Robert J. Snyder, MD
Did you know that there are more than 150 bursae in the human body? Almost every joint has at least one of these slippery, cushiony, synovial fluid-filled sacs that provide padding, reduce friction and add lubrication between the points of bones, muscles and tendons near the joints. These little marvels usually perform quite admirably until we stress them out over time with repetitive motion, overwork, or injury. Then, they can become sore and angry like nobody’s business, making movement difficult and painful. Sometimes, they can even become infected, which if left untreated, can become life-threatening. When that happens, the diagnostic test of bursa aspiration and analysis is performed to help the physician understand what bacteria has decided to set up housekeeping and what antibiotic is needed to send that critter packing.
As a busy orthopaedic surgeon in Newport News, I have seen my share of bursitis, both non-infectious and septic. Both are painful and cause dysfunction in the way patients work, move, and rest. Theoretically, a patient can get bursitis anywhere they have bursae. Two areas of the body are more prone, because they are used and abused more often, at work and at play – the knees and the elbows.
When a patient presents to me with a painful joint, bursitis is on my usual suspect list. After I order x-rays to rule out arthritis and other mechanical issues, do a thorough physical examination and ask the patient a lot of questions, I typically can make a diagnosis quickly. Bursitis is a very common diagnosis, but thankfully, infectious bursitis isn’t quite as common. A septic or infectious bursa typically feels hot, looks hot (red) and swollen…sometime ridiculously so. That’s why a person with septic bursitis in the elbow (olecranon bursitis) is referred to as having Popeye’s elbow, because of it’s sometimes “comic” proportions. I also will be looking for a fever, possibly chills, and complaints of feeling unwell, although some patients will not run a temperature. These symptoms are indications that the fluid inside the bursa most likely is infected. Aspirating that extra fluid out of the joint area will also provide pain relief for the patient by relieving pressure. The synovial fluid withdrawn needs to be cultured in a lab to make sure we are administering the correct antibiotic to mitigate the infection.
Depending on the level of infection and swelling, it may be easier for me to lance the area to release the accumulated pus and infected fluid. I can then flush out the wound, put in a drain, cover the area with a sterile dressing and send the patient home on a broad-spectrum antibiotic, such as Cefalexin, until the lab culture comes back with a positive ID on the specific bacterium present. Some patients will need to have IV antibiotics due the severity of their infection and may need to be admitted to the hospital depending on their overall condition.
When the lab results come back to me, I can always adjust the patient’s medication if necessary to address whatever bacteria, or fungi may have been found.
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