Tiivistelmä

Syvät limapussit ovat synnynnäisiä rakenteita, kun taas pinnalliset bursat kehittyvät kuormituksen ­seurauksena.

Pinnallisten infektiivisten bursiittien hoitona on ripeä antibioottihoidon aloitus limapussin punktion ja ­bakteeriviljelyn jälkeen.

Pinnallisten inflammatoristen bursiittien hoitona on punktio ja lepo.

Kuormitusperäisiin syviin bursiitteihin käytetyt kortikosteroidi-injektiot voivat lievittää oireita, ­mutta niistä ei ole pitkävaikutteista hyötyä.

Syvissä bursiiteissa tulee huomioida usein taustalla vaikuttava lisääntynyt tai poikkeava epäsuora ­mekaaninen kuormitus, tarvittaessa kuntoutuksen avulla.

English summary

Diagnosis and treatment of bursitis

A bursa is a structure that reduces friction between soft tissues and bony structures. Bursitis can be either aseptic or septic. Aseptic bursitis is more frequent. Septic bursitis occurs mainly in superficial bursae. Infection in deep bursae is less frequent. The diagnosis of superficial bursitis is fairly straightforward based on clinical examination, but imaging can be useful in some cases. Treatment consists of aspiration of the bursa and relative rest. The diagnosis of deep bursitis is more challenging and ultrasound or magnetic resonance imaging can be helpful in reaching the diagnosis. Indirect mechanical loading is a common contributing factor in deep bursitis, and tendinopathy findings are frequent in adjacent tendons. The treatment in the acute phase consists of relative rest and medication. However, when aiming for long-term effects, improvement in the loading tolerance of the bursa and the loading capacity of the adjacent tendons should be targeted in rehabilitation. Corticosteroid injections can be useful in the short-term, but they do not have any long-term benefit and, thus, the use of injections should be considered carefully. Surgery is required infrequently.