Bursitis is a condition in which the slippery pads of the joint space, called a bursa, become inflamed. (In medical terminology, the suffix -it means inflammation .)
There are over 150 burs on the body in total, designed to reduce friction between two surfaces when moving in different directions. The bursa itself consists of a thin sac filled with a small amount of synovial fluid that has the consistency of an egg white.
Healthy bursae create movement between bones, muscles, and tendons with little or no friction as they move in coordination or opposition. If bursitis develops, the inflamed sac can impede movement and cause localized pain and swelling.
Bursitis is generally associated with repetitive stress on the joints. According to a 2012 study in Occupational Medicine, people who work in construction or other manual work are eight times more likely to have bursitis than office workers.
Bursitis usually affects the superficial bursa of the shoulders, knees, elbows, or thighs. Symptoms can vary in severity, but generally include pain, swelling, stiffness, and warmth . Pain is usually worse during and after physical activity.
If bursitis is caused by an infection, a high fever (over 100.4 F), chills, and general pain in the joints and muscles may develop. Complications of septic bursitis include osteomyelitis (bone infection), sepsis (blood poisoning), and shock.
Bursitis is most commonly caused by repetitive strain injuries or prolonged pressure applied directly to the bursa itself. Other causes include acute injuries like bruising or systemic inflammatory conditions like rheumatoid arthritis or gout .
Septic bursitis, a form of bursitis caused by infection, can develop if bacteria enter a puncture wound or spread from nearby soft tissues. Cellulite is a common cause of septic bursitis .
Cellulite is a life-threatening condition. Get immediate help if you develop red, swollen skin that becomes hot and tender to the touch. Red streaks coming from the infection site are a sign of a medical emergency.
Bursitis can often be diagnosed with a physical exam and your medical history. Findings consistent with bursitis include:
- Bursa pain: The inflamed bursa is usually tender to the touch. Even those deep in the joint can cause pain with pressure.
- Pain on Movement: When the bursa is inflamed, any movement of the surrounding tissue can cause a stabbing or shooting pain. Sometimes a squeaking sensation, called crackling , can be felt when normally smooth surfaces become rough or uneven.
- Bursa Edema: If inflammation occurs in a superficial bursa (such as above the kneecap or behind the elbow), redness and swelling will often be seen.
If an infection is suspected, your healthcare provider may want to collect a sample of synovial fluid from the affected bursa. Usually, fluid can be removed with a needle and syringe through a procedure known as arthrocentesis .
Imaging tests such as X-rays and magnetic resonance imaging (MRI) are generally not necessary unless there is some kind of accident or injury.
Treatment of bursitis depends a lot on the type of bursitis you have. The main goal is to reduce physical stress on the bursa, reduce inflammation, and allow enough time to recover.
Most cases resolve with conservative treatment. Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), such as Advil (ibuprofen) or Aleve (naproxen), can often provide significant pain relief. In addition to rest, ice can help reduce swelling, while short-term immobilization may be recommended if there is any evidence of connective tissue damage .
Avoid prolonged immobilization as this can freeze the joint. Immobilization should not last more than a few days and should be accompanied by light rotational exercises performed once or twice a day.
Although in most cases, improvement occurs within a few days or weeks, in some cases it can take months. Chronic bursitis is sometimes treated with an intrabursitis injection of corticosteroids to quickly relieve inflammation .
If bursitis persists despite proper treatment, surgical removal may be necessary. The procedure, known as a bursectomy, can be performed as open surgery (using a scalpel) or arthroscopy (using an endoscope and keyhole incisions). After removing the bag, a new one can be formed in its place.
Septic bursitis can be treated with oral or intravenous antibiotics, depending on the severity of the infection. Surgical drainage can also be used if pus collects in and around the bursa.
In some people, bursitis can come back, especially if it was caused by repetitive movements or prolonged sports injuries. In such cases, bursitis can appear after physical activity or for no reason.
There are several things you can do to reduce the risk of a relapse or the severity of an exacerbation:
- Wear suitable footwear. Knee or hip bursitis is often aggravated if the arches of the foot are flat or if the pronation (alignment) of the foot is abnormal. The right pair of shoes can significantly reduce stress on your lower extremity joints.
- Supports the affected joint. If you like to walk or play tennis, but are prone to knee or elbow bursitis, buy a neoprene brace from your local pharmacy and wear it every time you play sports .
- Change your bad habits. If your bursitis flares up from the way you sit or from certain movements, take whatever steps are necessary to "wean" yourself off these habits. This could include finding alternative exercises at the gym (such as using a Smith machine instead of free weights) or moving to a chair that improves posture.
- Warm up before class. Never play sports or any type of physical activity without first stretching and warming up the affected joints .
- Consult a physical therapist. Sometimes small adjustments can correct long-lasting posture or movement problems. A physical therapist is trained to identify these problems, and an occupational therapist can provide tools to help you overcome them.
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While bursitis can often be treated with rest and pain relievers, don't rule out the problem if it recurs or restricts your movements. Bursitis is usually progressive and can get worse over time if it is not treated. The same applies if the condition is caused by gout or rheumatoid arthritis.
Early diagnosis and treatment can often reduce the frequency or severity of bursitis flare-ups. If there are any signs of infection, call your doctor right away, especially if you have a high fever, open wound, increased redness or warmth, or discharge of any kind.