Bursitis

Overview

Bursitis is the inflammation of one or more bursae - small, fluid-filled sacs that act as cushions between bones and the soft tissues that cover them. These sacs reduce friction and allow smooth movement between bones, tendons, and muscles around joints. When a bursa becomes inflamed, it fills with extra fluid and becomes painful, limiting joint movement and causing discomfort.

There are more than 150 bursae in the human body, located near large joints like the shoulders, elbows, hips, and knees. Bursitis most commonly affects the shoulder (subacromial bursitis), elbow (olecranon bursitis), hip (trochanteric bursitis), and knee (prepatellar bursitis). The condition can be acute, developing suddenly, or chronic, developing gradually over time.

While bursitis can be painful and temporarily disabling, it's generally not a serious condition and often improves with conservative treatment. However, if left untreated or if the underlying cause isn't addressed, bursitis can become a recurring problem that significantly impacts quality of life and mobility.

Symptoms

The symptoms of bursitis typically develop around the affected joint and can range from mild discomfort to severe pain that limits movement. The severity often depends on the cause and location of the inflammation.

Common Symptoms

Additional Symptoms by Location

• Joint Swelling: Visible swelling, especially in superficial bursae
• Joint Stiffness: Reduced range of motion in the affected joint
• Warmth and Redness: The area may feel warm and appear red
• Tenderness: Pain when pressure is applied to the area
• Sharp or Aching Pain: Pain that worsens with movement or pressure
• Night Pain: Discomfort that interferes with sleep, especially with hip bursitis

Causes

Bursitis occurs when bursae become inflamed due to various factors that irritate or damage these protective sacs:

Primary Causes

• Repetitive Motion: Repeated movements or positions that put pressure on bursae
• Direct Trauma: A blow or fall onto a joint
• Prolonged Pressure: Extended kneeling, leaning on elbows, or sitting on hard surfaces
• Overuse: Sudden increase in activity level or intensity
• Infection: Bacterial infection of the bursa (septic bursitis)

Contributing Factors

• Age-related Changes: Tendons become less flexible with age
• Rheumatoid Arthritis: Inflammatory condition affecting joints
• Gout: Crystal deposits can irritate bursae
• Diabetes: Increases risk of infection
• Poor Posture: Places abnormal stress on bursae
• Bone Spurs: Can irritate nearby bursae

Occupational and Activity-Related Causes

• Carpet laying or tile setting (knee bursitis)
• Painting or overhead work (shoulder bursitis)
• Computer work with poor ergonomics (elbow bursitis)
• Running on hard surfaces (hip bursitis)
• Gardening or plumbing work (various sites)

Risk Factors

Several factors can increase your likelihood of developing bursitis:

Diagnosis

Diagnosing bursitis typically begins with a thorough medical history and physical examination:

Clinical Evaluation

• Medical History: Questions about activities, occupation, and symptom onset
• Physical Examination: Checking for swelling, warmth, tenderness, and range of motion
• Palpation: Feeling the affected area for fluid accumulation
• Movement Tests: Assessing which movements cause pain

Diagnostic Tests

• X-rays: To rule out other conditions like arthritis or fractures
• Ultrasound: Can visualize fluid in the bursa and guide injections
• MRI: Provides detailed images of soft tissues
• Blood Tests: To check for infection or inflammatory conditions
• Bursa Fluid Analysis: If infection is suspected, fluid may be aspirated and tested

Differential Diagnosis

Other conditions that may mimic bursitis include:

• Tendinitis
• Arthritis
• Muscle strains
• Ligament injuries
• Nerve compression

Treatment Options

Treatment for bursitis focuses on reducing inflammation, relieving pain, and preventing recurrence:

Conservative Treatment (First Line)

• Rest: Avoid activities that worsen symptoms
• Ice: Apply for 15-20 minutes, 3-4 times daily for acute inflammation
• Compression: Elastic bandage to reduce swelling
• Elevation: Raise the affected limb when possible

Medications

• NSAIDs: Ibuprofen, naproxen for pain and inflammation
• Acetaminophen: For pain relief without anti-inflammatory effects
• Topical Anti-inflammatories: Creams or gels applied to the skin
• Antibiotics: If bacterial infection is present

Medical Interventions

• Corticosteroid Injections: Direct injection into the bursa for persistent inflammation
• Aspiration: Draining excess fluid from the bursa
• Physical Therapy: Exercises to strengthen muscles and improve flexibility
• Occupational Therapy: Modifying work activities and ergonomics

Advanced Treatments

• Platelet-Rich Plasma (PRP): Injection of concentrated platelets to promote healing
• Shock Wave Therapy: For chronic cases
• Surgery: Rarely needed; removal of the bursa in severe, recurring cases

Home Care and Lifestyle Modifications

• Use padding for pressure points (knee pads, elbow pads)
• Maintain proper posture and body mechanics
• Take frequent breaks during repetitive activities
• Gradually increase activity levels
• Maintain a healthy weight

Prevention

Many cases of bursitis can be prevented with proper precautions and lifestyle modifications:

• Use proper techniques when exercising or playing sports
• Warm up before physical activities and cool down afterward
• Take regular breaks during repetitive tasks
• Use cushioning or padding when kneeling or leaning on hard surfaces
• Maintain good posture at work and home
• Strengthen muscles around joints through regular exercise
• Maintain flexibility with stretching exercises
• Avoid sudden increases in activity intensity or duration
• Use proper ergonomic equipment at work
• Wear appropriate footwear with good support

When to See a Doctor

While mild bursitis often improves with home treatment, certain symptoms require medical attention:

Schedule an appointment if:

• Pain persists for more than 1-2 weeks despite home treatment
• Symptoms recur frequently
• Pain interferes with daily activities or sleep
• You have diabetes or a compromised immune system
• Swelling doesn't improve with rest and ice

Related Conditions

Frequently Asked Questions