What is the role of surgery in the treatment of bursitis?

Updated: Dec 11, 2020
  • Author: Kristine M Lohr, MD, MS; Chief Editor: Herbert S Diamond, MD  more...
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Answer

In general, bursitis is not treated surgically. However, there are some cases in which surgical interventions such as the following are appropriate:

  • Incision and drainage

  • Excision of chronically inflamed bursae

  • Removal of underlying bony prominences

As a rule, surgical intervention is reserved for the following situations [47] :

  • Failure of needle aspiration to drain the bursa adequately

  • Bursa site inaccessible to repeated needle aspirations

  • Abscess, necrosis, or sinus formation

  • Need for exploration to assess the extent of infection of adjacent structures

  • Recurrent or refractory disease after conservative treatment

Surgical release may be indicated when adhesive bursitis develops that severely limits joint motion. During surgery, the adhered bursa is removed, and the contiguous tissues are released. [48, 49, 20, 50]

In the upper extremity, subscapular bursitis can be caused by bony exostoses, and surgery may be needed to reduce these structures. In addition, the association of subacromial bursitis with rotator cuff impingement and tears is high, and surgical repair of the tear may be indicated. Singh and Bain describe a technique for treatment of olecranon spurs in which the spur is dissected out and excised in its entirety under endoscopic vision; this technique results in less morbidity compared with open excision and avoids an incision in the sensitive skin over the olecranon. [51]

In the lower extremity, Baker cysts (popliteal bursitis) are often removed surgically. Before open excision, arthroscopy should be performed to evaluate for intra-articular conditions. Most cysts are approached posteromedially through a hockey-stick incision.

Pretell et al described distal “Z” lengthening of the fascia lata in 13 hips and reported that 12 of the 13 patients reported good results. [52] According to the authors, this technique is less aggressive, can be performed with local anesthesia, and is associated with little morbidity and disability. The mean operating time for the procedure was 15 minutes, and one seroma was reported as a complication.

Lohrer and Nauck, in a prospective study of 89 athletes who underwent surgery for recalcitrant retrocalcaneal bursitis or recalcitrant midportion Achilles tendinopathy, found that clinical severity scores improved significantly at 6 and 12 months following surgery, and that improvements were similar among patients who did or did not undergo tendon repair. [53]


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