A bursa (bursa synovialis) is a sack-like structure filled with synovial fluid. These bursa are located in the musculoskeletal system, especially in places that are mechanically exposed to particularly high pressure. There they reduce the tensile and compressive forces and thus the friction between bone, skin, muscle and tendons.
An inflammation of the bursa (bursitis) can be caused by injuries, a permanent irritation (overloading) or, more rarely, by an infection. Bursitis often occurs in joints that are subject to high mechanical stress, such as the knee. However, they can also occur on the elbow, shoulder, hip or heel.
Symptoms
Typical signs of inflammation are found in bursitis, especially a usually strong pain. In addition, the affected area is subject to redness, swelling and overheating. If the inflammation is localized near a joint, it often leads to limited mobility. Only in rare cases does the inflammation spread to the entire body, so that general symptoms such as fever or lymph node swelling can occur.
Cause
The treatment of bursitis should be carried out as soon as possible after diagnosis by the doctor. The treatment options are manifold, whereby the decision should be based on the general condition of the patient, his preferences and the stage of the disease. The therapy of aseptic and septic bursitis differs fundamentally in that in septic inflammation, in addition to the treatment of the inflammation, the causative pathogen must also be fought.
In aseptic bursitis, where no pathogens are involved, the protection of the affected joint is of great importance. The point here is to overload the bursa as the cause of its inflammation. By sparing the tissue, the inflammation can be reduced and the healing process can begin.
However, even in the case of septic bursitis, the affected joint should be spared in order to avoid consequential damage after the inflammation has healed. Another conservative method is the application of cold and warm compresses to promote blood circulation and thus accelerate the healing process. Medically, NSAIDs (non-steroidal anti-inflammatory drugs) are the drugs of choice, as they combat both pain and inflammation.
Commonly used agents are aspirin (ASS), ibuprofen or diclofenac. As these irritate the stomach lining, they should only be used in combination with stomach protection tablets in patients who have already suffered from a stomach ulcer. In any case, even if the drugs are over-the-counter, they should only be taken after the advice of a doctor who is familiar with the appropriate dosage and duration of use.
If the bursitis is septic, the use of antibiotics is necessary. The choice of the right antibiotic may require a puncture of the bursa. A puncture can also be used for therapeutic purposes: by draining purulent secretions, the joint is relieved and the patient feels an immediate improvement.
If the inflammation is particularly resistant or the patient is suffering from a high degree of suffering, the bursa can also be flushed with glucocorticoids (cortisone), which have a stronger anti-inflammatory effect than NSAIDs than ibuprofen. As a rule, surgical intervention is not necessary in cases of bursitis. This is only considered if the above-mentioned conservative methods fail or if the inflammation is peracute (extremely rapid).
In this case, there is a risk of a leaking of pathogens into the entire body circulation (sepsis), which can be life-threatening. Fortunately, such a course is rarely observed. Even if the bursitis has developed after an operation, surgical treatment is often recommended, as otherwise chronic progressions may occur.
In surgical therapy, endoscopic endoscopy (similar to arthroscopy) is used. Here the surgeon works in a minimally invasive way, whereby the bursa is left in the joint. A clear advantage of this method is that by leaving the bursa in place, it can continue to perform its function and cushion the joint from excessive stress.
Another possibility is to cut out the entire inflamed bursa. The complete removal of the inflammation leads to a quick and complete healing. However, the absence of the bursa can severely restrict the joint function and make it more susceptible to wear (arthrosis).
