Bursitis

Bursitis is a condition that occurs when one or more of the bursae are inflamed. The bursae are small sacs filled with synovial fluid. They are present at the points in the body where components such as muscles and tendons move across the bone. The function of the bursae is to reduce friction and so to protect the tissue from being damaged as it encounters the bone. They allow the soft parts of the joint to glide smoothly and painlessly across the bone.

Bursa means purse in Latin. The name stems from the appearance of the bursae, which are small sacs filled with a slimy fluid. The sac is lined by synovial membrane, a soft tissue that secretes and encloses the synovial fluid. This fluid has a consistency that is similar to that of an uncooked egg white. The name synovial is actually derived from the Latin word for egg, ovum.

Inflammation of the Bursae

Bursitis occurs when the bursae become inflamed. There are two basic reasons why this can occur. First, excessive use of or strain upon the joint could result in inflammation of the bursae. Second, the bursa could become infected and therefore inflamed.

Inflammation of the bursae may sometimes be associated with another medical condition, such as rheumatoid arthritis or scoliosis.

Whatever the cause of the inflammation, it will result in pain and a burning sensation in the joint. The treatment of this condition will vary depending on what has caused the inflammation. An infection must be treated with antibiotics, while a non-infected case of bursitis can often be treated at home without the need for any medication. The joint must simply be rested, although pain medication and anti-inflammatory drugs may be required.

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Additional Names

Bursitis has a number of different names, depending upon which joints of the body are being affected by the condition.

Prepatellar bursitis causes pain above the kneecap. It is also known as housemaid’s knee, because it is often experienced as a result of repetitive work while in a kneeling position, and was therefore common in housemaids who had to kneel down while cleaning the floor. Infrapatellar bursitis is a similar condition, also known as clergyman’s knee. It causes inflammation below the kneecap, however, and it can be caused by kneeling upon a hard surface.

Trochanteric bursitis, which is also known as greater trochanteric pain syndrome or GTPS affects bursae in the hip. Olecranon bursitis causes inflammation in the elbow. Subacromial bursitis occurs in the shoulder joint.

Symptoms

The symptoms of bursitis can vary a great deal, depending upon the severity of the inflammation. Pain in the affected joint is common, as is joint stiffness, but patients may also experience a burning sensation around the joint.

Generally, the pain will be worse while the joint is being used, and after a period of activity. It is also common for the affected joint to feel stiff on the day following this activity. The joint can also appear red and swollen, and the pain is likely to increase if any additional pressure is applied to it, or when the joint is moved.

Patients who are experiencing severe joint pain that lasts for more than two weeks, or which is affecting their lifestyle, then they should make an appointment to see their doctor. If there is particularly excessive swelling, bruising, redness or a rash around the affected joint then there is also reason to seek medical advice. Experiencing a fever or a shooting or sharp pain in the joint, particularly when exercising, is also a sign that a doctor’s appointment is necessary.

Diagnosis

Although most patients who are affected by bursitis usually visit their family doctor at first, they may be referred on to a rheumatologist, a specialist in disorders of the joints.

The doctor will perform a physical examination of the affected joint or joints. They will place a gentle pressure upon different parts of the joint in order to determine which of the bursae are inflamed. They should be able to identify the specific bursa that is causing the problem. The doctor will also ask about the symptoms that have been experienced, such as the type and severity of the pain, and they will also ask whether the patient has been taking part in any activities that could have led to bursitis.

Additional Testing

Sometimes, the doctor will choose to run some additional tests in order to make a diagnosis. This could be because there is no obvious reason why the patient is suffering from bursitis. The patient may not be able to recall any activity that could have resulted in irritation of the joint. These tests can rule out any other causes of joint pain, and therefore lead the doctor to determine that the problem must be bursitis. The doctor may wish to perform an X ray of the joint in order to check for any reasons why the joint could be sore.

If it is bursitis that has caused the problem, there will be nothing to see on the X ray, but if there is some other source of discomfort, it may show up in the image. There are also some laboratory tests that can help to rule out different causes of joint pain and inflammation, such as diseases that can affect the joints. Tests may be performed on the patient’s blood or on fluid from the affected bursa. These materials can also be tested to determine whether the inflammation is due to an infection of the bursa, which will require different treatment than a case of bursitis that has a purely physical cause.

