Bursite: manifestações clínicas, diagnóstico e tratamento

Abstract

Introduction:  A bursa is a lubricated, fluid-filled sac or sac adjacent to or between soft tissues. The purpose of the bursa is to reduce friction between nearby structures, such as bones, joints, tendons and skin. Bursitis can develop when the bursae become irritated or inflamed and can present acutely with pain and swelling, or more chronically with functional limitations due to joint contractures. A wide range of conditions can cause bursitis, including infection (septic bursitis), chronic overuse/trauma, gout, rheumatoid arthritis (RA), or, rarely, systemic sclerosis. Objectives: discuss bursitis: clinical manifestations, diagnosis and treatment. Methodology: Integrative literature review based on scientific databases from Scielo, PubMed and VHL, from January to April 2024, with the descriptors “Bursitis”, “Clinical Manifestations” AND “Treatment”. Articles from 2019-2024 (total 62) were included, excluding other criteria and choosing 5 full articles. Results and Discussion: Bursitis may develop in response to trauma, chronic overuse, infection (also known as septic bursitis), or certain systemic rheumatic diseases (e.g., gout, rheumatoid arthritis [RA]). Diagnostic assessment. The most common signs of bursitis are pain, swelling, and tenderness near a joint. Acute bursitis and the functional limitations of acute bursitis usually develop over days. Acute bursitis of the superficial bursa usually causes swelling, warmth, and erythema of the overlying skin, whereas acute bursitis of the deep bursa rarely causes visible changes on examination. Active movement of the muscles adjacent to the involved bursa and flexion of the joint that compresses the bursa often worsens the bursa. In contrast, passive movement and extension of the joint generally do not worsen the bursa. Patients with chronic bursitis often have symptoms that are present for weeks to months and may have functional limitations. Patients with chronic bursitis of superficial bursae may have swelling of the bursa and thickening of the bursa wall that can be felt on examination.The local heat and overlying redness are generally less pronounced than in an acute process, and the pain is less than expected given the degree of swelling. When to Drain a Bursa – Fluid should be removed from an inflamed bursa whenever there is a question of an infectious cause or a question of bursitis due to another inflammatory cause. In cases where the affected bursa is deep, relatively inaccessible, and/or close to other important structures (e.g., a major artery or nerve), imaging (e.g., սltrаѕοսոd or CТ) may be used for guidance rather than palpation alone. If the aspirated fluid appears grossly inflammatory (e.g., cloudy or purulent), we send tests including a Gram stain, bacterial culture (aerobic and anaerobic), white blood cell count (WBC) with differential, and crystal evaluation by polarized light microscopy. When to Imaging Most patients do not require imaging; however, it may be indicated in the context of trauma when guidance for bursal drainage or intrabursal glucocorticoid injection is required and/or to exclude alternative diagnoses where timely intervention is imperative.The diagnosis of bursitis is made clinically based on a suggestive history and consistent physical examination. The main clinical features of bursitis depend on the cause, location and chronicity, but generally include tenderness, pain with movements that increase pressure on the bursa (usually joint flexion), swelling of the superficial bursae and/or thickening of the bursa wall in chronic bursitis. The bursa fluid should be non-bloody and bland. The main goal of treatment for patients with bursitis is to reduce pain and therefore improve mobility. It is also important to address any contributing factors, such as overuse of the joint, mechanical imbalance, or underlying systemic rheumatic diseases. Conclusion: A bursa is a lubricated, fluid-filled sac or sac adjacent to or between hard or soft tissues that reduces friction and tension between bones, joints, tendons and/or skin. Bursitis happens when a bursa becomes irritated or inflamed.