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Bursitis is the inflammation of a bursa and is typically triggered by acute trauma, overuse, or an underlying inflammatory joint disease, such as rheumatoid arthritis or gout. Bursitis most commonly affects the olecranon, prepatellar, subacromial, or anserine bursae. Depending on which bursa is involved, the clinical presentation may include localized swelling, fluctuance, and/or pain with passive range of motion of the adjacent joint. Bursitis that is complicated by infection is referred to as septic bursitis and should be ruled out in patients with significant tenderness, erythema, and/or warmth of the inflamed bursa. Although bursitis is primarily a clinical diagnosis, imaging modalities such as x-ray, ultrasound, and MRI may be used to evaluate for alternative diagnoses or underlying joint disease. In patients with signs of acute inflammation, bursal aspiration with fluid analysis is indicated to rule out septic bursitis and gout. Conservative management (including rest, compression, and NSAIDs) is the mainstay of treatment for patients with nonseptic bursitis; intrabursal glucocorticoid injections may be used in refractory cases. Septic bursitis requires systemic antibiotic therapy and bursal drainage; surgical intervention is considered for patients with severe, recurrent, or refractory purulent effusions.
- Nonseptic bursitis: inflammation of a without infection
- Septic bursitis: inflammation of a bursa due to infection
- Nonseptic bursitis 
Septic bursitis 
- Causative organisms: S. aureus (most common), Streptococcus spp
- Infection of superficial bursae often due to trauma of the skin; infection of deep bursae often due to iatrogenic trauma (e.g., injection or aspiration)
- Risk factors: immunocompromise (e.g., diabetes, chronic alcohol use), chronic skin or joint inflammation (e.g., atopic dermatitis, rheumatoid arthritis), prior nonseptic bursitis
By onset 
- Acute bursitis
- Chronic bursitis
- Olecranon bursitis: inflammation of the typically caused by acute direct trauma or prolonged pressure ; 
- Prepatellar bursitis: inflammation of the typically caused by frequent kneeling or acute direct trauma ; 
- Subacromial bursitis: inflammation of the often caused by repetitive overhead motion 
- Pes anserine bursitis: inflammation of the , often secondary to overuse in runners, or in middle-aged women in association with obesity and osteoarthritis
- Trochanteric bursitis: inflammation of the (rare)
Bursitis is primarily a clinical diagnosis. 
- Bursal aspiration: Consider if are present (to rule out septic bursitis or gout).
Nonseptic bursitis 
- Rest, ice or heat, elevation, and NSAIDs
- Bursal aspiration for significant swelling
- Compression to prevent fluid reaccumulation
- Consider intrabursal glucocorticoid injection with specialist guidance. 
- Bursectomy is a last resort but should not be performed during acute inflammation. 
Septic bursitis 
Antibiotics: Empiric coverage for S. aureus and Streptococcus spp. 
- Immunocompetent with mild to moderate infection: Consider trial of outpatient oral antibiotic therapy for 10–14 days
- Immunocompromised, poor follow-up, or severe infection : Inpatient treatment with IV vancomycin 
- Adjust antibiotic therapy according to culture results.
- Bursal aspiration: : Repeat every 1–3 days as needed for persistent purulent effusion. 
Surgical intervention: Consider for severe, recurrent, or refractory purulent effusions.