What is bursitis?

滑囊炎是一种囊炎. It is a condition usually characterized by pain and sometimes by redness and swelling. A bursa is a very thin (i.e., a few cells thick), 囊状结构，位于可能有摩擦的地方, such as between skin and bones, 在肌腱和骨头之间或者韧带和骨头之间. In other words, they serve to decrease the friction that occurs between hard bone and softer tissues. 一个很好的类比是在桌子角上摩擦皮革——随着时间的推移, you would rub a hole in the leather. Skin, tendons, and ligaments would likewise wear out if there were no bursa between them and bony surfaces. As a result, there are over 150 bursae in the body, wherever there is the possibility of rubbing.

粘液囊通常很薄，在不被注意的情况下完成它的工作. 然而，如果摩擦太多，它就会发炎或发炎. When this happens the bursa gets thicker and sometimes produces fluid to create more cushion. It goes from being very thin (like tissue paper) to thick and lumpy (like corrugated cardboard). 如果粘液囊内产生大量液体，粘液囊就会很大. Sometimes it can be colonized by bacteria, and in this case, becomes an infected bursa. It can be difficult to distinguish an inflamed bursa (irritated with no infection) and an infected bursa (irritated with infection or bacteria present).

而粘液囊遍布全身, 最常见的炎症或刺激发生在肘部, knee, and shoulder (see below). The terms “housemaid’s knee” (i.e., 家务劳动后的滑囊炎(手和膝盖), “miner’s elbow” (bursitis following work in mines performed on the hands and knees) or “student’s elbow” (bursitis following hours of studying with the elbows pressed against a table) are sometimes used to refer to bursitis in a specific group of patients due to repetitive friction.

What causes bursitis?

滑囊炎有几种途径, 但这种情况通常是由滑囊承受的压力过大引起的. 然而，一般来说，法氏囊刺激大致可分为三组. 第一种被称为慢性滑囊炎，可能是由多种因素引起的. This type is the most common and develops over time due to repetitive irritation of the bursa. 大多数患有这种类型的人没有易感问题, 而且炎症的发生没有明显的原因. It occasionally can occur in people who have a preexisting medical condition that causes the bursa to swell. 而不是最常见的原因，这种类型的法氏囊肿胀, it can be seen in people who have gout, pseudogout, diabetes, rheumatoid arthritis, uremia, and other conditions.

第二种被称为感染性滑囊炎，更为严重. 在这种情况下，粘液囊被细菌感染. 如果感染扩散，可能会导致严重的问题.

The last type, typically seen in athletes, 称为外伤性滑囊炎(或急性外伤性滑囊炎). 在这三种类型中，它是最不常见的. It is due either to repetitive rubbing of an extremity against a hard surface or from too much bending of the joint.

What are the symptoms of bursitis?

The symptoms of bursitis depend on the severity of the inflammation and the type of bursitis present. 慢性滑囊炎中，肿胀是最明显的症状. Patients with this type often seek medical attention because they notice swelling that has gone on for some time and does not improve. 它很少疼痛，通常不会变红. However, this type of bursal swelling can get warm and painful without being infected.

In infected bursitis patients usually experience excessive warmth at the site of the inflamed bursa. 他们经常抱怨有很大的压痛、疼痛和发烧. The swelling and redness may spread away from the affected site and go up or down the arm. 此外，感染的滑囊会让你感到恶心、发烧和疲倦. If you have any of these symptoms, it is very important to seek immediate medical attention.

外伤性滑囊炎表现为快速肿胀. 这些情况通常发生在特定事件之后, such as when a lacrosse or football player hits his or her elbow on hard artificial turf, 或者摔跤手的手肘撞到垫子上. 受影响的区域可能有些柔软和温暖，但不要过度. 肿胀也可能伴有瘀伤.

我怎么知道我得了哪一种滑囊炎?

这些症状有时指向一种滑囊炎而不是另一种, 但这种区别往往很难区分. This is especially the case when trying to differentiate chronic bursitis from an infected bursa. Chronic bursitis presents with swelling but lacks the other more serious signs of an infected bursa. 它们包括发红、发炎、发烧和疼痛. 出现这些症状时，应立即就医.

What is the treatment for bursitis?

治疗取决于你所患的滑囊炎的类型. 慢性滑囊炎的治疗方法是减少引起肿胀的活动. In some cases, it may even be necessary to immobilize the affected extremity with a splint. 此外，这种类型的处理包括填充(i).e.(如膝盖或肘部垫)和使用消炎药(如.e., ibuprofen, Naprosyn, Celebrex, etc.) for a few weeks. We recommend icing two or three times per day for 20 to 30 minutes each time until the swelling is gone. 肿胀可能在几周内不会消失. 不要使用热敷，因为它会增加炎症. Injection of steroids into the bursa may decrease the swelling and inflammation but can be associated with unwanted side effects (infection, skin atrophy, chronic pain). Injection of cortisone is best reserved for those bursae that do not get better with the treatment above. 此外，任何可能感染的囊都不应注射可的松.

感染性滑囊炎需要你的医生立即评估. 医生可能想要抽吸滑囊(如.e., take fluid out with a syringe) to reduce its size and to collect fluid needed to diagnose an infection. 需要抗生素来杀死细菌. The true danger with this type of bursitis is the risk that bacteria can spread to the blood. 和其他类型的法氏囊炎症一样, ice, rest, 消炎药可以改善肿胀和炎症.

外伤性滑囊炎通常通过吸出滑囊来治疗.e.(用小针从受影响的滑囊抽取液体/血液). 冰敷和非甾体抗炎药(消炎药)有助于减少肿胀. It is also important to compress the bursa with an elastic bandage and use padding upon returning to the activity that initially caused the problem. The use of protection is particularly important in football players (playing on artificial turf), wrestlers and basketball players. Also, gardeners, roofers, and carpet layers should take special precautions to prevent irritation to the knee area.

如果滑囊炎的症状没有改善，我该怎么办?

如按上述方法治疗，症状应会改善. 如果你没有看到改善，你可能需要和你的医生谈谈. It is especially important to seek medical care if you think you may have an infection. You should also seek attention if you notice swelling in more than one area or if the swelling increases despite the treatment above.

滑囊炎什么时候需要手术治疗?

治疗滑囊炎很少需要手术 and is usually done only in the chronic cases that have not improved with traditional therapy. The most common surgical treatment, if needed, is an incision and drainage (called an I and D) and is used only in cases of infected bursa. The surgeon first numbs the skin with an anesthetic and then opens the bursa with a scalpel. 最后，他或她排出存在于发炎囊中的液体. 有时需要手术切除整个滑囊. 只有当法囊肿胀引起问题时才需要这样做.

滑囊炎是一种运动相关损伤吗?

Bursitis is quite uncommon in sports. 大多数病例属于急性创伤型. As mentioned above, activities in which an athlete repeatedly rubs an extremity on a hard surface predispose him or her to bursitis (i.e.(足球、摔跤和篮球). 使用膝盖或肘部护垫来防止滑囊肿胀是很重要的.

What about bursitis in the shoulder?

Bursitis can also occur in the shoulder and is part of a process doctors use different names to describe: impingement, bursitis, rotator cuff tendinitis or biceps tendinitis. 在这种情况下，粘液囊通常会发炎但不会肿胀. The treatment is similar to chronic bursitis: ice, NSAIDs and range-of-motion exercises. 如果这些都不起作用，那么进一步的治疗可能是必要的.