Abstract
A bursa is an extra-articular sac that may communicate with a joint and functions to decrease friction between tendons and either bone or skin. Bursae can be classified as native and non-native (adventitious) bursae. The native bursae are lined with a synovial membrane and occur at predictable anatomical sites; knowledge of these normal structures can help distinguish them from other pathological entities. An adventitious bursa can form at sites of friction rather than at predictable anatomical sites, but otherwise have imaging features similar to native bursae. Bursal distention can occur from many pathological processes, most commonly resulting from chronic overuse injury. When imaging bursal pathological conditions, there is often an overlap of imaging findings, regardless of the cause. In general, ultrasound of a distended bursa reveals a fluid collection with either simple anechoic or more complex hypoechoic fluid. Bursal distention is characteristically unilocular and compressible, unlike other structures such as ganglion cysts, which are usually multilocular and non-compressible. This article reviews the anatomical locations of common bursae and shows pathological examples using ultrasound. Knowledge of typical locations and imaging appearances of bursae can aid in narrowing the differential diagnosis and guiding further management and treatment decisions.
Similar content being viewed by others
References
Resnick D, Kang HS, Pretterklieber ML (eds). Internal derangements of joints. 2nd ed. Philadelphia: Saunders; 2007. p. 82–5.
Rubin DA. Magnetic resonance imaging: practical considerations. In: Resnick D, Kang HS, Pretterklieber ML, editors. Internal derangements of joints. 2nd ed. Philadelphia: Saunders; 2007. p. 22–3.
Van Mieghem IM, Boets A, Sciot R, Van Breuseghem I. Ischiogluteal bursitis: an uncommon type of bursitis. Skeletal Radiol. 2004;33(7):413–6.
Bird PA, Oakley SP, Shnier R, Kirkham BW. Prospective evaluation of magnetic resonance imaging and physical examination findings in patients with greater trochanteric pain syndrome. Arthritis Rheum. 2001;44(9):2138–45.
Chau CL, Griffith JF. Musculoskeletal infections: ultrasound appearances. Clin Radiol. 2005;60(2):149–59.
Jacobson JA, Khoury V, Brandon CJ. Ultrasound of the groin: techniques, pathology, and pitfalls. AJR Am J Roentgenol. 2015;205(3):513–23.
Beaman FD, Peterson JJ. MR imaging of cysts, ganglia, and bursae about the knee. Radiol Clin N Am. 2007;45(6):969–82. vi.
Janzen DL, Peterfy CG, Forbes JR, Tirman PF, Genant HK. Cystic lesions around the knee joint: MR imaging findings. AJR Am J Roentgenol. 1994;163(1):155–61.
Fang CS, McCarthy CL, McNally EG. Intramuscular dissection of Baker’s cysts: report on three cases. Skeletal Radiol. 2004;33(6):367–71.
Steinbach LS, Stevens KJ. Imaging of cysts and bursae about the knee. Radiol Clin N Am. 2013;51(3):433–54.
Friedman L, Finlay K, Jurriaans E. Ultrasound of the knee. Skeletal Radiol. 2001;30(7):361–77.
Van Holsbeeck M, Strouse PJ. Sonography of the shoulder: evaluation of the subacromial-subdeltoid bursa. AJR Am J Roentgenol. 1993;160(3):561–4.
Meraj S, Bencardino JT, Steinbach L. Imaging of cysts and bursae about the shoulder. Semin Musculoskelet Radiol. 2014;18(4):436–47.
Bureau NJ, Dussault RG, Keats TE. Imaging of bursae around the shoulder joint. Skeletal Radiol. 1996;25(6):513–7.
Jacobson JA. Fundamentals of musculoskeletal ultrasound. 2nd ed. Philadelphia: Saunders; 2013.
Fam AG, Rubenstein J. Hydroxyapatite pseudopodagra. A syndrome of young women. Arthritis Rheum. 1989;32(6):741–7.
Daghir AA, Sookur PA, Shah S, Watson M. Dynamic ultrasound of the subacromial-subdeltoid bursa in patients with shoulder impingement: a comparison with normal volunteers. Skeletal Radiol. 2012;41(9):1047–53.
Kiss E, Keusch G, Zanetti M, Jung T, Schwarz A, Schocke M, et al. Dialysis-related amyloidosis revisited. AJR Am J Roentgenol. 2005;185(6):1460–7.
