EpistemisLocalized periarticular swelling
Specialty: Musculoskeletal.
Why it occurs
- Olecranon bursitis (gout, acute trauma, repetitive microtrauma to the elbow)
- Prepatellar bursitis ("maid's knee" due to continuous kneeling)
- Direct bacterial infection of the bursa (septic bursitis due to staphylococcus, common after skin abrasions)
- Ruptured Baker's cyst (extravasation of synovial fluid into the subcutaneous tissue of the calf, simulating venous thrombosis)
- Acute tenosynovitis of wrist or foot extensors
- Large volume tendon sheath ganglion
Initial workup
Soft tissue ultrasound (evaluates extra-articular fluid collection, bursa wall thickening and Doppler neovascularization) | Puncture-aspiration of the bursa for analysis of synovial fluid (cell count, Gram stain, culture and search for urate or pyrophosphate microcrystals) | Plain x-ray to rule out bone spurs or underlying loose bodies.
red flags
Periarticular swelling with diffuse erythema that exceeds the limits of the joint, intense heat to the touch, exquisite pain on gentle friction, fever above 38°C and ascending lymphangitis (septic bursitis or severe cellulitis, requiring drainage of the bursa and intravenous antibiotics).
Standard management
- Cloxacillin — 500 mg every 6 hours orally if bacterial etiology due to S. aureus is suspected or confirmed
- Meloxicam — 15 mg once a day orally, if the bursitis is purely chemical inflammatory or due to microtrauma
- Colchicine — 0.5 mg every 12 hours orally if the inflammation is of gouty/microcrystalline origin
- Amoxicillin/clavulanic acid (875/125 mg every 8 hours orally, alternative for empirical septic bursitis).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Musculoskeletal
- Listed causes
- 6
- Treatment options
- 4