Bursitis

A bursa is a small, fluid-filled sac that acts as a cushion between a bone and other moving parts, such as muscles, tendons, or skin. Bursitis occurs when a bursa becomes inflamed.

People get bursitis by overusing a joint. It can also be caused by an injury. It usually occurs at the knee or elbow. Kneeling or leaning your elbows on a hard surface for a long time can make bursitis start. Doing the same kinds of movements every day or putting stress on joints increases your risk.

Symptoms of bursitis include pain and swelling. Your doctor will diagnose bursitis with a physical exam and tests such as x-rays and MRIs. He or she may also take fluid from the swollen area to be sure the problem isn't an infection.

Treatment of bursitis includes rest, pain medicines, or ice. If there is no improvement, your doctor may inject a drug into the area around the swollen bursa. If the joint still does not improve after 6 to 12 months, you may need surgery to repair damage and relieve pressure on the bursa.

 

When possible, avoid activities that include repetitive movements of any body parts.

Bursitis is often a result of overuse. It can be caused by a change in activity level, such as training for a marathon or by being overweight.

Bursitis can also be caused by trauma, rheumatoid arthritis, gout, or infection. Sometimes the cause cannot be found.

Bursitis commonly occurs in the shoulder, knee, elbow, and hip. Other areas that may be affected include the Achilles tendon and the foot.

 

Symptoms of bursitis may include any of the following:
  • Joint pain and tenderness when you press around the joint
  • Stiffness and aching when you move the affected joint
  • Swelling, warmth or redness over the joint

 

Diagnosis of tendinitis and bursitis begins with a medical history and physical examination. The patient will describe the pain and circumstances in which pain occurs. The location and onset of pain, whether it varies in severity throughout the day, and the factors that relieve or aggravate the pain are all important diagnostic clues.

Therapists and physicians will use manual tests called selective tissue tension tests to determine which tendon is involved, and then will palpate (a form of touching the tendon) specific areas of the tendon to pinpoint the area of inflammation.

X rays do not show tendons or bursae, but may be helpful in ruling out bone problems or arthritis. In the case of a torn tendon, x rays may help show which tendon is affected. In a knee injury, for example, an x ray will show that the patella is lower than normal in a quadriceps tendon tear and higher than normal in a patellar tendon tear.

The doctor may also use magnetic resonance imaging (MRI) to confirm a partial or total tear. MRIs detect both bone and soft tissues like muscles, tendons and their coverings (sheaths), and bursae.

To rule out infection, the doctor may remove and test fluid from the inflamed area.

 

Your doctor will talk to you about a treatment plan to help you resume your normal activity.

Tips to relieve bursitis pain:
  • Use ice 3 to 4 times a day for the first 2 or 3 days. 
  • Cover the painful area with a towel, and place the ice on it for 15 minutes.
  • When sleeping, do not lie on the side that has bursitis.
For bursitis around the hips, knees, or ankle:
  • Try not to stand for long periods.
  • Stand on a soft, cushioned surface, with equal weight on each leg.
  • Placing a pillow between your knees when lying on your side can help decrease pain.
  • Flat shoes that are cushioned and comfortable often help.
  • If you are overweight, losing weight may also be helpful.

You should avoid activities that involve repetitive movements of any body part when possible.

Other treatments include:
  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen
  • Physical therapy
  • Exercises you do at home to build strength and keep the joint mobile as pain goes away
  • Removing fluid from the bursa and getting a shot of corticosteroid

As the pain goes away, your doctor or nurse may suggest exercises to build strength and keep movement in the painful area.

Surgery is rarely needed.

 

Some people do well with treatment. When the cause cannot be corrected, you may have long-term pain.