Purulent bursitis - Causes, symptoms and treatment. MF.
Causes of purulent bursitis.
Purulent bursitis develops due to bacterial infection of the bag cavity. The causative agents are mainly staphylococci and streptococci. The development of bursitis in most cases is preceded by a mechanical trauma. Microorganisms penetrate through the obtained abrasions and scratches of the skin into the bag cavity. Direct damage to the synovial bag in almost all cases leads to the development of an inflammatory process. At the initial stage, the inflammation is serous or catarrhal. In the absence of proper treatment, the process goes to the stage of purulent inflammation. If the treatment is inadequate, the process can take a chronic course.
Often the disease is of a professional nature, associated with a forced position with support on the elbows, knees( for example, engravers, masters, porters with prolonged wearing of weights on the shoulder).And also occurs with a long static position with support on them during alcohol or narcotic intoxication.
The presence of a number of located foci of infection, pustular skin lesions( pyoderma) can both determine the development of the disease and promote a faster transition to a purulent stage with a mechanical trauma. Symptoms of purulent bursitis.
The most common are the bags of the elbow, knee and shoulder joints.
With the development of serous inflammation of the articular bag due to the accumulation of fluid in the lumen of the bag, it increases in size and a well-defined swelling is formed in the joint region, usually painless, elastic upon palpation and not interfering with the movement of the joint in the projection of which it is located.
When the infection becomes painful in the area of swelling, the skin over it blushes, becomes hot to the touch, swelling of surrounding tissues appears, the body temperature rises to 37.5 ° C and higher. Redness and edema can spread beyond the boundaries of the tumor-like formation, which indicates the possibility of an expansion of the suppurative process on the surrounding synovial bag anatomical formations. If there is a wound penetrating into the cavity of the bag, a purulent discharge can come from it( photo below).
Photo1.Purulent bursitis of the elbow joint
Photo 2. Acute bursitis of the knee joint
This clinical picture is typical for bursitis of the knee and elbow joints. With ulnar bursitis, the swelling will be located on the top of the elbow, with knee bursitis - along the front surface of the patella( prepatellar bursitis).
With the defeat of synovial bags in the shoulder region, there are pains during the withdrawal and rotation to the inside of the upper limb, which is due to the arrangement of bags under the muscles that perform these movements. The mobility of the shoulder in the purulent nature of inflammation due to pain and high pressure of purulent contents is limited. There is a smoothing of the intermuscular furrows in the joint area, an increase in the joint volume, but only over the outer surface of the shoulder.
Examination for purulent bursitis.
If these symptoms occur, you should contact the surgeon of the polyclinic at your place of residence. You should donate blood for a general analysis and for glucose( sugar) blood, as well as a general urine test. Determination of blood glucose level is necessary to exclude the presence of diabetes mellitus, and if there is a definition of severity and correction of treatment. Instrumental examination methods are rarely used due to a clear clinical picture. However, in case of doubtful cases and atypical location of bursitis( for example, in the region of the hip joint), additional methods of investigation are possible. The latter include radiography of the joint and ultrasound.
Radiography of the joint allows you to exclude the inflammatory process in the cavity of the joint itself. Ultrasonic examination establishes the localization and dimensions of the cavity, allows performing a diagnostic puncture under ultrasound control.
Puncture of the cavity of the joint bag allows you to evaluate the liquid content, determine its nature.
The only disease with which it is necessary to differentiate purulent bursitis is purulent arthritis. The difference between them is the preservation of movements in the joint with bursitis. With arthritis, the movements are sharply painful and limited. When bursitis pain is felt near the joint, not inside.
Treatment of purulent bursitis.
Conservative treatment of acute bursitis is possible only with a serous nature of inflammation. In such cases, the hand is immobilized on a kerchief, the puncture of the articular bag is performed with the evacuation of the liquid contents, the bag cavity is washed with an antiseptic solution. Further on the area of the bag, put a tight bandage with an elastic bandage.
In order to accelerate resorption, physiotherapeutic treatment is prescribed: dry heat, UHF therapy, ultrasound therapy and others.
In the purulent nature of the process, it is necessary to open a purulent focus with partial excision of the bag walls involved in the inflammatory process, treatment of the cavity with antiseptic solutions and open wound management, which heals by secondary tension. Often, the healing is slow with the formation of fistulas with serous discharge, which is explained by the production of the liquid by the bag itself.
With a recurring course of purulent bursitis, a complete excision of the synovial bag is indicated. In the postoperative period, antibacterial therapy, physiotherapy and pain medication are prescribed.
Complications of purulent bursitis.
In the absence of timely treatment, the purulent fusion of the walls of the synovial bag occurs and the process spreads to neighboring structures. As a result:
• phlegmon - purulent melting of subcutaneous and intermuscular cellular spaces, accompanied by the transition of redness and swelling to the surrounding skin;
• lymphangitis - inflammation of the lymphatic ducts of the skin, which become noticeable in the form of a mesh or red ducts on the skin directed centripetally from a purulent focus;
• lymphadenitis - inflammation of the lymph nodes, to which lymph flows from the purulent focus, can result in the formation of an abscess;
• purulent arthritis - the transition of a purulent process to an adjacent joint with a violation of its mobility.
Preventing purulent bursitis.
The only prevention is to prevent traumatic effects on the area of synovial bags, timely treatment of suppurative processes in the joints.
The use of folk remedies is not rational, as it will lead to the progression of the purulent process and the development of complications. Therefore, self-medication is dangerous and can lead to tragic consequences.
Positive outcome for this disease is possible only with the early application of medical care. Take care of your health. It is better to overestimate the severity of your symptoms than it is too late to seek medical help.
Surgeon-physician Tevs DS