Name
BURSITIS
DESCRIPTION
DETAIL
CAUSES : β’ Bursitis may be acute or chronic, and its etiology is often unknown β’ There are many types of bursitis, including infectious, traumatic, infl ammatory or gouty β’ Less often rheumatoid disease or TB as well as gout and pseudogout -------------------------------------------------------------------------- DIFFERENTIAL DIAGNOSIS : β’ Tendinitis, strains and sprains β’ Joint pains may be caused by gout, pseudogout, rheumatoid arthritis, osteoarthritis β’ Arthritis. Many elderly patients think it is the cause of their pain. (Lars Goran-Larsson, a rheumatologist from Sweden, and John Barn, M.D., reviewed their referrals for a 26-month period and found that 108 of 600 (18%) patients had some form of soft tissue problem rather than arthritis).Following will all help in differentiating soft tissue disease from rheumatic and connective tissue disease: β’ CBC β’ ESR β’ Serum protein electrophoresis β’ Rheumatoid factor (RF) β’ Serum uric acid β’ Calcium β’ Phosphorus β’ Alkaline phosphatase β’ VDRL β’ Joint fluid analysis (when available) * ASPIRATION OF THE FLUID FROM BURSA FOR ANALYSIS
TYPENOTES
RISK FACTORS: Individuals who engage in repetitive and vigorous training or others who suddenly increase their level of activity (e.g., weekend warriors). Also, improper or over-zealous stretching may lead to injury.GENERAL MEASURES: β’ Conservative therapy consists of rest, ice and local care, elevation, gentle compression (often referred to as RICE therapy [rest-ice-compression-elevation]) β’ Physical therapy/hydrocollator treatments β’ Invasive therapy would include aspiration of the bursa, injection of steroids β’ Have patient wear a sling to protect arm and support shoulder β’ Treatment of any underlying infection SURGICAL MEASURES: In severe cases, possibly surgical excision ACTIVITY: Rest and elevation of affected extremity DRUG(S) OF CHOICE : β’ Non-steroidal anti-infl ammatories (NSAIDs) or aspirin. Injectable steroids and stronger analgesics if needed. β’ Antibiotic therapy if infection present ALTERNATIVE DRUGS : β’ Application of local analgesic balms, capsaicin cream, injection of a corticosteroid along with lidocaine β’ Systemic steroids (if not contraindicated) PATIENT MONITORING: β’ Discontinue NSAIDs as soon as possible to avoid side effects β’ Some patients may require repeated injections (usually no more than three) of a corticosteroid and lidocaine (Xylocaine) PREVENTION/AVOIDANCE: β’ Appropriate warm-up and cool-down maneuvers, avoidance of overuse or inadequate rest between workouts β’ Range of motion exercises β’ Maintain high level of fi tness and general good health POSSIBLE COMPLICATIONS : β’ Acute bursitis may progress to chronic β’ Severe long-range limitation of motion EXPECTED COURSE/PROGNOSIS: β’ Most bouts of bursitis heal without sequelae β’ Repetitive acute bouts may lead to chronic bursitis necessitating repeated joint/bursal aspirations or eventually surgical excision of involved bursa
RELATED DISEASE
Not Available Disease
DISEASE
INVESTIGATION
RA FACTOR, MONTOUX TEST, COMPLETE BLOOD COUNT, X-RAY
[BURSITIS]