Bursitis
| Classification according to ICD-10 | |
|---|---|
| M70 | Soft tissue diseases related to use, overuse and pressure |
| M70.1 | Bursitis of the hand |
| M70.2 | Olecranon bursitis |
| M70.3 | Other bursitis in the area of the elbow |
| M70.4 | Prepatellar bursitis |
| M70.5 | Other bursitis in the knee area |
| M70.6 | Trochanteric bursitis |
| M70.7 | Other bursitis in the hip area |
| M71 | Other bursopathies |
| M71.1 | Other infectious bursitis |
| M71.4 | Calcular bursitis |
| M71.5 | Other bursitis, not elsewhere classified |
| M71.9 | Bursopathy, unspecified - bursitis onA |
| M73 * | Soft tissue diseases in diseases classified elsewhere |
| M73.0 * | Gonorrheal bursitis |
| A54.4 + | Gonococcal infection of the musculoskeletal system |
| M73.1 * | Syphilitic bursitis |
| A52.7 + | Other active late syphilis |
| M75 | Shoulder lesions |
| M75.3 | Tendinitis calcarea in the shoulder area - Bursitis calcarea in the shoulder area |
| M75.5 | Bursitis in the shoulder area |
| M76 | Enthesopathies of the lower extremity with the exception of the foot |
| M76.4 | Bursitis in the area of the collateral tibial ligament (Stieda-Pellegrini) |
| M76.6 | Achilles tendon tendonitis - subachillic bursitis |
| ICD-10 online (WHO version 2019) | |
Bursitis (synonym: bursitis ; plural bursitis ) is the inflammation of a bursa ( latin Bursa synovialis ). It is caused by injuries , infections or permanent irritation, especially on the elbow , knee and shoulder joints . In veterinary medicine , the symptoms of bursitis are also referred to as bile .
etiology
Due to their superficial position directly under the skin are the three skin bursa of the knee ( Bursa subcutanea prepatellar , Bursa subcutanea infrapatellaris and Bursa subcutanea tuberosity of the tibia ) and the elbow ( Bursa subcutanea olecranon ) particularly vulnerable to infections from minor injuries and mechanical irritation caused by non-physiological stress situations . Usually, mechanical overloading (e.g. knees - "housemaid knee", sport, multiple trauma) leads to irritation and, as a result, to inflammation of the synovia . This inflammation (formerly also known as "fibrositis" of the bursa) can in rare cases also be caused by chronic inflammation ( rheumatism , gout ) or a systemic infection such as tuberculosis .
Epidemiology
In sport, wrestlers often suffer from bursitis because of the intense stress with increased pressure and friction. In ice hockey, too, athletes often suffer from bursitis caused by falls on their elbows or after hard body checks.
Students often suffer from elbow bursitis (bursitis olecrani, jokingly also bursitis informaticus olecrani ). The elbows, which are raised when reading frequently, are subjected to constant mechanical stress which can lead to inflammation. This special form of bursitis is also called students elbow ( "student's elbow"). Olecranon bursitis is also more common in other exposed occupational groups such as miners.
For prepatellar bursitis, kneeling professions, such as B. Mechanics, cleaning staff, craftsmen clearly exposed.
In animals, the symptoms of this disease are referred to as stud bumps .
Symptoms
The symptoms of bursitis are very minor in the early stages. The affected person feels a rubbing, burning sensation in the area of the kneecap or the elbow. This can usually be tolerated for a very long time by those affected in the sense of a foreign body sensation (eg: "balls"). Typically, in the pronounced stage, there are clear pressure pain, easily palpable swelling in the area of the joint, rubbing, burning pain when exerted, overheating and redness. If a bacterial infection is the cause, a fever may persist.
One of the most common causes of restricted mobility in the shoulder joint is subacromial bursitis , which is characterized by rapidly increasing pain, especially at night, which is extremely intense and has no apparent cause.
diagnosis
The diagnosis is made using the clinical examination. An accurate anamnesis is essential to determine the cause . A laboratory test ( inflammation parameters , rheumatism signs, uric acid ) can also be useful.
