Bursitis
Introduction
Introduction to bursitis Bursitis refers to acute or chronic inflammation of the bursa, which is a cystic space in connective tissue. It is a closed capsule composed of endothelial cells. The inner wall is a synovial membrane with a little synovial fluid. A small number of joints with the joints, located in the vicinity of the joint between the bones and tendons or muscles, between the skin. Where there is a large friction or pressure, there may be a sac, which is mainly beneficial for sliding, thereby reducing or avoiding friction and compression between the bone protuberance and soft tissue near the joint. Many joint lesions can cause this disease. basic knowledge The proportion of illness: 0.003% Susceptible people: no specific population Mode of infection: non-infectious Complications: swelling
Cause
Cause of bursitis
Infection (30%):
The bursitis can be caused by injury, some are direct violent injuries, some are joint flexion, extension, abduction, external rotation and other excessive movements. After repeated, long-term, continuous friction and compression, the sac injury causes inflammation, bursa Can be thickened by wear and tear, such as anterior sacral bursitis of the squatting worker, sciatic nodular bursitis after sedentary elderly women; sulcular bursitis caused by over-tightening of shoes, in addition, infected lesions The pathogenic bacteria can cause suppurative bursitis,
Gout (30%):
Gout is a metabolic disease caused by an increase in uric acid synthesis caused by abnormal metabolism of sputum. When renal function is abnormal, the uric acid level rises due to a decrease in the uric acid clearance rate of the kidney. The uric acid in the plasma is saturated, causing the monosodium urate crystal to deposit in the tissue that is relatively devoid of blood vessels around the distal joint. The appearance of such crystallization can lead to acute inflammatory synovitis of single or multiple joints. Gout is more common in men, and the big toe is the most common area of involvement, with 50% to 70% of the initial onset. 90% of gout patients develop the first metatarsophalangeal joint at some point in their life.
Tumor (30%):
Local infiltration and distant metastasis are the most important features of malignant tumors and are the main cause of death from malignant tumors. The tumor is formed by the proliferation and proliferation of a transformed cell.
Prevention
Bursal inflammation prevention
1. Pay attention to hygiene: Strengthen labor protection and develop the habit of washing hands with warm water after work.
2, rest is the best way: rest is the primary method to solve any joint pain, so the joint should be well rested.
3, ice: If the joint is very hot to touch, you can use the ice method, alternating with 10 minutes of ice, 10 minutes of rest, as long as the joint is still hot, do not use hot compress.
4, ice and heat alternate: If the acute swelling and pain is weakened, and the heat has been eliminated, it can be treated by alternating hot and cold methods, that is, hot for 10 minutes after 10 minutes of ice application, so repeatedly.
5. Swinging the painful arm: The painful part is on the elbow or shoulder. The doctors suggest that the arm swing freely to relieve the pain.
6, avoid too sedentary and kneeling work, when going long distance, the elderly shoes should not be too tight.
7, to prevent bursal injury and infection, reduce the friction between the olecranon and the anterior and posterior sac.
Complication
Bursitis complications Complications swelling
After multiple episodes of bursitis or repeated trauma, it can develop into chronic bursitis, which can last for several days to several weeks, and multiple recurrences. After abnormal exercise or excessive exertion, acute symptoms can occur, due to synovial hyperplasia. The wall of the sac becomes thicker, and the sac becomes eventually stuck, forming villi, sputum and calcium deposits. Due to pain, swelling and tenderness, it can cause muscle atrophy and limited mobility. Under the deltoid muscle, especially the infraorbital muscle is slippery. The calcination of the sac can be confirmed by X-ray films. Infectious bursitis can be complicated by surrounding tissue cellulitis, and gout bursitis can be accompanied by deposition of lime-like sediment.