Sommer R, Valen GJ, Ori Y, Weinstein T, Katz M, Hendel D, et al. Sonographic features of dialysis-related amyloidosis of the shoulder. J Ultrasound Med. 2000;19(11):765–70.
Schraner AB, Major NM. MR imaging of the subcoracoid bursa. AJR Am J Roentgenol. 1999;172(6):1567–71.
Grainger AJ, Tirman PF, Elliott JM, Kingzett-Taylor A, Steinbach LS, Genant HK. MR anatomy of the subcoracoid bursa and the association of subcoracoid effusion with tears of the anterior rotator cuff and the rotator interval. AJR Am J Roentgenol. 2000;174(5):1377–80.
Tracy MR, Trella TA, Nazarian LN, Tuohy CJ, Williams GR. Sonography of the coracohumeral interval: a potential technique for diagnosing coracoid impingement. J Ultrasound Med. 2010;29(3):337–41.
Sofka CM, Adler RS. Sonography of cubital bursitis. AJR Am J Roentgenol. 2004;183(1):51–3.
Draghi F, Gregoli B, Sileo C. Sonography of the bicipitoradial bursa: a short pictorial essay. J Ultrasound Med. 2012;15(1):39–41.
Skaf AY, Boutin RD, Dantas RW, Hooper AW, Muhle C, Chou DS, et al. Bicipitoradial bursitis: MR imaging findings in eight patients and anatomic data from contrast material opacification of bursae followed by routine radiography and MR imaging in cadavers. Radiology. 1999;212(1):111–6.
Martinoli C, Bianchi S, Zamorani MP, Zunzunegui JL, Derchi LE. Ultrasound of the elbow. Eur J Ultrasound. 2001;14(1):21–7.
Stevens KJ. Magnetic resonance imaging of the elbow. J Magn Reson Imaging. 2010;31(5):1036–53.
Fowler KA, Chung CB. Normal MR imaging anatomy of the elbow. Radiol Clin N Am. 2006;44(4):553–67. viii.
Blankstein A, Ganel A, Givon U, Mirovski Y, Chechick A. Ultrasonographic findings in patients with olecranon bursitis. Ultraschall Med. 2006;27(6):568–71.
Floemer F, Morrison WB, Bongartz G, Ledermann HP. MRI characteristics of olecranon bursitis. AJR Am J Roentgenol. 2004;183(1):29–34.
Sampaio ML, Schweitzer ME. Elbow magnetic resonance imaging variants and pitfalls. Magn Reson Imaging Clin N Am. 2010;18(4):633–42.
Finlay K, Ferri M, Friedman L. Ultrasound of the elbow. Skeletal Radiol. 2004;33(2):63–79.
Donahue F, Turkel D, Mnaymneh W, Ghandur-Mnaymneh L. Hemorrhagic prepatellar bursitis. Skeletal Radiol. 1996;25(3):298–301.
Turecki MB, Taljanovic MS, Stubbs AY, Graham AR, Holden DA, Hunter TB, et al. Imaging of musculoskeletal soft tissue infections. Skeletal Radiol. 2010;39(10):957–71.
Jaovisidha S, Chen C, Ryu KN, Siriwongpairat P, Pekanan P, Sartoris DJ, et al. Tuberculous tenosynovitis and bursitis: imaging findings in 21 cases. Radiology. 1996;201(2):507–13.
Thiele RG, Schlesinger N. Diagnosis of gout by ultrasound. Rheumatology (Oxford). 2007;46(7):1116–21.
Nestorova R, Vlad V, Petranova T, Porta F, Radunovic G, Micu MC, et al. Ultrasonography of the hip. Med Ultrason. 2012;14(3):217–24.
Blankenbaker DG, Tuite MJ. Iliopsoas musculotendinous unit. Semin Musculoskelet Radiol. 2008;12(1):13–27.
Lin Y, Wang T. Ultrasonographic examination of the adult Hip. J Med Ultrasound. 2012;20(4):201–9.
Woodley SJ, Mercer SR, Nicholson HD. Morphology of the bursae associated with the greater trochanter of the femur. J Bone Joint Surg Am. 2008;90(2):284–94.
Long SS, Surrey DE, Nazarian LN. Sonography of greater trochanteric pain syndrome and the rarity of primary bursitis. AJR Am J Roentgenol. 2013;201(5):1083–6.
