Pediatric emergency medicine trisk 3958 3958
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the next most common cause. There is no consensus on the need for parenteral
versus oral antibiotics. The prepatella bursa and olecranon bursa are most
commonly infected.
Bursae are located throughout the body, but bursitis occurs only in a few.
Prepatella bursitis, commonly called “housemaid’s knee” results from frequent or
prolonged kneeling. Pes anserinus bursitis occurs on the lateral aspect of the knee
where the tendons of the hamstring muscles overlie the tibia. Retrocalcaneal
bursitis occurs between the calcaneus and Achilles tendon, and is often caused by
direct pressure from ill-fitting footwear or high-heeled shoes. Olecranon bursitis
most often results from a single direct blow to the elbow. Shoulder or subacromial
bursitis is often associated with calcifications and produces severe pain with
abduction. Other commonly affected bursae include the inferior calcaneal bursa
and the trochanteric bursa.
An unusual form of bursitis is known as a popliteal or Baker cyst. This occurs
in the bursa that cushions the tendons of the gastrocnemius and semimembranous
muscles from the distal femur. The presence of this condition in adults is highly
suggestive of intra-articular knee damage. In children with a Baker cyst, there is
frequently a congenitally wide opening joining the bursa sac with the knee joint
itself. One-way flow of synovial fluid into the bursa produces swelling just below
the popliteal fossa on the medial side. Patients with chronic inflammatory
conditions of the knee, such as JIA, are at increased risk of developing popliteal
cysts. In children, the cyst frequently comes to medical attention as an
asymptomatic mass behind the knee. The swelling may limit full flexion of the
knee and produces the sensation of tension with extension. The mass is typically
nontender and transilluminates. Presence of an associated knee effusion is
unusual and suggests the need for further evaluation of intra-articular knee
pathology. Ultrasound is the preferred imaging technique in children as it can
distinguish the fluid-filled popliteal cyst from other solid masses. Ultrasound is
noninvasive, avoids ionizing radiation, and can identify even small cysts. MRI is
more accurate than ultrasound but not as essential in children, given the
significantly lower incidence of accompanying intra-articular injury. Rarely, an
arthrogram or bursagram may be used to outline the cyst, document the articular
connection, and detect ruptures of the cyst.
Bursa inflammation produces swelling and localized tenderness with direct
palpation. Any movement of the tendons overlying the site will reproduce the
pain.
Conservative therapy consisting of restricted activity, frequent application of
ice, and regular use of nonsteroidal anti-inflammatory medications is successful
