Orthopedics - Oleksa A.P. 2006

Occupational Musculoskeletal Disorders
Occupational Bursitis

Occupational bursitis typically occurs among miners, parquet layers, and individuals in other professions that require prolonged work on their knees or elbows. The most common forms are prepatellar or infrapatellar bursitis, less frequently olecranon bursitis, and, in ballet dancers, achillobursitis. Excessive microtrauma to the subpatellar, prepatellar, or olecranon subcutaneous bursa leads to aseptic inflammation accompanied by fluid exudation within its cavity.

Patients present with localized Swelling on the anterior surface of the knee joint or in the olecranon region. Pain in these areas is generally absent, except when working on the knees or elbows, where increased pressure and distension of the bursa occur. The swelling increases gradually, which is why patients usually consult a physician only when pain arises that limits their ability to work.

Upon examination, There is a clearly demarcated swelling of normal color with somewhat thickened Skin over the front of the knee or the olecranon area. Palpation reveals no local hyperthermia or only a slight elevation; examination shows solely a soft, elastic, fluctuating mass, predominantly round in shape with sharply defined contours.

Aspiration of the bursa yields a straw-colored, transparent, or slightly turbid fluid. Following fluid evacuation, one can occasionally palpate the thickened, irregular walls of the bursa as well as loose bodies within the cavity.

Occupational bursitis should be differentiated from infectious suppurative bursitis, which follows an acute course characterized by severe pain, local or systemic fever, and sometimes skin hyperemia and diffuse infiltration of the surrounding Tissues. The bursa typically contains purulent-serous fluid.

Hemobursitis resulting from a single acute trauma is rare and is diagnosed on The basis of the patient's history and bursal aspiration.

Occupational bursitis is managed through both conservative and surgical approaches. Conservative Treatment consists of maximum evacuation of the exudate via bursa aspiration, followed by the application of a pressure bandage and rest (relieving the patient from work), along with UHF therapy and anti-inflammatory medications.

Repeated aspiration is sometimes necessary. To induce obliteration of the bursal cavity, sclerosing agents (such as 1 ml of iodine tincture, carbolic acid, etc.) are injected following aspiration, and a compression bandage is applied to the bursal area. To prevent circulatory impairment, a posterior plaster splint is applied first, followed by the bandage.

This treatment method has fallen out of favor because the administration of these agents triggers acute inflammation with severe pain, and ultimately, the desired outcome is not always achieved. For the same purpose, mechanical excoriation of the bursal mucosa is performed under local anesthesia (via a small incision), followed by the application of a compression bandage, as in the previous method. However, this operation is palliative, and bursitis recurrences frequently follow.

The most radical treatment method for occupational bursitis is surgical excision of the bursa, or bursectomy. Local hyperthermia and tissue infiltration are not contraindications for surgery. Under local anesthesia with a 0,5 % novocain solution, an arcuate incision is made along the edge of the bursa (designed so that the scar does not fall on the weight-bearing area of the knee), and the bursa is exposed and isolated. Isolation is easier after incising the bursa and evacuating its serous contents. To prevent Blood accumulation beneath the created skin flap at the bursal site, the flap is anchored to the underlying tissues using three or four U-shaped sutures tied over gauze rolls placed on the skin surface, which compress the subcutaneous dead space over a larger area. Recurrences do not occur following Surgical treatment.

Prevention of occupational bursitis involves providing workers in relevant occupations with elastic, porous, waterproof knee and elbow pads.

Due to advancements in coal-mining technology in recent years, the incidence of occupational bursitis among miners has decreased dramatically.