Bursa

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BURSA AND BURSITIS

Definition: -

Bursa is a closed sac lined with membrane similar to synovial membrane, located at boney prominence or between moving parts to permit gliding and prevents friction.

Bursitis

Bursitis is an inflammatory reaction within a bursa that can range from mild inflammation to sepsis. It is more common and important in horses. It can be classified as true (congenital) or acquired (false). True bursitis is inflammation in a congenital or natural bursa (deeper than the deep fascia), as trochanteric bursitis and supra-spinous bursitis (fistulous withers). Acquired bursitis affects subcutaneous bursa that was not previously present or affects superficial bursa as capped elbow over the olecranon process, shoe boil over the point of the elbow, and capped hock over the tuber calcaneus.

Bursitis may manifest as an acute or chronic inflammation. Examples of acute bursitis include bicipital bursitis and trochanteric bursitis in the early stages. It is generally characterized by swelling, local heat, and pain. Chronic bursitis usually develops in association with repeated trauma, fibrosis, and other chronic changes (as capped elbow, capped hock, and carpal hygroma). Excess bursal fluid accumulates, and the wall of the bursa is thickened by fibrous tissue. Fibrous bands or a septum may form within the bursal cavity, and generalized subcutaneous thickening usually develops. These bursal enlargements develop as cold, painless swellings and, unless greatly enlarged, do not severely interfere with function. Septic bursitis is more serious and is associated with pain and lameness. Infection of a bursa may be hematogenous or follow direct penetration

Classification of bursa: -

I-ACCORDING TO POSITION

1-Subcutaneous

2-Sub-fascial

3-Sub-muscular

4-Sub-tendinous

II-ACCORDING TO HEREDITARY

1-Congenital (True, deep or typical)

They develop before birth and located in fixed position. Usually they associated the deep structures like deep fascia, tendons or muscles.

2-Acquired (False, Subcutaneous or atypical)

They develop after birth subcutaneously over bony prominence. Usually they grew as a result of mechanical effects as movement of the skin with subsequent tearing of SC connective tissue with gap formation that is filled with fluid and encapsulated with fibrous tissue.

Classification of bursitis: -

I-ACUTE BURSITIS

1-Aseptic bursitis

1-Dry

2-Serous

Causes: -

Usually it is traumatic in origin and an example is acquired bursitis of olecranon bursa (capped elbow), capped hock (calcaneal bursitis), and capped knee (pre-carpal bursitis)

Signs: -

1-Pain during extension and flexion of the joint at early stages but distension is not clear (dry bursitis)

2-Pronounced exudation and distension at late stages (serous bursitis)

Treatment: -

1-Remove the cause

2-Rest of the animal and the organ

3-Cold application at early stage to prevent effusion and swelling

4-Systemic anti inflammatory

5-Local injection of steroids and penicillin but repeated injections may result in infection

2-Septic bursitis

Causes: -

The main cause of that type of bursitis is infection either via contaminated penetrating object or via circulation. Septic navicular bursitis may ensue after picked up nail while fistulous withers may ensue as a result of infection of the bursa by brucella.

Signs: -

1-General signs of inflammation over the distended bursa

2-Certain bursae may show draining as fistulous withers

3-Lameness may be evident

Treatment: -

1-Surgical drainage with removal of necrotic tissue

2-Control of infection

II-CHRONIC BURSITIS

It ensues as a result of mild repeat trauma or as a squalled of acute infectious bursitis. The bursa shows swelling but pain is not marked as a result of chronicity. Usually it causes mechanical interference.

1-Cystic

This form characterized by cyst formation that has variable quantity of viscid fluid that may contain cartilaginous materials and a thick fibrous wall

2-Proliferative

The inner surface of the bursa contains vegetative papillae extend into the lumen of the bursa may with presence of cartilaginous materials

3-Fibrous

This type of bursitis characterized by presence of high amount of fibrous tissue and low amount of fluid and it appears as fibroma

4-Hemorrhagic

This form is characterized by presence of extra-vasated blood in the lumen of the bursa indicating the severity of the trauma

Treatment: -

1-Remove the cause

2-Topical application of absorbent (iodine ointment), counter irritant, or firing or

3-Aspirate its contents in case of cystic bursae with injection of irritants like Tr. Iodine or carbolic acid to destroy the epithelial lining and stimulate granulation to obliterate the cavity, this is performed in conjunction with application of bandage or

4-Application of seton or

5-Incision of the bursa with swapping the lining with irritant to stimulate granulation or

6-Surgical excision