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Shoulder bursitis seldom appears in rheumatoid arthritis. It is usually associated with an involvement of the omohumeral joint but it may be isolate and sometimes indicative. The production of foreign bodies is very rare (3 published cases). We report about one observation of subacromiodeltoid bursitis with rice bodies, associated with rheumatoid arthritis following a severe evolution.
The trochanteric bursa is anatomically quite susceptible to traumatic injury. However, specific reports of traumatic trochanteric bursitis in the literature are lacking. This may be due to failure to recognize this condition and to differentiate it from other pain syndromes involving the hip. This case report demonstrates the clinical presentation and management of traumatic trochanteric bursitis.
Iliopsoas bursitis is often overlooked as the cause of symptoms involving the inguinal area and lower extremity. We report 8 patients with iliopsoas bursitis. All had either osteoarthritis or rheumatoid arthritis of the hip but only 3 had significant hip pain. Patients presented with an inguinal mass and hip pain (2); unilateral leg swelling (2); inguinal mass and unilateral leg swelling (1); hip pain (1); pelvic mass with bladder compression (1); and no symptoms (1). The diagnosis was entertained initially in only 2 patients. Computed tomography was useful in establishing the diagnosis.
A case of bursitis intermetacarpophalangea calcarea is presented which, after clinical and X-ray examination, raised problems regarding differential diagnosis. Because of the rarity of the findings, the anatomical localization as well as the surgical procedure is presented. Calcifications which may show in tendons and ligaments are discussed. In cases of acute calcareous infiltration in hands, surgery very rarely is indicated. By contrast, in cases of bursitis intermetacarpophalangea calcarea, surgery should be performed as soon as possible to preserve normal hand function.
A 5-year-old Ayrshire cow with severe forelimb lameness of 6 weeks' duration was determined to have bilateral bicipital bursitis. Results of synovial fluid analyses were compatible with nonseptic bursitis. The cow's lameness resolved in 7 days after box stall confinement, parenteral treatment with nonsteroidal anti-inflammatory drugs, and a single intrabursal injection of a combination of methylprednisolone, sodium hyaluronate, and gentamicin sulfate. Lameness had not recurred during the 22 months since discharge.
Sixteen cases of bacterial infection of subcutaneous bursae were reviewed. Septic subcutaneous bursitis usually occurred following injury to the skin overlying the bursa. Two cases developed after bursal corticosteroid injection for treatment of aseptic bursitis. Bursal fluid culture yielded staphlococci in 14 cases and streptococci in 2. Blood cultures obtained in 8 patients were negative. No patient had clinical manifestations suggestive of bacteremia. Needle and/or incisional drainage of the bursa plus systemic antibiotics led to uneventful recovery in 14 patients. Two patients had chronic drainage. One resolved spontaneously and the other required bursectomy.
The anserina bursa is located on the medial surface of the tibia deep to the tendons of the sartorius, gracilis, and semimembranosus muscles and superficial to the insertion of the tibial collateral ligament. Knee pain, a palpable swelling of the bursa, and tenderness over the medial anterior aspect of the tibia just below the knee are the hallmarks of anserina bursitis. In a three-year period, 24 patients with anserina bursitis were seen in a rheumatology clinic. All but one were women, 18 were obese, and only four were under 50 years old. Knee x-ray studies showed degenerative arthritis in 20 of the 24 patients. In ten, varus knee deformities were present, while three had valgus deformities. Ultrasound or local steroid injections gave dramatic relief in all but one patient.
The effects of 1,200 mg of oxaprozin once daily, 100 mg of phenylbutazone four times daily, and placebo were compared in the treatment of 125 patients with acute tendinitis and bursitis in a seven-day double-blind study at six clinical sites. Patients in all three treatment groups showed significant (P less than 0.05) improvement as early as the third treatment day. Both the oxaprozin- and phenylbutazone-treated patients frequently showed significantly (P less than 0.05) greater improvement than those in the placebo group in both physician and patient efficacy assessments. The most frequently reported adverse effects were nausea, vomiting, and headache. The results of this study indicate that oxaprozin is as effective and safe as phenylbutazone and superior to placebo in the treatment of patients with acute tendinitis and bursitis.
Rupture of the triceps tendon is rare, and no previous report of its association with olecranon bursitis was found in the literature. A previously healthy 72-year-old man fell from a stationary bicycle and was examined by his family physician. Calcification over the olecranon area with an intact triceps tendon was revealed. Two months later the patient presented with triceps rupture and weakness of elbow extension with olecranon bursitis. Grossly, the pathologic lesion consisted of synovial frond proliferation and invasion of the cut end of a tendon. A "collar stud-shaped" bursa was found in front of and behind the triceps tendon and across a 3-cm gap in the tendon. The advancement was completed by splitting the tendon in partial thickness proximal to the cut end. The flap was turned down and anchored to the olecranon through drill holes. The end result was good return of function. Patients with chronic olecranon bursa problems should be carefully examined for triceps function. The gap in the tendon can be treated by mobilizing the tendon in the manner described.