Symptom
Symptoms of bursitis symptoms Common symptoms Severe pain Foot pain in the foot Muscle atrophy Synovial membrane Black stained arm Stretching pain Cellulitis Wrist square size... Stretching finger weakness near the hook bone
The most common bursitis occurs in the shoulder (under the shoulder or deltoid bursitis). Other common sites include the humeral olecranon (miner elbow), the anterior (wife's knee) or the iliac crest, and the Achilles tendon (the Achilles bursa). Inflammation), sputum (squatting waist), ischial bone (tailor or weaver arm), trochanter and first humeral head (capsulitis), the main clinical manifestations are as follows:
1. Acute bursitis is characterized by pain, localized tenderness and limited mobility. For example, shallow bursal involvement (anterior and olecranon), local redness, chemical (such as crystallization) or bacterial slippery There are severe pains in the bursitis, local skin is obviously red, and the temperature rises. The attack can last for several days to several weeks, and multiple recurrences. Acute symptoms can occur after abnormal exercise or excessive exertion.
2. Chronic bursitis is developed after multiple episodes of acute bursitis or repeated trauma. Due to synovial hyperplasia, the wall of the sac becomes thicker. The sac is eventually blocked, forming villi, sputum and calcium deposits. Etc. Because of pain, swelling and tenderness, it can lead to muscle atrophy and limited mobility. Calcium deposition under the deltoid muscle, especially in the infraorbital tendon sac, can be confirmed by X-ray films. In the acute attack of gout inflammation, Crystallization can be formed in the sac sac and the sac sac.
3, acromion sac bursitis (deltoa bursitis) manifested as shoulder pain and tenderness, especially in the abduction of 50 ° ~ 130 ° more obvious. Shoulder sac bursitis and calcified supraspinatus tendinitis, It is difficult to distinguish between clinical and X-ray examination. The latter may be the result of partial or total tearing, or caused by the release of crystals.
4, traumatic bursitis is more common, chronic, often in the prominent parts of the bone structure, due to long-term, repeated friction and compression, such as thin elderly women can sit sciatica bursitis; Pre-orbital bursitis occurs; over-tightening of the shoes can cause posterior bursitis, pathological manifestations of synovial congestion, edema, villous, increased synovial fluid and filling the bursa, which can cause thickening and fibrosis of the sac wall Acute bursitis often occurs on the basis of chronic bursitis, and when the damage is large, bloody synovial fluid may be exuded.
5, infectious bursitis due to infection caused by pathogenic bacteria, can cause suppurative bursitis, and can cause peripheral tissue cellulitis, often residual sinus after ulceration.
6, gout bursitis is easy to occur in the olecranon and anterior sac sac, chronic inflammatory changes can occur in the wall of the sac, and there is deposition of lime-like sediment.
Examine
Bursitis check
During the examination, it is necessary to find out the localized tenderness on a certain bursitis. For the shallow bursa (such as the olecranon, anterior iliac crest), it is necessary to check for a certain swelling and no synovial fluid. If the patient has obvious pain, redness, fever and swelling. Infection should be excluded, tears of muscle tendons or muscles around the joints, purulent bursitis, bursal bleeding, synovitis, osteomyelitis and cellulitis should be excluded. The pathological process can involve the same sacs and joints.
In some cases, mucus or bloody mucus can be drawn during the puncture of the bursa.
Diagnosis
Diagnosis and differentiation of bursitis
diagnosis
The patient has a history of chronic injury and a history of occupation related to the disease. The bones near the joint have round or elliptical shapes, and the edges have clear and different masses. The acute pain and tenderness are obvious, while the chronic ones are lighter. The affected limbs may have different degrees of activity disorder. The superficial bursa can detect fluctuations. The deep bursa or the capsular pressure is often difficult to touch and fluctuate. The puncture can obtain mucus or bloody mucus. If the infection is secondary, Then there may be red, swollen, hot, and painful performance.
Differential diagnosis
1. Tuberculous bursitis can be a primary tuberculosis infection of the bursa, or secondary to tuberculosis lesions in the vicinity, often occurs in the femoral trochanter, slow onset, lumps and pain gradually, the puncture fluid is A purulent or cheese-like substance, positive for tuberculosis culture or animal vaccination.
2. Rheumatoid bursitis often occurs in the heel, often accompanied by other rheumatoid arthritis changes.
