Bursitis

  • What Is Bursitis?

    Bursitis is inflammation of a bursa—one of the small, fluid-filled sacs located near joints and bony prominences throughout the body. The bursae (plural form) act as cushions between muscles and tendons and between muscles and bones. They produce a lubricating fluid to minimize friction at these sites, thus facilitating joint movement. Irritation, overuse, infection, or injury can inflame a bursa, resulting in painful bursitis.

    Shoulders, elbows, hips, knees, heels, and the base of the big toe are among the sites most often affected. Bursitis is so common that it has acquired a number of familiar names, including “student’s elbow” and “housemaid’s knee.”

    Bursitis can come on suddenly and resolve quickly, or it can become chronic and increasingly debilitating. The condition can be classified according to the part of the body affected, or according to the cause, such as septic bursitis, which is caused by bacterial infection.

     

    Who Gets Bursitis?

    Anyone can develop bursitis, including athletes and the elderly. The condition affects men and women equally.

     

    Symptoms

    • Pain and swelling around a joint.
    • Restricted and painful movement of the affected joint.
    • Pain spreading into the neck or arms due to bursitis in the shoulder.
    • Fever, which could indicate infection.

     

    Causes/Risk Factors

     

    • Physical activities that put constant pressure on a bursa, such as resting the elbow on a desk or kneeling, as well as repetitive and vigorous joint movement, can cause bursitis.
    • A blow or other injury to a bursa.
    • Medical conditions, including gout, rheumatoid arthritis, osteoarthritis, diabetes, and thyroid disease.
    • Calcium deposits in, or degeneration of, a nearby tendon is sometimes associated with bursitis.
    • Inadequate ergonomics, such as sitting at a computer for extended periods of time.
    • Sleeping in one position for too long.
    • Improper body mechanics in lifting or reaching.

     

    What If You Do Nothing?

    Although painful, bursitis usually is not serious and subsides on its own within one or two weeks if the aggravating activity is altered or stopped. However, the condition has a tendency to recur.

    Acute, mild cases of bursitis may clear up on their own with rest and self-care remedies. Chronic or more severe cases require medical attention.

     

    Diagnosis

    • A health care professional will take a full medical history and conduct a physical examination.
    • X-rays, magnetic resonance imaging and ultrasound, as well blood tests may be needed to rule out other conditions, such as diabetes and rheumatoid arthritis.
    • In some cases, fluid may be withdrawn (aspirated) from the bursa and examined in a laboratory for signs of infection.

     

    Treatment

    • Apply ice packs for the first 48 hours to relieve pain and swelling. Then, if desired, switch to heat packs, which stimulate blood flow and ease pain.
    • Rest the affected joint and avoid putting pressure on the area. Your doctor may recommend a sling, a cane, or an over-the-counter or custom-made orthotic, splint, or brace to keep the joint still. An ACE bandage or other compression bandage may be helpful. Wear knee or elbow pads for protection.
    • Take over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen to relieve pain and swelling, or acetaminophen (e.g., Tylenol) to relieve pain. Acetaminophen won’t reduce inflammation.
    • Your doctor may administer injections of corticosteroids and a local anesthetic to reduce swelling and ease pain. To reduce swelling, he/she may draw excess fluid from the bursa with a syringe and then tightly bandage the joint.
    • Temporarily avoid any activities that aggravate the condition, but gradually resume moving the affected joint to prevent stiffening and muscle atrophy.
    • In some cases, professional physical therapy is needed. Physical therapy may include manual therapy, stretching to strengthen muscles, and instruction about proper body mechanics to reduce the risk of further injury or inflammation.
    • For more severe, persistent bursitis cases, surgical removal of the bursa may be recommended.
    • Septic bursitis caused by a bacterial infection requires antibiotics. If oral antibiotics are not effective, antibiotics may be administered intravenously.

     

    Bursitis Prevention

    • Wear protective gear when playing sports. Check with a coach, trainer, or professional to be sure that you are using proper techniques.
    • Pace yourself with regard to strenuous or repetitive physical activities, if possible. Take frequent breaks—and anytime you’re in pain, stop.
    • If you work in a kneeling position, use kneepads or cushions, change positions often, and take frequent breaks to stretch.
    • To prevent bursitis in the feet, wear properly fitting shoes with a comfortable, supportive heel. Women should wear high heels only when necessary. Buy new running or exercise shoes when old ones wear out.

     

    When to Call Your Doctor

    • Make an appointment with a doctor if joint pain or swelling persists despite treatment, if pain becomes disabling, or if the affected joint becomes red and swollen with decreased range of motion.
    • Call your doctor right away if fever develops with bursitis symptoms. Fever may indicate infectious bursitis—a condition that requires immediate medical attention. Infectious bursitis often affects the elbow.

     

    Reviewed by Michael S. Soliman, M.D., family medicine physician in private practice and hospitalist at Mount Holyoke Medical Center, Mount Holyoke, MA.