or gout.
The shoulder is most susceptible to bursitis, but the condition may also occur in the hips, knees, pelvis, elbows, toes, and heels. Bursitis may be acute or chronic and infectious or non-infectious.
The cause of bursitis is often unknown (idiopathic). Risk factors for bursitis include having a hobby or a profession that requires repetitive movement, staphylococcal infection, and advancing age. Crystal mineral deposits due to gout or pseudogout may also cause bursitis. Rarely, tuberculosis may result in bursitis. Use of certain medications, such as corticosteroids and immunosuppressants, can increase risk of infection in the bursae.
|
Source: Medical Disability Advisor
| History: Individuals with bursitis may report localized tenderness, warmth, swelling (edema), redness (erythema) of the skin, a dull ache or stiffness, worsening of pain with movement or pressure, and limited joint movement. If the bursa is infected, the individual may report systemic symptoms including fever and red streaks leading from the affected area. Questions should be directed to a history of recent trauma directly over the bursae or to repetitive activity. Physical exam: Visual inspection may reveal edema and erythema. Skin should be inspected for breakdown and possible entry of a foreign object. Touching (palpation) the affected joint and bursae often reveals soft, boggy, or tense tissue depending on the amount of fluid build up. The bursa will be tender. Motion is limited by pain and edema in acute cases. Chronic cases may show decreased range of motion from adhesions and thickening of the tissue. Muscle weakness may develop from lack of use (disuse atrophy). Tests: Plain x-rays of the joint and surrounding area generally are not helpful in confirming the diagnosis but may be used to rule out other conditions and to detect the calcium deposits often seen in chronic bursitis. It is important to look for changes in the bone from chronic irritation and to rule out bone infection (osteomyelitis). MRI and ultrasound may be used to help confirm bursitis in bursae located deeper within the body, such as those in the hip. A portion of the bursa fluid may be withdrawn using a needle (aspirated) and examined to rule out gout and infection (synovial fluid analysis). If infection is suspected, erythrocyte sedimentation rate (ESR) and complete blood count (CBC) tests may be ordered. If infection is suspected in the adjacent joint, fluid may be withdrawn for evaluation (arthrocentesis). |
Source: Medical Disability Advisor
| Treatment for noninfectious acute bursitis consists of rest, ice, temporary immobilization of the affected area, compression (e.g., elastic bandage), padding, elevation of the affected area above the level of the heart, and pain medication (e.g., nonsteroidal anti-inflammatory drugs [NSAIDs]). In severe cases of noninfectious bursitis, an opioid analgesic may be needed to relieve pain or a corticosteroid (oral or injected locally) may be needed to relieve inflammation.
Chronic noninfectious bursitis is treated in a similar fashion, although immobilization and rest may not be of much help. Large calcium deposits in the shoulder may require removal through irrigation or surgery.
Surgical excision of bursae (bursectomy) may be required if the condition is chronic or recurs frequently. Surgery is generally performed only if nonoperative (conservative) treatment fails. The type of operation depends on the area affected.
In infectious bursitis, the bursae will be drained and oral antibiotics started as soon as blood cultures are drawn. Staphylococcus aureus is the most common organism involved. Individuals with systemic symptoms (e.g., fever or chills) may require hospitalization and intravenous antibiotics. |
Source: Medical Disability Advisor
| In general, bursitis responds well to conservative treatment. Most individuals respond to therapy within several days to 2 weeks. In infectious bursitis, the bursae may need to be drained every 1 to 3 days until the infection has cleared. If the underlying cause of the condition is not corrected, chronic bursitis may develop.
Bursectomy usually yields a satisfactory outcome. |
Source: Medical Disability Advisor
| The goal of rehabilitation for individuals with bursitis is first to decrease inflammation and pain and second to restore motion and strength to affected joints.
The physical therapist first instructs the individual how to reduce edema and minimize pressure from the inflamed bursa. Cold therapy (cryotherapy), sometimes in conjunction with electrical stimulation (transcutaneous electric nerve stimulation [TENS]), is then used to control edema and pain. Once acute pain and inflammation decrease, heat therapy can be initiated.
After the pain and edema are sufficiently reduced, passive range of motion exercises can help restore full motion to the affected joint and/or limb. The type of exercise program depends on the location of the affected bursa, stage of the inflammation (i.e., recent flare-up or chronic pain), and whether surgery was required. |
Source: Medical Disability Advisor
| Poorly treated or untreated acute bursitis may develop into chronic bursitis. Frozen joint syndrome or permanent limitations of joint mobility are other possible complications. Bursitis caused by gout, arthritis, or chronic overuse may recur if the underlying condition is not treated or corrected. |
Source: Medical Disability Advisor
| If a certain activity (e.g., repetitive motion) caused the individual's bursitis, the individual may need to limit that activity or use protective measures. For example, kneepads or other cushioning should be used when kneeling during gardening or scrubbing floors. Plumbers, roofers, and carpet layers should wear knee protection. Shoes with appropriate cushioning or ankle pads may be needed. The individual should perform exercises to strengthen the muscles and improve flexibility around the affected bursa. Adequate breaks and changes in activity can reduce stress from repetitive motions and tasks. Using heat or ice treatments after work to relieve any soreness may help reduce the recurrence of bursitis. Anti-inflammatory medications can help relieve pain and inflammation. Company policy on medication usage should be reviewed to determine if pain medication use is compatible with job safety and function. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Was diagnosis of bursitis confirmed?
-
Did laboratory examination of synovial fluid aspiration reveal crystals or bacterial infection?
-
Has individual experienced any complications?
Regarding treatment:
- Did conservative treatment such as rest, ice, elevation, compression, immobilization, and pain medication help?
-
Were opioids or oral corticosteroids necessary?
-
Was surgery indicated?
-
If bursitis was infectious, were antibiotics given and bursae drained?
Regarding prognosis:
- Is joint function impaired?
-
Would individual benefit from additional physical therapy to strengthen muscles and re-establish joint's full range of motion?
-
In infectious bursitis, was the area drained until the infectious fluid no longer returned? Could infection still be present?
-
Would individual benefit from additional antibiotic therapy?
-
Were comorbid conditions such as gout, rheumatoid arthritis, or chronic overuse appropriately addressed?
|
Source: Medical Disability Advisor
| Masi, Alfonse T. "Bursitis." The Merck Manual of Home Health Care. Ed. Mark H. Beers. 2nd ed. Whitehouse Station, NJ: Merck Research Laboratories, 2003. 417-418.Mayo Clinic Staff. "Bursitis." MayoClinic.com. 30 Sep. 2004. Mayo Foundation for Medical Education and Research. 19 May 2005 <http:www.mayoclinic.com/invoke.cfm?id=DS00032>. |
Source: Medical Disability Advisor
| Feedback |
| Send us comments, suggestions, corrections, or anything you would like us to hear. If you are not logged in, you must
include your email address, in order for us to respond. We cannot, unfortunately, respond to every comment.
If you are seeking medical advice, please contact your physician. Thank you! |
Send this comment to:
Sales
Customer Support
Content Development
|
|
| |
|
|
|
|
|
This publication is designed to provide accurate and authoritative information in
regard to the subject matter covered. It is published with the understanding that
the author, editors, and publisher are not engaged in rendering medical, legal,
accounting or other professional service. If medical, legal, or other expert assistance
is required, the service of a competent professional should be sought. We are unable to respond to requests for advice.
Any Sales inquiries should include an email address or other means of
communication.
|