PassFinals
Musculoskeletal

Bursitis

Bursitis is inflammation or infection of a fluid-filled bursa, usually causing a localised swelling over a pressure point; the safety-critical task is to distinguish non-septic bursitis from septic bursitis, septic arthritis, crystal disease and a mass.

In a nutshell

Bursitis causes a localised painful swelling over a bursa, often from pressure, trauma, gout or inflammatory disease. The urgent distinction is septic bursitis, septic arthritis or severe soft-tissue infection versus sterile bursitis. Examine the whole joint and skin, aspirate when infection or crystals are suspected and it is safe and useful, use local antibiotics for infection, avoid steroid when infection is possible, and treat non-septic cases with pressure avoidance, ice, movement and appropriate analgesia.

Classic presentation

A carpet fitter develops a fluctuant tender swelling over the front of the knee, or a person who leans on their elbow develops olecranon swelling. Ask about skin breaks and fever, examine passive joint movement and do not assume that a red swollen area is simple bursitis.

Key points

  • Olecranon and prepatellar bursae are superficial and vulnerable to pressure and infection.
  • A hot swollen joint with severe pain on passive movement suggests septic arthritis, not uncomplicated bursitis.
  • Warmth, erythema, a skin break, fever, purulent fluid or systemic upset raise concern for septic bursitis.
  • Aspirate for microscopy, culture and crystals when infection or crystal disease is suspected and aspiration is safe and useful; do not delay emergency treatment.
  • Non-septic bursitis usually improves with pressure avoidance, padding, ice, gentle movement and appropriate analgesia.
  • Do not inject corticosteroid into a possibly infected bursa; consider injection only for persistent, function-limiting non-septic disease after review.
  • Lateral hip pain called trochanteric bursitis is often greater trochanteric pain syndrome with gluteal tendinopathy.

First-line investigation

Clinical examination of the bursa, skin and underlying joint; aspirate for microscopy, culture and crystals when septic or crystal bursitis is suspected, with targeted bloods or imaging for uncertainty or systemic illness.

Management

Identify infection and joint emergencies

  • Assess fever, systemic upset, skin breaks, spreading erythema and purulence, and examine passive movement of the underlying joint; severe restriction or passive-movement pain needs emergency septic-arthritis assessment.1,2,4

Confirm the site and obtain useful fluid

  • For suspected septic or crystal bursitis, seek timely clinical advice and aspirate for microscopy, culture and crystals when safe and useful; do not let aspiration delay treatment of a systemically unwell person.1,2,6,7

Treat the cause

  • Non-septic bursitis: avoid pressure, use padding, ice, gentle movement and safe analgesia. Septic bursitis: use local antimicrobial guidance and BNF checks, with drainage or admission when severe or not improving; never inject steroid if infection is possible.1,2,6,7
  • Treat gout, calcium pyrophosphate deposition, rheumatoid disease, tendon pathology or another identified cause through the relevant pathway rather than repeatedly treating a presumed bursa.1,4,3

Review refractory or atypical swelling

  • Review worsening, recurrent or persistent symptoms and refer for specialist assessment when conservative measures fail, the mass is atypical or firm, function is significantly impaired, or infection remains unresolved.1,4,6

Exam traps

  • Preserved joint movement does not completely exclude septic arthritis; severe passive-movement pain is the key emergency clue.
  • A normal inflammatory marker does not rule out local septic bursitis.
  • Do not routinely aspirate every sterile bursa or inject steroids before infection is excluded.
  • Do not give a universal antibiotic or dose: use current local antimicrobial guidance, culture, allergy, renal function and severity.
  • Do not call all lateral hip pain trochanteric bursitis; assess for gluteal tendinopathy and greater trochanteric pain syndrome.
  • A persistent, firm or enlarging mass needs reassessment for tumour or another soft-tissue lesion.
  • Systemic toxicity, spreading cellulitis, immunosuppression or failure to improve needs urgent specialist or hospital review.

Illustrations

Olecranon bursitisA clinical photograph of a fluctuant swelling over the point of the elbow, with a note that the photograph does not determine whether the bursa is sterile or infected and that the elbow joint must still be examined.NJC123, Wikimedia Commons · Public domain

Key sources

  1. NICE CKS, Bursitis (Current NICE Clinical Knowledge Summary topic used as the primary UK primary-care pathway; direct page access was restricted in this environment, so no unsupported dose or threshold claim is retained.)
  2. NHS 111 Wales, Bursitis (UK NHS information on symptoms, self-care, aspiration, infection red flags, antibiotics and avoiding steroid injection when infection is present)
  3. Cambridge University Hospitals NHS, Gluteal tendinopathy (NHS specialist information explaining that lateral hip pain historically called trochanteric bursitis is often gluteal tendinopathy with bursal involvement rather than isolated bursitis)
  4. NHS Tayside Right Decisions, Olecranon bursitis (NHS regional clinical guidance accessed 4 August 2026 on examination, urgent referral, conservative treatment, septic bursitis and rare surgery)
  5. Leeds Community Healthcare NHS, Pre-patella bursitis (NHS patient information accessed 4 August 2026 on pressure avoidance, infection red flags, aspiration and rare surgical referral)
  6. NHS Tayside Right Decisions, Pre-patellar and infra-patellar bursitis (NHS regional clinical guidance accessed 4 August 2026 on non-septic versus septic bursitis, aspiration, antibiotic escalation and conservative care)
  7. BNF, antibacterial drugs and anti-inflammatory medicines (Current UK prescribing source for antibiotic choice, dosing, duration, interactions, allergy, renal adjustment and NSAID safety; BNF access was restricted in this environment, so detailed dose claims are intentionally omitted)

This page is exam revision material, not medical advice, and must not be used for patient care. Always check drug doses against the BNF and current guidance. Full disclaimer.