Pes anserine bursitis : incidence in symptomatic knees and clinical presentation. To determine the prevalence and associated clinical symptoms of pes anserine bursitis in symptomatic adult knees. A retrospective review was performed of the reports of knee MRI studies obtained from July to June on patients presenting to an orthopaedic clinic with knee pain suspected to be due to internal derangement. The MRI studies and case histories of all patients reported to have pes anserine bursitis were reviewed. The management of these patients was also noted. The prevalence of pes anserine bursitis as detected on MRI is 2.
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NCBI Bookshelf. Taha Faruqi ; Tara J. Authors Taha Faruqi 1 ; Tara J. Rizvi 2. A bursa is a fluid-filled sac found at several locations in the human body. It serves to lubricate joints and body surfaces exposed to higher degrees of wear and friction.
The subacromial space in the shoulder is such a location. The subacromial bursa is bordered superiorly by the acromion, coracoid, coracoacromial CA ligament and the proximal deltoid muscle fibers and inferiorly by the fibers of the supraspinatus muscle.
The height of the subacromial space ranges from approximately 1. Any process that causes inflammation of the subacromial bursa can lead to bursitis. Common etiologies include:. Bursitis accounts for approximately 0. Gender prevalence is equal. It is seen more often in individuals who participate in repetitive overhead activities such as athletes, factory workers, and manual laborers. Older individuals are more prone to experiencing subacromial bursitis likely due to years of wear leading to an increase in subacromial impingement.
Any of the etiologies can lead to inflammation of the subacromial bursa, which causes increased fluid and collagen formation by the synovial cells of the bursa. The fluid is often rich in fibrin and can become hemorrhagic . Bursitis can subdivide into three phases: acute, chronic and recurrent. The acute phase is marked by local inflammation with thickened synovial fluid.
Chronic bursitis leads to the development of constant pain due to a chronic inflammatory process occurring in the bursa, which can also lead to weakness and eventual rupture of the surrounding ligaments and tendons. In cases of chronic bursitis, attention must be paid to tendinitis since these entities can be present simultaneously. Recurring bursitis can occur in patients exposed to repetitive trauma or routine overhead activities.
It can also present in patients with inflammatory conditions such as rheumatoid arthritis. Histopathologic studies are rarely used to diagnose subacromial bursitis. These studies are more relevant in cases of infection or in the setting of chronic or recurrent subacromial bursitis, where the etiology may not be apparent. In their research, Santavirta et al.
A thorough history and physical is of vital importance since this condition is primarily a clinical diagnosis. Subacromial bursitis usually presents with pain in the anterolateral aspect of the shoulder.
Patients may report sustaining trauma such as a fall with direct impact to the shoulder. A history of repetitive overhead activities such as overhead sports, lifting boxes, etc. Impingement syndrome is a common cause of subacromial bursitis. It results when the area of the subacromial space is decreased, mainly due to overhead activities.
Abduction of the arm elevates the humerus, bringing it closer to the acromion, which effectively reduces the space under the acromion where the subacromial bursa and the supraspinatus muscle lie. The subacromial bursa serves its function by protecting the underlying supraspinatus muscle from attrition wear between the humeral head and the acromion. However, repetitive activity can lead to irritation and inflammation of the bursa, causing it to get inflamed. When considering impingement as a cause for subacromial bursitis, it is, therefore, essential to also include tendon pathology in the differential since concomitant supraspinatus tendinitis or tendon tear may be present.
On physical exam, the patient will have point tenderness at the anterolateral aspect of the shoulder below the acromion. The pain is localized and does not typically radiate to other parts of the shoulder or the arm if the pain does radiate, one must include cervical spine pathology in the differential.
The skin may also be warm or boggy at this site, although erythema is generally not seen. Pain is also elicited on resisted abduction of the arm beyond 75 to 80 degrees since during this arc of motion the subacromial bursa is compressed at the undersurface of the acromion.
Laboratory tests are unremarkable and are as such not generally indicated for making a diagnosis. If there is a concern for septic arthritis of the shoulder, joint aspiration, and synovial fluid analysis may be an option at that time.
Imaging may be performed but is, once again, not necessary to elucidate a diagnosis of simple subacromial bursitis. However, it may still be worthwhile to obtain X-rays of the shoulder to rule out other causes of shoulder pain including fractures, dislocations, osteoarthritis, etc.
