Last updated: September 11, 2023

CME information and disclosurestoggle arrow icon

To see contributor disclosures related to this article, hover over this reference: [1]

Physicians may earn CME/MOC credit by reading information in this article to address a clinical question, and then completing a brief evaluation, in which they will identify their question and report the impact of any information learned on their clinical practice.

AMBOSS designates this Internet point-of-care activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only credit commensurate with the extent of their participation in the activity.

For answers to questions about AMBOSS CME, including how to redeem CME/MOC credit, see "Tips and Links" at the bottom of this article.

Summarytoggle arrow icon

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.

Pes anserine bursitis and trochanteric bursitis can occasionally contribute to pain syndromes that are primarily caused by tendinopathies; see “Pes anserinus pain syndrome” and “Greater trochanteric pain syndrome.”

Definitiontoggle arrow icon

  • Nonseptic bursitis: inflammation of a bursa without infection
  • Septic bursitis: inflammation of a bursa due to infection

Etiologytoggle arrow icon

Clinical featurestoggle arrow icon

By onset [5]

By localization

General joint swelling and significant pain with passive range of motion of the elbow or knee should raise concern for arthritis rather than bursitis. [2]

Fever, signs of acute inflammation, and/or overlying cellulitis suggest septic bursitis. [2]

Diagnosticstoggle arrow icon

Bursitis is primarily a clinical diagnosis. [2][3]

Identification of monosodium urate crystals in bursal fluid indicates gout but does not rule out concurrent septic bursitis. [4]

Treatmenttoggle arrow icon

Nonseptic bursitis [2][3]

  • Rest, ice or heat, elevation, and NSAIDs
  • Bursal aspiration for significant swelling
  • Compression to prevent fluid reaccumulation
  • Consider intrabursal glucocorticoid injection with specialist guidance. [2]
  • Bursectomy is a last resort but should not be performed during acute inflammation. [6]

Septic bursitis [2][4]

Oral antibiotic therapy for septic bursitis may fail in up to 50% of patients. Maintain a low threshold for admission and inpatient IV antibiotic therapy. [2][5]

Referencestoggle arrow icon

  1. $Contributor Disclosures - Bursitis. None of the individuals in control of the content for this article reported relevant financial relationships with ineligible companies. For details, please review our full conflict of interest (COI) policy:.
  2. Walls R, Hockberger R, Gausche-Hill M, Erickson TB, Wilcox SR. Rosen's Emergency Medicine 10th edition- Concepts and Clinical Practice E-Book. Elsevier Health Sciences ; 2022
  3. Sherman SC. Simon's Emergency Orthopedics, 8th edition. McGraw Hill Professional ; 2018
  4. Lormeau C, Cormier G, Sigaux J, Arvieux C, Semerano L. Management of septic bursitis. Joint Bone Spine. 2019; 86 (5): p.583-588.doi: 10.1016/j.jbspin.2018.10.006 . | Open in Read by QxMD
  5. Khodaee M. Common Superficial Bursitis.. Am Fam Physician. 2017; 95 (4): p.224-231.
  6. Baumbach SF, Lobo CM, Badyine I, Mutschler W, Kanz KG. Prepatellar and olecranon bursitis: literature review and development of a treatment algorithm. Arch Orthop Trauma Surg. 2013; 134 (3): p.359-370.doi: 10.1007/s00402-013-1882-7 . | Open in Read by QxMD
  7. Umer M, Qadir I, Azam M. Subacromial impingement syndrome. Orthop Rev (Pavia). 2012; 4 (2): p.18.doi: 10.4081/or.2012.e18 . | Open in Read by QxMD

Icon of a lock3 free articles remaining

You have 3 free member-only articles left this month. Sign up and get unlimited access.
 Evidence-based content, created and peer-reviewed by physicians. Read the disclaimer