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Bursitis


Inflammation of the periarticular mucous bags, the causative agent of which can be any pyogenic microbes, but more often staphylococci and streptococci. The conditions for their development creates a chronic injury. In this regard, individual bursitis (ulnar, shoulder, etc.) are classified as occupational diseases. Microbes penetrate into the mucous membranes from small abrasions of the skin or along the lymphatic paths from a purulent foci that has arisen near (furuncle, carbuncle, osteomyelitis). Under the influence of mechanical irritation, serous accumulates, and with the addition of infection, purulent exudate, the bag gradually stretches, reaching the size of a large tumor.
With serous effusion in the rounded cavity of the mucous membrane of the bag contains a viscous yellow liquid, rich in protein. Initially, the walls of the cavity are thin and without pronounced inflammatory changes. But gradually they thicken due to the proliferation of connective tissue, protrusions and cords are formed, chronic bursitis develops.
With purulent exudate, an acute inflammatory process occurs, which with necrosis of the wall of the bag passes to the surrounding soft tissues with the formation of subcutaneous or intramuscular phlegmon. The skin over the swelling is swollen, inflammatory changed, its temperature is elevated. On palpation, pain is noted. The function of the nearby joint is not limited, the movements are painless. General symptoms are absent or mild.
The course is chronic with periods of exacerbation. With spontaneous opening of the abscess, a long non-healing fistula remains.
Treatment:
The diseased limb is immobilized. In order to accelerate the absorption of exudate, dry heat, UHF, dressings with Vishnevsky ointment, etc. are used. Antibiotics are administered. In some cases, with prolonged treatment, a cavity is punctured with suction of the exudate and the introduction of antibiotics into it.
With purulent bursitis, surgery is indicated - opening an abscess of the mucous membrane of the bag and removing pus, followed by debridement of the wound. Healing usually occurs extremely slowly, for a long time serous-purulent fluid is released from the wound.
It is more rational to resort to removing the mucous bag without opening its lumen. An incision is made on the side of the bag, the wound is left open or sutured after preliminary introduction of antibiotics into the formed cavity.