History and exam

Key diagnostic factors

common

pain at site of bursa

A key symptom.

tenderness to palpation at site of bursa

A typical finding, although there are no validated diagnostic criteria and the efficacy of palpation for accurate diagnosis has not been established.[5][6][7]

decreased active range of motion

If the affected bursa is near a joint, the patient may have limited range of movement. Typically, passive range is preserved but active range is restricted.

Other diagnostic factors

common

presence of risk factors

Risk factors may predispose to particular forms of bursitis. These include occupations that causes mechanical stress on bursa (e.g., kneeling), abnormal gait, and autoimmune disease.

low-grade temperature

May accompany septic bursitis. The presence of low-grade temperature does not prove a septic bursitis, but can raise the suspicion.

swelling

May be prominent if the bursa is superficial. May also be seen in septic bursitis.

erythema

May accompany swelling with a superficial bursitis. Particularly pronounced when crystals are present. Often seen in septic bursitis.

warmth of overlying skin

This is suspicious of a septic bursitis and may be seen in conjunction with swelling and erythema. These signs do not prove a septic bursitis, but can raise the suspicion.

painful arc on shoulder abduction (subacromial)

Due to compression of the inflamed bursa under the coracoacromial arch. This can also occur with rotator cuff tears, and the two conditions may coexist.

lateral hip pain (trochanteric)

A suggested key factor in the diagnosis of trochanteric bursitis.

uncommon

pain at the extremes of hip rotation, abduction, or adduction (trochanteric)

Suggests trochanteric bursitis when seen in combination with lateral hip pain and tenderness around the greater trochanter.

pain of contraction of the hip abductors against resistance (trochanteric)

Suggests trochanteric bursitis when seen in combination with lateral hip pain and tenderness around the greater trochanter.

pseudoradiculopathy: pain radiating down the lateral aspect of the thigh (trochanteric)

Suggests trochanteric bursitis when seen in combination with lateral hip pain and tenderness around the greater trochanter.

impalpable patella (prepatellar)

If swelling of the superficial prepatellar bursa is significant, the patella may not be palpable.

palpable bump over heel (retrocalcaneal)

May be seen in retrocalcaneal bursitis.

Risk factors

weak

occupation that causes mechanical stress on bursa

Any occupation that causes repetitive mechanical stress over a bursa may result in bursitis. Infrapatellar bursitis has been associated with kneeling in the upright position (e.g., for praying) and is therefore colloquially known as 'clergyman's knee'. The term 'housemaid's knee' has been used to describe prepatellar bursitis, as this could be subject to repetitive trauma from kneeling to scrub floors. Carpet layers may also be at increased risk.

rheumatoid arthritis

Autoimmune aetiology has been suggested as a possible contributing factor to the development of bursitis.

gout or calcium pyrophosphate deposition disease

Crystal deposition is a possible cause of bursal inflammation. Bursitis may be the first presenting feature of gout.

penetrating injury

Provides a source and route of entry for infective microorganisms, which may result in an infective bursitis.

osteoarthritis of the hip

Has been implicated as a cause of trochanteric bursitis through osteophyte deposition, but this remains unproven.[5]

infection in a nearby joint

Septic bursitis can result from infection in a nearby structure and can occasionally cause inflammation in a communicating joint.[5][6][7][8]

lower limb length discrepancy

May predispose to trochanteric bursitis by altering the normal gait pattern, the mechanical stress on the hip, and the movement of muscles on the trochanteric bursa.[5]

iliotibial band contracture

May alter gait and consequently movement of the hip muscles on the trochanteric bursa.[5]

lumbar spondylosis

Unproven but thought to affect the pattern of hip movement and therefore affect pressure on the trochanteric bursa.[5]

valgus knee deformity

A risk factor for anserine bursitis; may be found in combination with medial collateral ligament damage.

low-riding shoes

May exert excessive pressure on the heel and cause retrocalcaneal bursitis.[9]

anatomical or functional impingement within the coracoacromial arch

Thought to be the most common cause of subacromial (subdeltoid) bursitis.[10][11]

Use of this content is subject to our disclaimer