A bursa is a soft tissue structure and will not be visible on plain films unless calcification of the bursa is present. The morphology of the acromion can also be studied since certain anatomic variations can increase the likelihood of developing bursitis. The shape of the acromion can be flat type 1 , curved type 2 or hooked type 3. With a downward sloping curved or hooked acromion, less space is available in the subacromial space and the probability of developing subacromial bursitis increases.
An unstable os acromiale can cause subacromial impingement and lead to bursitis. Other imaging modalities including MRI and ultrasound can also be useful. Bursal fluid accumulation is visible on MRI. Additionally, MRI is an excellent modality to assess the rotator cuff muscles and any tendon lesions that may be present. Ultrasound can be used to evaluate the thickness of the bursa. In asymptomatic shoulders, Tsai et al. Comparatively, patients with bursitis had a bursal thickness of 1. Nonoperative treatment is the usual treatment route for subacromial bursitis.
Treatment modalities include rest, non-steroidal anti-inflammatory medications NSAIDs , physical therapy, and corticosteroid injections. A bursectomy may be performed either arthroscopically or via an open approach. If surgery is performed, additional procedures such as subacromial decompression, rotator cuff repair, etc. The prognosis for subacromial bursitis is good. Age also plays a role with older patients generally having poorer outcomes. On the spectrum of shoulder pathologies, subacromial bursitis is not one that is associated with many complications.
Repeated steroid injections always pose the theoretical risk of introducing an infection into the skin or shoulder joint. There is also a concern of damaging the rotator cuff muscles with recurrent injections. However, Bhatia et al. Subacromial bursitis is a common etiology of shoulder pain. It results from inflammation of the bursa, a sac of tissue present under the acromion process of the shoulder. It is usually brought about by repetitive overhead activities or trauma.
Steroid injections and rarely surgery may be necessary in persistent cases. Subacromial bursitis is a relatively benign condition that is easy to diagnose and treat.
Treatment can be rendered in this setting efficiently and effectively. The primary care providers including the orthopedic nurse should educate the patient on methods to prevent this pathology. Therefore, in cases where the bursitis is unable to be treated, or other pathologies are suspected, the patient should obtain a referral to an orthopedic surgeon for further care.
Subacromial bursitis is best managed by an interprofessional team that includes physicians, specialists, therapists, specialty-trained nursing, and pharmacists, engaged in a collaborative team effort to bring about the optimal care and the best possible patient outcomes. To access free multiple choice questions on this topic, click here. This book is distributed under the terms of the Creative Commons Attribution 4. Turn recording back on. National Center for Biotechnology Information , U.
StatPearls [Internet]. Search term. Affiliations 1 Beaumont Health. Introduction A bursa is a fluid-filled sac found at several locations in the human body. Etiology Any process that causes inflammation of the subacromial bursa can lead to bursitis. Common etiologies include: Subacromial impingement. Epidemiology Bursitis accounts for approximately 0. Pathophysiology Any of the etiologies can lead to inflammation of the subacromial bursa, which causes increased fluid and collagen formation by the synovial cells of the bursa.
Histopathology Histopathologic studies are rarely used to diagnose subacromial bursitis. History and Physical A thorough history and physical is of vital importance since this condition is primarily a clinical diagnosis.
Evaluation Laboratory tests are unremarkable and are as such not generally indicated for making a diagnosis. Differential Diagnosis Impingement syndrome.
Prognosis The prognosis for subacromial bursitis is good. Complications On the spectrum of shoulder pathologies, subacromial bursitis is not one that is associated with many complications. Deterrence and Patient Education Subacromial bursitis is a common etiology of shoulder pain. Enhancing Healthcare Team Outcomes Subacromial bursitis is a relatively benign condition that is easy to diagnose and treat.
Questions To access free multiple choice questions on this topic, click here. Figure Subacromial bursa. Image courtesy S Bhimji MD. References 1. Subacromial impingement syndrome.
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NCBI Bookshelf. Taha Faruqi ; Tara J. Authors Taha Faruqi 1 ; Tara J. Rizvi 2. A bursa is a fluid-filled sac found at several locations in the human body. It serves to lubricate joints and body surfaces exposed to higher degrees of wear and friction. The subacromial space in the shoulder is such a location.