Healing and course
Usually, bursitis heals relatively quickly and without complications, with mild and drug therapy. Dangerous, peracute courses with impending sepsis are extremely rare. It is important, however, that the structures around the inflamed bursa are sufficiently protected, as otherwise chronicity can occur, which can usually only be corrected surgically.
Elbows
An inflammation of the bursa often occurs at the elbow and is then called bursitis olecrani. The bursa at the elbow, which is located just under the skin, is inflamed. The olecranon, which gives the disease its name, is the back part of the ulna, this bony protrusion corresponds to the colloquial elbow.
This bone lies just under the skin and is surrounded by little protective fat padding, which is why the bursa (bursa olecrani) is supposed to take over this padding task.Bursitis olecrani can occur, for example, due to mechanical overload. For example, bursitis of the elbow is also called “student ́s elbow”, because the elbow is often supported on the tabletop when working at the desk. Even a fall can lead to an inflammation of the bursa sac in the elbow due to effusion and irritation of surrounding structures.
Septic bursitis can also occur in the elbow, for example, when pathogens enter the bursa through cuts and cause inflammation. Bursitis olecrani is particularly conspicuous due to a painful swelling above the elbow (olecranon), which is very sensitive to touch. The effusion (accumulation of fluid in the bursa) can cause a swelling that can be as large as a chicken egg. In most cases, bursitis olecrani can be treated without complications with the above mentioned therapy options.
Knee
An inflammation of the bursa occurs preferably in heavily loaded joints, including the knee joint. The bursa sacs of the knee are particularly susceptible to inflammation due to their location directly under the skin, similar to the elbow. There are three different bursa sacs in the knee, all of which can be affected by inflammation.
In the case of bursitis praepatellaris, the bursa that lies directly on the kneecap is affected. It serves as a buffer between the skin and the kneecap. In bursitis infrapatellaris, the bursa directly below the patella is inflamed.
The Pes-anserinus burstis affects a bursa located directly below the Pes anserinus (goosefoot). It is a common starting point of several thigh muscles on the inside of the knee. Inflammation of the bursa at the knee often occurs under strong mechanical stress, for example, when kneeling for a long time.
This clinical picture is often found in certain occupational groups such as tilers. Furthermore, the penetration of bacteria in the context of open injuries can lead to septic inflammation of a bursa in the knee. Similar to the shoulder, chronic joint diseases can also lead to the inflammation of a bursa in the knee.
In addition to a prallelastic swelling (effusion), patients report a rubbing pain, especially during movements in the knee joint. Here, too, protection and immobilization (e.g. by elevating the affected leg) is of great importance for the success of the therapy. The inflammation of the bursa in the shoulder is also called bursitis subacromialis and is a common clinical picture, especially in middle age.
The bursa (bursa subacromialis) forms a sliding layer for the shoulder muscles and separates them from the surface of the hard bone. If the bursa becomes inflamed, it can no longer perform its tasks adequately, so that the sliding of the muscles together causes severe pain, especially during shoulder movements. In addition to swelling and redness, the so-called “painful arc” is typical for subacromial bursitis.
The patient feels strong pain when lifting the affected arm up to 90°, beyond that the movement is painless again. Due to the strong pain, movement is often restricted as a result. The causes of subacromial bursitis are manifold.
Many small traumas can lead to inflammation due to a tear in the bursa. More rarely, open injuries can lead to septic bursitis. The so-called impingement syndrome can also be causal, in that the incarceration of the supraspinatus muscle leads to permanent irritation and inflammation of the adjacent bursa.
Microcalcification, which every person in advanced age has, can lead to inflammation of the bursa by a permanent irritation of the bursa. Likewise, subacromial bursitis can occur in the context of chronic joint diseases such as arthrosis, rheumatoid arthritis or gout. The inflammation of the bursa in the shoulder can, if detected early, be treated well with conservative therapeutic measures. Immobilization of the shoulder is of great importance here, since otherwise the constant strain on the bursa by the muscles prevents healing and chronification is imminent.