Silva F, Adams T, Feinstein J, Arroyo RA. Trochanteric bursitis: refuting the myth of inflammation. J Clin Rheumatol. 2008;14(2):82–6.
Blankenbaker DG, Ullrick SR, Davis KW, De Smet AA, Haaland B, Fine JP. Correlation of MRI findings with clinical findings of trochanteric pain syndrome. Skeletal Radiol. 2008;37(10):903–9.
Kong A, Van der Vliet A, Zadow S. MRI and US of gluteal tendinopathy in greater trochanteric pain syndrome. Eur Radiol. 2007;17(7):1772–83.
Dunn T, Heller CA, McCarthy SW, Dos Remedios C. Anatomical study of the “trochanteric bursa”. Clin Anat. 2003;16(3):233–40.
Murphey MD, Rhee JH, Lewis RB, Fanburg-Smith JC, Flemming DJ, Walker EA. Pigmented villonodular synovitis: radiologic-pathologic correlation. Radiographics. 2008;28(5):1493–518.
Cho KH, Lee SM, Lee YH, Suh KJ, Kim SM, Shin MJ, et al. Non-infectious ischiogluteal bursitis: MRI findings. Korean J Radiol. 2004;5(4):280–6.
Davis RI, Hamilton A, Biggart JD. Primary synovial chondromatosis: a clinicopathologic review and assessment of malignant potential. Hum Pathol. 1998;29(7):683–8.
Walker EA, Murphey MD, Fetsch JF. Imaging characteristics of tenosynovial and bursal chondromatosis. Skeletal Radiol. 2011;40(3):317–25.
Nisolle JF, Blouard E, Baudrez V, Boutsen Y, De Cloedt P, Esselinckx W. Subacromial-subdeltoid lipoma arborescens associated with a rotator cuff tear. Skeletal Radiol. 1999;28(5):283–5.
Mandl P, Brossard M, Aegerter P, Backhaus M, Bruyn GA, Chary-Valckenaere I, et al. Ultrasound evaluation of fluid in knee recesses at varying degrees of flexion. Arthritis Care Res. 2012;64(5):773–9.
Murphey MD, Vidal JA, Fanburg-Smith JC, Gajewski DA. Imaging of synovial chondromatosis with radiologic-pathologic correlation. Radiographics. 2007;27(5):1465–88.
Dye SF, Campagna-Pinto D, Dye CC, Shifflett S, Eiman T. Soft-tissue anatomy anterior to the human patella. J Bone Joint Surg Am. 2003;85-A(6):1012–7.
Aguiar RO, Viegas FC, Fernandez RY, Trudell D, Haghighi P, Resnick D. The prepatellar bursa: cadaveric investigation of regional anatomy with MRI after sonographically guided bursography. AJR Am J Roentgenol. 2007;188(4):W355–8.
Draghi F, Corti R, Urciuoli L, Alessandrino F, Rotondo A. Knee bursitis: a sonographic evaluation. J Ultrasound. 2015;18(3):251–7.
Naranje S, Mittal R, Kumar A, Nataraj AR. Hemorrhagic prepatellar bursitis: a rare case report and review of the literature. Eur J Orthop Surg Traumatol. 2009;19(4):281–4.
Tejwani SG, Cohen SB, Bradley JP. Management of Morel-Lavallee lesion of the knee: twenty-seven cases in the national football league. Am J Sports Med. 2007;35(7):1162–7.
Viegas FC, Aguiar RO, Gasparetto E, Marchiori E, Trudell DJ, Haghighi P, et al. Deep and superficial infrapatellar bursae: cadaveric investigation of regional anatomy using magnetic resonance after ultrasound-guided bursography. Skeletal Radiol. 2007;36(1):41–6.
LaPrade RF. The anatomy of the deep infrapatellar bursa of the knee. Am J Sports Med. 1998;26(1):129–32.
Ward EE, Jacobson JA, Fessell DP, Hayes CW, van Holsbeeck M. Sonographic detection of Baker’s cysts: comparison with MR imaging. AJR Am J Roentgenol. 2001;176(2):373–80.
Lindgren PG, Willen R. Gastrocnemio-semimembranosus bursa and its relation to the knee joint. I. Anatomy and histology. Acta Radiol Diagn (Stockh). 1977;18(5):497–512.