Medical records of 10 horses with olecranon bursitis were reviewed to examine treatments, evaluate a technique for en bloc resection of the bursa in standing horses, and determine outcome of the horses after treatment. Before admission, 6 horses had been treated by needle aspiration of fluid from the mass, followed by injection of corticosteroids. Subsequent treatment for 2 of these 6 horses included open drainage and packing of the cavity with gauze soaked in 7% iodine solution. None resolved after these treatments. After admission to the hospital, 5 horses were treated medically and 5 were treated by en bloc resection of the bursa. One horse that had received intralesional injection of a radionuclide was lost to follow-up evaluation. One horse treated conservatively by open drainage and packing and 1 treated by injection of a radionuclide had resolution of the olecranon bursitis. Only 1 of these 2 horses had a cosmetic result. The acquired bursae decreased in size in 2 horses (1 treated with a corticosteroid and 1 with orgotein), but were still visible 7 and 46 months after treatment, respectively. The surgery site of 4 horses that were treated by en bloc resection healed by primary intention, and the owners of these horses were pleased with the cosmetic results. The suture line of 1 horse dehisced 5 days after surgery. Proliferative granulation tissue was removed on 2 occasions, and the site healed by second intention after 2 months. A small knot and some white hair remained at the surgery site.
Six horses with septic navicular bursitis or distal sesamoid osteomyelitis were treated by means of surgical debridement and lavage, followed by packing of the wound created in the bottom of the foot with an autogenous cancellous bone graft. Two horses were euthanatized, one 18 months after surgery because of complications in the contralateral support limb, and one 68 days after surgery because of continuing severe lameness. Four horses were alive 9, 16, 21, and 42 months after surgery. One horse was used as a broodmare and did not have observable lameness. Two horses were being ridden. The remaining horse had improved markedly, but was still lame. It appears that cancellous bone grafts can be used successfully, in conjunction with debridement and antimicrobial treatment, in horses with septic navicular bursitis and distal sesamoid osteomyelitis.
This article discusses two cases of chronic bursitis of the hip and shoulder treated by transverse friction massage. While clinical evidence has substantiated the benefits of friction massage on chronic tendinitis, previous literature has discouraged the use of friction massage in chronic bursitis. A functional examination and attention to associated biomechanical faults are also necessary for a complete noninvasive manual resolution of the problem.
Bursitis is a common cause of lower extremity pain in patients presenting to primary care physicians. Several bursae in the lower extremity account for most of these injuries, including the ischiogluteal, greater trochanteric, pes anserine, medial collateral, prepatellar, popliteal and retrocalcaneal. Often the symptoms are mild, with the patient successfully self-treating through activity modification and other conservative measures. A systematic approach to the evaluation and treatment of patients with bursitis, including prevention, relative rest, ice, compression, elevation, anti-inflammatory medication and treatment modalities such as ultrasound and electrical stimulation, combined with a structured rehabilitation program, will greatly facilitate the healing process.
We describe a patient with no history of gout and persistently normal serum uric acid concentrations in whom septic acute prepatellar bursitis was diagnosed initially, but empiric antibiotic therapy failed. Urate crystals were detected when the prepatellar bursa was aspirated for the 3rd time, and the diagnosis was changed to gouty bursitis. The case illustrates the importance of repeatedly aspirating suspicious sites to establish the diagnosis in elusive cases of crystal deposition disease.
Bursitis is a common clinical entity usually induced by trauma and infection. It often occurs in inflammatory diseases such as gout and rheumatoid arthritis. We describe a patient with systemic sclerosis who developed multiple bursitis in the later stage of the disease.
Sudden death resulting from embolic complications of iliopsoas bursitis has not been previously reported. This case report deals with a 48-year-old woman with seropositive rheumatoid arthritis who presented with symptoms suggestive of deep vein thrombosis. She was found to have complete occlusion of the femoral vein secondary to iliopsoas bursal inflammation and swelling. She died suddenly. At autopsy, a large pulmonary embolism was identified as the cause of death. This report should increase awareness of the incidence of iliopsoas bursitis in rheumatoid arthritis and its potential danger. Early and aggressive management approaches described herein might have prevented this fatality.
We present four cases of subcutanea trochanterica bursitis (one involving both sides). The bursitis was acute and inflammatory in two cases, chronic and microtraumatic in one, asymptomatic in one and septic in the last case. The acutely inflamed bursa may contain a blood effusion increasing the pain. CT and MRI provide distinctive images for the diagnosis of these particular types of periarticular diseases.
Thirty cases of idiopathic olecranon bursitis were studied. Most had previous local trauma. The process was unilateral and often associated with nontender pitting edema in cases of short duration. Ten patients exhibited a bony spur at the olecranon process, and amorphous calcific deposits were seen in 6. The bursal fluid was hemorrhagic with a xanthochromic supernatant, and the mucin clot test was poor or fair. Leukocyte count averaged 878/mm3, predominantly mononuclears. Many cells contained inclusion bodies. Glucose, total protein, and complement (C3) concentration averaged 80, 60, and 60% of the respective serum values.