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- Bursae are synovial fluid-filled sacs found in areas subject to musculoskeletal friction, such as when tendons pass over bony prominences.
- Although there are at least 78 different sites where bursae are found, the most common sites of clinical bursitis are the following:
- Olecranon (“student’s elbow”)
- Prepatellar (“housemaid’s knee”)
- Infrapatellar (“clergyman’s knee”)
- Ischial (“weaver’s bottom”)
- Pes anserinus
- Bursae serve a lubricating function, allowing for musculotendinous units to glide over bony prominences.
- Bursae are lined with synovial membrane and play a role in synovial fluid mechanics.
- System(s) affected: musculoskeletal
Bursitis is less common in children.
- 15 to 50 years (most common in skeletally mature)
- Traumatic bursitis is more likely in patients <35 years of age.
- Bursitis: 32/1,000 per year
- Approximately 1 in 31; 3.2% or 8.7 million people in the United States impacted annually.
- Trochanteric pain: 1.8/1,000 per year
Etiology and Pathophysiology
- Trauma: acute or chronic
- Repetitive movement: Upper extremity bursitis, in particular, is usually the result of repetitive microtrauma.
- Infections: transcutaneous transit > hematogenous, most commonly Staphylococcus aureus
- Systemic disease: rheumatoid disease, tuberculosis, pancreatitis, lupus
- Crystal deposition: gout and pseudogout
- Individuals who engage in repetitive motion and/or vigorous training
- Prolonged pressure on particular bursae (e.g., “clergyman’s knee” and “student’s elbow”)
- Sudden increase in level of activity
- Leg length discrepancy and Trendelenburg gait increase risk for trochanteric bursitis.
- Anabolic steroid use increases risk of bursitis due to increased training, estrogen suppression causing increased inflammation, and muscle stiffness.
- Appropriate warm-up and cool-down maneuvers
- Frequent breaks between repetitive activities
- Use of protective gear (e.g., knee and elbow pads)
- Maintain fitness and general health.
Commonly Associated Conditions
- Sprains, strains
- Associated stress fractures
- Muscular tightness and physical deconditioning