Tschirch FT, Schmid MR, Pfirrmann CW, Romero J, Hodler J, Zanetti M. Prevalence and size of meniscal cysts, ganglionic cysts, synovial cysts of the popliteal space, fluid-filled bursae, and other fluid collections in asymptomatic knees on MR imaging. AJR Am J Roentgenol. 2003;180(5):1431–6.
Uson J, Aguado P, Bernad M, Mayordomo L, Naredo E, Balsa A, et al. Pes anserinus tendino-bursitis: what are we talking about? Scand J Rheumatol. 2000;29(3):184–6.
Rothstein CP, Laorr A, Helms CA, Tirman PF. Semimembranosus-tibial collateral ligament bursitis: MR imaging findings. AJR Am J Roentgenol. 1996;166(4):875–7.
Ahmed A, Bayol MG, Ha SB. Adventitious bursae in below knee amputees. Case reports and a review of the literature. Am J Phys Med Rehabil. 1994;73(2):124–9.
Mencia M. Limbo-dancer’s bursa of the knee. Int J Orthop Surg. 2008;12(1):1–3.
Stimson H. Bursitis. Am J Surg. 1940;50(3):527–33.
De Maeseneer M, Shahabpour M, Van Roy F, Goossens A, De Ridder F, Clarijs J, et al. MR imaging of the medial collateral ligament bursa: findings in patients and anatomic data derived from cadavers. AJR Am J Roentgenol. 2001;177(4):911–7.
Smith G. Limbo-dancer’s bursa. Lancet. 1979;2(8140):475–6.
Muhle C, Ahn JM, Yeh L, Bergman GA, Boutin RD, Schweitzer M, et al. Iliotibial band friction syndrome: MR imaging findings in 16 patients and MR arthrographic study of six cadaveric knees. Radiology. 1999;212(1):103–10.
Boutin RD, Pathria MN, Resnick D. Disorders in the stumps of amputee patients: MR imaging. AJR Am J Roentgenol. 1998;171(2):497–501.
Precerutti M, Bonardi M, Ferrozzi G, Draghi F. Sonographic anatomy of the ankle. J Ultrasound. 2014;17(2):79–87.
Mathieson JR, Connell DG, Cooperberg PL, Lloyd-Smith DR. Sonography of the Achilles tendon and adjacent bursae. AJR Am J Roentgenol. 1988;151(1):127–31.
Kachlik D, Baca V, Cepelik M, Hajek P, Mandys V, Musil V, et al. Clinical anatomy of the retrocalcaneal bursa. Surg Radiol Anat. 2008;30(4):347–53.
Bottger BA, Schweitzer ME, El-Noueam KI, Desai M. MR imaging of the normal and abnormal retrocalcaneal bursae. AJR Am J Roentgenol. 1998;170(5):1239–41.
Narvaez JA, Narvaez J, Ortega R, Aguilera C, Sanchez A, Andia E. Painful heel: MR imaging findings. Radiographics. 2000;20(2):333–52.
Fessell DP, Vanderschueren GM, Jacobson JA, Ceulemans RY, Prasad A, Craig JG, et al. US of the ankle: technique, anatomy, and diagnosis of pathologic conditions. Radiographics. 1998;18(2):325–40.
Zanetti M, Strehle JK, Zollinger H, Hodler J. Morton neuroma and fluid in the intermetatarsal bursae on MR images of 70 asymptomatic volunteers. Radiology. 1997;203(2):516–20.
Theumann NH, Pfirrmann CW, Chung CB, Mohana-Borges AV, Haghighi P, Trudell DJ, et al. Intermetatarsal spaces: analysis with MR bursography, anatomic correlation, and histopathology in cadavers. Radiology. 2001;221(2):478–84.
Studler U, Mengiardi B, Bode B, Schottle PB, Pfirrmann CW, Hodler J, et al. Fibrosis and adventitious bursae in plantar fat pad of forefoot: MR imaging findings in asymptomatic volunteers and MR imaging-histologic comparison. Radiology. 2008;246(3):863–70.
Acknowledgements
Illustrations courtesy of Danielle Dobbs, Ann Arbor, Michigan
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
Conflicts of interest/disclosures
The authors state that they have no conflicts of interest.
Rights and permissions
About this article
Cite this article
Ruangchaijatuporn, T., Gaetke-Udager, K., Jacobson, J.A. et al. Ultrasound evaluation of bursae: anatomy and pathological appearances. Skeletal Radiol 46, 445–462 (2017). https://doi.org/10.1007/s00256-017-2577-x
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00256-017-2577-x