An Overview of Bursitis

Causes, Symptoms, Diagnosis, and Treatment

shoulder pain
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Bursitis is a condition in which slippery cushions within a joint space, called bursa, become inflamed. (In medical terminology, the suffix "-itis" refers to inflammation.)

All told, there are over 150 bursae situated throughout the body. The function of a bursa is to decrease friction between two surfaces as they move in different directions. The bursa itself is comprised of a thin sac filled with a tiny amount of synovial fluid which has the consistency of egg white.

Healthy bursae create an almost frictionless movement between bones, muscles, and tendons as they move either in coordination or opposition. If bursitis develops, the inflamed sac can impair movement and cause localized pain and swelling.

Bursitis is typically associated with repetitive joint stress. According to a 2012 study in Occupational Medicine, people who work in construction or other types of manual labor are eight times more likely to have bursitis than office workers.

Symptoms

Bursitis commonly affects the superficial bursa of the shoulders, knees, elbow, or hips. Symptoms can vary in their severity but typically include pain, swelling, stiffness, and warmth. The pain is usually worse during and after activity. Stiffness is greatest in the morning.

If the bursitis is caused by an infection, high fever (over 100.4 F), chills, and generalized joint and muscle aches may develop. Complications of septic bursitis include osteomyelitis (bone infection), septicemia (blood poisoning), and shock.

Causes

Bursitis is most often caused by a repetitive overuse injury or prolonged pressure applied directly to the bursa itself. Other causes include an acute injury, such as a contusion, or systemic inflammatory conditions, such as rheumatoid arthritis or gout.

Septic bursitis, a form of bursitis caused by infection, can develop if bacteria enters a puncture wound or spreads from nearby soft tissues. Cellulitis is a common cause of septic bursitis.

Cellulitis is a potentially life-threatening condition. Seek immediate care if you develop a red, swollen skin that feels hot and tender to the touch. Red streaks emanating from the site of the infection is a sign of a medical emergency.

Diagnosis

Bursitis can often be diagnosed with a physical examination and a review of your medical history. The findings consistent with bursitis include:

  • Tenderness over the bursa: An inflamed bursa will usually be tender to the touch. Even ones situated deep within a joint can cause pain when pressure is applied.
  • Pain with movement: When a bursa is inflamed, any movement of the surrounding tissue can cause a shooting or stinging pain. Occasionally, a grinding sensation, called crepitus, can be felt when normally smooth surfaces become rough or uneven.
  • Swelling of the bursa: If the inflammation occurs in a superficial bursa (such as above the kneecap or behind the elbow), the redness and swelling will often be visible.

If there is any suspicion of infection, your doctor may want to obtain a sample of synovial fluid from the affected bursa. The fluid can usually be extracted with a needle and syringe in a procedure known as arthrocentesis.

Imaging tests such as X-rays and magnetic resonance imaging (MRI) are usually not needed unless there is some sort of accident or injury.

Treatment

The treatment of bursitis depends largely on the type of bursitis you have. The primary aims are to alleviate physical strain on the bursa, to decrease inflammation, and to allow ample recovery time.

Most cases will resolve with conservative treatment. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) such as Advil (ibuprofen) or Aleve (naproxen) can often provide ample pain relief. In addition to rest, ice application can help reduce swelling, while short-term immobilization may be recommended if there is any evidence of connective tissue damage.

Long-term immobilization is avoided as it may cause a joint to freeze. Immobilization should last for more than a few days and should be accompanied by gentle rotational exercises performed once or twice daily.

While most cases tend to improve within days or weeks, there are some that can take months. Chronic bursitis is sometimes treated with an intrabursal corticosteroid injection to quickly alleviate inflammation.

If bursitis persists despite appropriate treatment, surgical excision may be required. The procedure, known as bursectomy, can be performed as an open surgery (with a scalpel) or arthroscopically (with a scope and keyhole incisions). Once a bursa is removed, a new one can form in its place.

Septic bursitis may be treated with oral or intravenous antibiotics depending on the severity of the infection. Surgical drainage may also be used if pus develops in and around the bursa.

Coping

Bursitis can recur in some people, particularly if it was caused by repetitive motion or a long-term sports injury. In cases like these, bursitis can flare up after activity or for no reason at all.

There are several things you can do to reduce the risk of recurrence or the severity of a flare-up:

  • Wear appropriate shoes. Bursitis of the knee or hip is often exacerbated if your foot arches are flat or the pronation (alignment) of your foot is abnormal. Getting the right pair of shoes properly fitted can significantly reduce stress on the lower extremity joints.
  • Support the affected joint. If you enjoy walking or playing tennis but are prone to bursitis in the knee or elbow, buy a neoprene orthopedic brace at your local drugstore and wear it whenever you engage in the activity.
  • Change your bad habits. If your bursitis is inflamed by the way you sit or by specific movements, take whatever steps you need to "unlearn" those habits. This may include finding alternative exercises at the gym (such as using a Smith machine instead of free weights) or switching to a chair that encourages better posture.
  • Warm up before activity. Never launch into sports or any physical activity without first stretching and warming up the affected joints.
  • See a physical therapist. Little adjustments can sometimes correct long-standing problems with movement or posture. A physical therapist is trained to spot these issues, while an occupational therapist can provide you with the tools to help overcome them.

    A Word From Verywell

    While bursitis can often be treated with rest and painkillers, don't shrug off the problem if it recurs or restricts your movement. Bursitis is often progressive and can worsen over time if left untreated. The same applies if the condition is triggered by gout or rheumatoid arthritis.

    Early diagnosis and treatment can often reduce the frequency or severity of a bursitis flare. If there are any signs of infection, call your doctor immediately, especially if there is a high fever, an open wound, increasing redness or warmth, or a discharge of any sort.

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