Monday, December 22, 2014

Definition

Bursitis is the painful inflammation or irritation of the bursa. The bursa is a soft, fluid-filled sac that covers and cushions the movement between the bones, tendons and muscles near the joints.

Bursitis usually occurs under the shoulder muscles, at the elbows (called epitrochlear bursitis or "tennis elbow"), the hip sockets (called trochanteric bursitis), heel bones (called retrocalcaneal bursitis) or the kneecaps (called infrapatellar bursitis or "housemaid's knee"). It can also occur in the buttocks (called ischiogluteal bursitis) or the thigh (called trochanteric bursitis).

Description

Bursitis can be acute (a sudden, sharp pain following an injury) or chronic (a recurrent inflammation in the same area).

When a joint is overused or when it stays under pressure or tension for extended periods of time, a nearby bursa can become inflamed. The bursa fills with excess fluid, causing pressure on the surrounding tissue and resulting in bursitis.

Causes

Most commonly, bursitis is caused by trauma, infection, and crystal deposits. Some specific factors include:

  • Overuse or injury to the joint areas from playing or working
  • Incorrect posture at work or rest, or poor conditioning before exercise or playing sports
  • An abnormal or poorly positioned joint or bone (such as leg length differences or arthritis in a particular joint) that stresses soft tissue structures.
  • Sometimes in association with other diseases or conditions, such as rheumatoid arthritis, gout, tuberculosis or psoriatic arthritis
  • Staphylococcal or other (bacterial) infection

Symptoms

Symptoms of bursitis may include:

  • Pain that increases with movement of joint
  • Tenderness of joint
  • Limited movement in the affected areas
  • Swelling and redness in affected areas

Diagnosis

The diagnosis of bursitis includes a medical history and physical examination. Sometimes x-rays and blood tests are needed.

Medical history will include questions about a person's recent or ongoing activity regimen and/or joint injuries. A physical examination will include the palpation (lightly pressing) of the affected area. Localized pain, inflammation and a history of unusual strain or injury two or three days before the pain begins usually indicates bursitis. X-rays are taken to exclude bony abnormalities, arthritis or calcium deposits (a sign of calcific bursitis). Blood tests may be ordered to confirm underlying conditions, such as rheumatoid arthritis or gout.

Treatment

Treatment for bursitis includes applying the R.I.C.E therapy, protecting the area, and anti-inflammatory drugs.

The R.I.C.E. therapy includes:

  • Resting the affected joint by immobilizing it with a sling, splint or cast,
  • Ice the affected joint to reduce swelling, and
  • Compression and Elevation of the affected joint.

It can help to protect bursae close to the skin, such as the ankles and knees, with padding. Additionally, deep-heat therapy (diathermy) can also relieve the discomfort and inflammation of bursitis.

Anti-inflammatory medications, such as aspirin or over-the-counter nonsteroidal drugs (NSAIDs), such as ibuprofen, naproxen, or indomethacin can often be helpful. If the cause of the bursitis is bacterial, antibiotics will be administered.

If the inflammation does not respond to the R.I.C.E. therapy and medications, surgical drainage (aspiration) of fluid from the bursa and the injection of corticosteroids into the bursa is an alternative treatment. Surgical removal of the bursa is a possibility for chronic bursitis.

With adherence to treatment, bursitis usually subside in seven to 14 days. See your doctor if it does not subside, or if there are other signs of infection such as fever or warmth and redness and severe tenderness around the joint.

Questions

Will x-rays or any other tests need to be done in order to diagnose the condition or severity?

Will you be prescribing any medication to help the condition or to help relieve the pain?

What are the side effects?

Will this lead to any permanent disabling movement?

How long of a rest period is required?

How long will it take for the bursitis to heal?

How much movement of the affected joint can be done?

Prevention

People can protect themselves from bursitis by following these tips:

  • Avoid overuse of joints in sports or heavy labor.
  • Do appropriate warm-up and cool-down exercises.
  • Strengthen the muscles.
  • Keep in good shape.
  • Take breaks when doing physical labor or exercise.
  • Cushion the joints. Don't lean on elbows, kneel or sit on hard surfaces for long periods of time. Use cushioned chairs or protective gear whenever possible.
  • After an episode of bursitis, try to identify and change or remove whatever caused it (different shoes, etc.)