Bursae are closed fluid filled sacs that develop after birth and number over 140 within the body (Baumbach, Lobo, Badyine, Mutschler, & Kanz, 2014). Bursitis occurs after acute or chronic trauma, crystal deposition, or systematic disease. Trauma, pressure on the bursa, and/or occupational hazards were determined to be the chief cause of bursitis in 21 of 26 studies included in a systematic review by Sayegh and Strauch (2014). Bursitis can be classified as non-septic (NSB) or septic (SB). Infection may be secondary to lacerations of the skin although no cause or risk factor may be apparent (Sayegh & Strauch, 2014). Staphylococcus aureus was the most common organism found in bursal fluid analysis in 26 of 26 studies (Sayegh & Strauch, 2014).
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A fever, however, presents only in cases of SB; therefore, a patient with a fever should be considered infected (Baumbach et al., 2014). In a survey obtained by Baumbach, Wyen, Perez, Kanz, and Uçkay (2013) differentiation was based on clinical presentation (83%0, blood sampling (75%), microbiological bursal fluid culture (70%), and bursal aspirate (65%). In the literature review by Baumbach et al. (2014), it is suggested to obtain radiographs in two planes and ultrasound before aspiration. There may be an obvious deformity or cause of the bursitis, but if radiographs come back normal then aspiration can be performed. Of the many tests on bursa fluid aspirate, Gram staining is one of the most precise (Baumbach et al., 2014). Although Gram staining is so accurate, it was used less than 50% of the time by physicians and orthopedic surgeons in Switzerland (Baumbach et al., 2013). Each type of bursitis, SB or NSB, can be treated conservatively or …show more content…
Treatments utilized for non-septic bursitis included aspiration (70.9%), surgery (47.0%), CSI (39.3%), NSAIDs (10.3%), antibiotics (1.9%), anesthetic injection (1.3%), and/or observation (0.4%) (Sayegh & Strauch, 2014). When SB and NSB were analyzed together, clinical resolution was significantly higher after non-surgical treatment (93.2%) than surgical treatment (86.7%). Complications were significantly more common in patients treated for NSB (11.3%) than those treated for SB (6.1%). Aspiration can be used to relieve mechanical pressure, reduce bacterial load and increase range of motion (Baumbach et al., 2014). There is always the possibility that when aspirating a NSB, bacteria can be introduced to the bursa during or after aspiration. Seventy-three percent of physicians and orthopedic surgeons use antibiotics on SB and 90% of antibiotics used was penicillin (Baumbach et al., 2013). When looking at this information it is easy to conclude that non-surgical treatment should always be considered before surgical treatment. Surgical removal of bursa is indicated in critically ill patients, severe soft tissue complications, immunocompromised patients, refractory, and chronic/recurrent NSB or SB cases (Baumbach et al.,
A fever, however, presents only in cases of SB; therefore, a patient with a fever should be considered infected (Baumbach et al., 2014). In a survey obtained by Baumbach, Wyen, Perez, Kanz, and Uçkay (2013) differentiation was based on clinical presentation (83%0, blood sampling (75%), microbiological bursal fluid culture (70%), and bursal aspirate (65%). In the literature review by Baumbach et al. (2014), it is suggested to obtain radiographs in two planes and ultrasound before aspiration. There may be an obvious deformity or cause of the bursitis, but if radiographs come back normal then aspiration can be performed. Of the many tests on bursa fluid aspirate, Gram staining is one of the most precise (Baumbach et al., 2014). Although Gram staining is so accurate, it was used less than 50% of the time by physicians and orthopedic surgeons in Switzerland (Baumbach et al., 2013). Each type of bursitis, SB or NSB, can be treated conservatively or …show more content…
Treatments utilized for non-septic bursitis included aspiration (70.9%), surgery (47.0%), CSI (39.3%), NSAIDs (10.3%), antibiotics (1.9%), anesthetic injection (1.3%), and/or observation (0.4%) (Sayegh & Strauch, 2014). When SB and NSB were analyzed together, clinical resolution was significantly higher after non-surgical treatment (93.2%) than surgical treatment (86.7%). Complications were significantly more common in patients treated for NSB (11.3%) than those treated for SB (6.1%). Aspiration can be used to relieve mechanical pressure, reduce bacterial load and increase range of motion (Baumbach et al., 2014). There is always the possibility that when aspirating a NSB, bacteria can be introduced to the bursa during or after aspiration. Seventy-three percent of physicians and orthopedic surgeons use antibiotics on SB and 90% of antibiotics used was penicillin (Baumbach et al., 2013). When looking at this information it is easy to conclude that non-surgical treatment should always be considered before surgical treatment. Surgical removal of bursa is indicated in critically ill patients, severe soft tissue complications, immunocompromised patients, refractory, and chronic/recurrent NSB or SB cases (Baumbach et al.,