Bursa Aspiration: Procedure, When It's Needed, and What to Expect

How is a Bursa Drained?

Bursa drainage, medically known as aspiration, is a sterile procedure performed by a healthcare professional to remove excess fluid from an inflamed bursa, typically to alleviate pain, reduce swelling, and aid in diagnosis.

Understanding Bursae and Bursitis

To comprehend bursa drainage, it's essential to first understand the structure and function of a bursa. Bursae (plural of bursa) are small, fluid-filled sacs located throughout the body, acting as cushions between bones, tendons, muscles, and skin. Their primary role is to reduce friction during movement, facilitating smooth gliding of tissues over one another. Key bursae are found around major joints like the shoulders, elbows, hips, and knees.

Bursitis occurs when a bursa becomes inflamed, usually due to repetitive motion, prolonged pressure, trauma, or infection. This inflammation leads to increased fluid production within the bursa, causing pain, swelling, tenderness, and restricted movement in the affected area. Common types include subacromial bursitis (shoulder), olecranon bursitis (elbow), trochanteric bursitis (hip), and prepatellar bursitis (knee).

When is Bursa Drainage (Aspiration) Necessary?

Bursa aspiration is not the first line of treatment for bursitis. Initial management often involves conservative measures such as rest, ice, compression, elevation (RICE), non-steroidal anti-inflammatory drugs (NSAIDs), and physical therapy. However, aspiration may be considered when:

• Persistent Symptoms: Conservative treatments fail to alleviate significant pain and swelling.
• Diagnostic Purposes: To analyze the fluid for signs of infection (septic bursitis), gout crystals, or other underlying conditions. This is crucial as septic bursitis requires immediate antibiotic treatment.
• Severe Swelling: To relieve pressure and improve range of motion in cases of very large, tense bursal effusions.

The Procedure: Bursa Aspiration Explained

Bursa aspiration is a medical procedure performed in a clinical setting by a physician, often an orthopedist or primary care provider. It is a sterile technique to minimize the risk of infection.

• Preparation:
  • The skin over the affected bursa is thoroughly cleaned with an antiseptic solution (e.g., iodine or chlorhexidine) to prevent bacterial entry.
  • The area may be draped with sterile towels to maintain a sterile field.
• Anesthesia:
  • A local anesthetic (e.g., lidocaine) is typically injected into the skin and surrounding tissues to numb the area, minimizing discomfort during the procedure.
• Aspiration:
  • A sterile needle, usually larger than a standard injection needle to accommodate the thicker fluid, is carefully inserted directly into the bursa.
  • A syringe is attached to the needle, and the fluid is gently drawn out (aspirated). The amount of fluid removed varies depending on the size of the bursa and the extent of the inflammation.
  • The color and consistency of the fluid are often noted. Clear or straw-colored fluid is typical of non-infectious inflammation, while cloudy, purulent (pus-like) fluid strongly suggests infection.
• Post-Aspiration:
  • Once the desired amount of fluid is removed, the needle is withdrawn.
  • Pressure is applied to the site with a sterile gauze pad to prevent bleeding and help seal the needle track.
  • A small sterile bandage or dressing is applied.
  • In some cases, a corticosteroid medication may be injected into the bursa immediately after aspiration to reduce inflammation, especially if infection has been ruled out.

What Happens After Bursa Aspiration?

After the procedure, patients can typically go home the same day.

• Pain and Swelling: Some mild pain, bruising, or swelling at the injection site is common and usually resolves within a few days. Over-the-counter pain relievers and ice packs can help manage this.
• Activity Restrictions: Patients are usually advised to rest the affected joint and avoid strenuous activities or direct pressure on the bursa for a few days to allow it to heal and prevent re-accumulation of fluid.
• Fluid Analysis: If infection is suspected, the aspirated fluid will be sent to a laboratory for analysis (e.g., cell count, Gram stain, culture and sensitivity). Results typically take a few days, and treatment plans may be adjusted based on these findings.
• Follow-Up: A follow-up appointment may be scheduled to assess progress and discuss further treatment options, such as physical therapy or additional injections if necessary.

Potential Risks and Complications

While generally safe, bursa aspiration carries some potential risks, though rare:

• Infection: The most serious complication, occurring if bacteria are introduced during the procedure. Signs include increasing pain, redness, swelling, warmth, and fever.
• Bleeding/Hematoma: Bruising or a collection of blood under the skin.
• Pain: Discomfort during or after the procedure.
• Re-accumulation of Fluid: The bursa may refill with fluid, requiring repeat aspiration or other treatments.
• Damage to Surrounding Structures: Very rare, but possible if the needle deviates from the bursa.

Alternatives and Adjunctive Treatments

Bursa aspiration is often part of a broader treatment plan for bursitis. Other strategies include:

• Rest and Activity Modification: Avoiding activities that aggravate the bursa.
• Ice Application: To reduce inflammation and pain.
• NSAIDs: Over-the-counter or prescription anti-inflammatory medications.
• Physical Therapy: To improve joint mechanics, strengthen surrounding muscles, and increase flexibility, preventing recurrence.
• Corticosteroid Injections: Often administered after aspiration to reduce inflammation directly within the bursa.
• Antibiotics: Crucial for treating septic bursitis.
• Surgery (Bursectomy): In rare, chronic, or recurrent cases that do not respond to conservative management, the inflamed bursa may be surgically removed.

Prevention of Recurrent Bursitis

Preventing bursitis largely involves addressing the underlying causes:

• Proper Biomechanics: Ensure correct form during exercise and daily activities to minimize stress on joints and bursae.
• Gradual Progression: Avoid sudden increases in activity intensity or duration.
• Adequate Warm-up and Cool-down: Prepare muscles and joints for activity and aid recovery.
• Protective Gear: Use padding or cushions to protect areas prone to pressure (e.g., knee pads for prolonged kneeling).
• Ergonomics: Adjust workspaces or tools to reduce repetitive strain.
• Strength and Flexibility: Maintain balanced strength and flexibility around joints to support proper movement patterns.

When to Seek Medical Attention

If you suspect you have bursitis, especially if accompanied by severe pain, significant swelling, redness, warmth, or fever, it is crucial to consult a healthcare professional. These symptoms could indicate an infection, which requires prompt medical intervention.