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Veterinary Manual
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Last full review/revision Jan 2015 | Content last modified Jan 2015
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 or acquired. True bursitis is inflammation in a congenital or natural
bursa (deeper than the deep fascia), eg, trochanteric bursitis and supraspinous bursitis (fistulous withers, see below).
Acquired bursitis is development of a subcutaneous bursa where one was not previously present or inflammation of that
bursa, eg, 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 (eg, 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.
The pain in acute bursitis may be relieved by application of cold packs, aspiration of the contents, and intrabursal
medication. Repeated injections may result in infection. Treatment of chronic bursitis is surgical (and is done
arthroscopically (bursoscopy). In infected bursitis, systemic antibiotics as well as local drainage are required.
Treatment:
Acute early cases may respond well to applications of cold water, followed in a few days by aseptic aspiration and injection
of a corticosteroid. The bursa may also be reduced in size by application of a counterirritant or by ultrasonic or radiation
therapy. Older encapsulated bursae are more refractory. Surgical treatment (usually curettage and drainage) is
recommended for advanced chronic cases or for those that become infected. A shoe-boil roll should be used to prevent
recurrence of a capped elbow if the condition has been caused by the heel or the shoe. With capped hock, behavioral
modification so the horse does not kick the stall offers the only hope of permanently resolving the problem.
Etiology:
The condition may be traumatic or infectious in origin. Agglutination titers support an infectious etiology. Brucella abortus
can sometimes be isolated from the fluid aspirated from the unopened bursa.
Clinical Findings:
The inflammation leads to considerable thickening of the bursa wall. The bursal sacs are distended and may rupture when
the sac has little covering support. In more chronic, advanced cases, the ligament and the dorsal vertebral spines are
affected, and occasionally these structures necrose.
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Fistulous withers
In the early stage, the supraspinous bursa distends with a clear, straw-colored, viscid exudate. The swelling may be dorsal,
unilateral, or bilateral, depending on the arrangement of the bursal sacs between the tissue layers. It is an exudative
process from the beginning, but no true suppuration or secondary infection occurs until the bursa ruptures or is opened.
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