Chondropathia patellae and Osgood-Schlatter's disease should be mentioned as differential diagnoses .
Bursitis on the elbow, completely painless, just a feeling of tension when bending
Olecranial bursitis , developed after falling on the elbow
X-ray bursitis on the elbow with a large bony spur
Bursitis of the knee ( prepatellar bursitis ) 10 days after fall
Acute prepatellar bursitis on the left with reddening, swelling and overheating in the knee joint
treatment
Cooling ointments, sprays, gels or ice pads usually alleviate the acute symptoms.
Conservative treatment
The affected joint is temporarily immobilized and supplied with a compression bandage. The most important point of therapy is pain relief. A long-term persistence of the pain can lead to excessive and lasting rest, which results in a restructuring of the joint apparatus and reduced stability.
The triggering activity should be stopped. A cooling of painful bursa is usually perceived as pleasant and is anti-inflammatory. Laser treatment or ultrasound therapy is more common . Good results are also achieved with antiseptics : Cooling compresses with Rivanol ( ethacridine lactate ) or a Chinosol solution (less yellowing) often reduce the swelling because the substance quickly penetrates the inflamed tissue.
When medications are nonsteroidal anti-inflammatory drugs (NSAIDs) such as diclofenac , ibuprofen or ketoprofen into consideration. These can inhibit the inflammatory reaction and shorten the duration of the complaint. On extended use can be used as a side effect stomach - intestinal discomfort by the COX-1 inhibition, especially stomach ulcers occur.
In subacromial bursitis , the local injection of corticosteroids usually brings rapid pain relief, often the only effective treatment option.
If the inflammation started as septic bursitis from a bacterial infection, it can also be treated by taking an antibiotic . The administration of cefotaxime or ceftriaxone with flucloxacillin or clindamycin is recommended for calculated therapy (before pathogen detection) .
Operative treatment
If the inflammation does not go down with the measures mentioned and a purulent bursitis begins to develop , surgical repair is necessary. The pus is drained or, if necessary, the entire bursa is resected (so-called bursectomy).
prevention
All measures that avoid mechanical overload caused by frequent or prolonged pressure on the knees and elbows help prevent this.
Occupational groups with particularly frequent activities that place stress on the joints, such as tilers, should wear knee and / or elbow pads as far as possible. Employers have to provide these. However, should initial symptoms occur, a few days of rest and cooling of the affected areas can prevent severe inflammation.
If the inflammation can be traced back to sporting activity, wearing sports or running shoes that are gentle on the joints and a targeted correction of the movement sequence can help. In particularly endangered athletes such as wrestlers , small skin abrasions and cracks on the joints (especially on the elbows and knees) should be disinfected and bandaged. Likewise, the affected joint can be protected from renewed stress by foam inserts in the form of a donut in the elbow pads or knee pads.
Web links
literature
- Joachim Grifka, Markus Kuster (ed.): Orthopedics and trauma surgery. Springer, Berlin 2011, ISBN 978-3-642-13110-3 .
Remarks
- ↑ Ludwig Heilmeyer , Wolfgang Müller: The rheumatic diseases. In: Ludwig Heilmeyer (ed.): Textbook of internal medicine. Springer-Verlag, Berlin / Göttingen / Heidelberg 1955; 2nd edition ibid. 1961, pp. 309–351, here: pp. 342–346: The soft tissue rheumatism (fibrositis, muscular rheumatism, myalgia, panniculitis).
- ^ Marianne Abele-Horn: Antimicrobial Therapy. Decision support for the treatment and prophylaxis of infectious diseases. With the collaboration of Werner Heinz, Hartwig Klinker, Johann Schurz and August Stich, 2nd, revised and expanded edition. Peter Wiehl, Marburg 2009, ISBN 978-3-927219-14-4 , p. 173.
- ↑ Marianne Abele-Horn (2009), p. 173.