Causes

The most common causes of bursitis are repetitive joint movements and excessive strain or pressure on the joints. Bursitis frequently affects the elbow and knee joints, but it can also occur in other parts of the body that are being placed under strain. It depends upon the sort of movements that are being made. The hips, shoulders and heel are also affected fairly often, and even the joint at the base of the big toe is frequently afflicted by bursitis.

A traumatic injury to a joint can also result in a case of bursitis. Sometimes an injury can result in a change in the space between the bone and the muscle or tendon so that the bursa no longer fits in its place, or it can increase the amount of pressure that is being placed upon the bursa by the bone.

Bursitis is a self-perpetuating condition. It can be caused by repetitive movement of the joint, and continuing to use the joint can therefore result in further pain and inflammation.

Other Causes

The sort of repetitive and strenuous movements that can result in bursitis include lifting heavy objects and taking parts in sports. Repeatedly throwing a baseball, for example, can cause bursitis in the shoulder. Remaining in a position that places a strain upon the bursae can also lead to bursitis. This could be while kneeling or leaning the elbows upon a hard surface for a long time, or even sitting still for an extended period.

An infection of the bursae can also cause bursitis. This type of bursitis commonly affects the knee and elbow joints, because the bursae in these joints are close to the surface of the skin. This means that they are more likely to suffer from a puncture injury that can cause them to become infected.

Risk Factors

Bursitis is more likely to occur during middle age. Most cases occur in people who are over the age of 40. It is also more common in people whose work or leisure activities place them in the sort of situations that could cause bursitis. This means that anyone who spends time doing repetitive activities, remaining for a long period in the same position, or performing activities that place an excessive strain on their joints are more likely to suffer from bursitis.

Risky activities include laying carpets, scrubbing a floor, setting tiles, working in the garden, riding a bike, playing a sport such as tennis, golf or baseball, or ice skating. Any other similar activities can also increase the chances of developing bursitis.

Certain medical conditions can also be a factor in bursitis. Gout, diabetes, thyroid disease, osteoarthritis and rheumatoid arthritis are all associated with an increased risk of bursitis.

Prevention

It is possible to reduce exposure to the risk factors that can cause bursitis, and therefore to protect oneself from the condition, or to prevent it from recurring. The measures that should be taken will depend upon the activities that are being pursued.

Avoiding excessive physical exertion can prevent bursitis. It may be possible to use a wheelbarrow or trolley to move heavy objects rather than carrying them, for example. If anything heavy does have to be lifted, it should be picked up carefully, bending the knees rather than placing all of the strain on the back and the bursae at the hips.

If a repetitive task needs to be performed, then it is important to take frequent breaks, perhaps alternating between tasks.

Changing Position

It is also beneficial to avoid staying ion one position for too long. It is a good idea to get up and walk around for a while rather than sitting still for a long period of time.

When leaning on a hard surface, or holding a position that places pressure upon the body, some sort of cushioning can be used to protect the joints and the bursae. A pad should be placed under the knees when kneeling, for example, or a cushion under the elbows while leaning on them.

Wearing Comfortable Clothes

Wearing comfortable shoes can also help to prevent bursitis, since it can reduce the strain, particularly upon the bursae of the hips and other leg joints.

Training the Body

When a repetitive or strenuous activity must be performed, it can also reduce the chances of bursitis developing if it is begun gradually, so that the body can get used to the new movement and strain, rather than attempting to do too much too soon. For example, it is a good idea to begin slowly when trying a new sport and build up the length of exercise sessions over time.

Treatments

Although the treatments that are recommended for bursitis are generally simple and can be administered by the patient themselves at home, in some cases the doctor will wish to prescribe additional drugs or suggest some exercises that can be used to strengthen the affects joint.

The basic methods for treating a joint that is affected by bursitis are resting the joint, cooling it with an ice pack and taking drugs that can relieve the pain and reduce the inflammation. The patient should rest the affected joint in a comfortable position, ideally an elevated one, although the exact way the joint should be held will depend upon which part of the body is affected by the bursitis. Cooling the joint with ice can help to reduce swelling or inflammation, and it can also relieve the pain.

Over the Counter

The patient should also take a nonsteroidal anti-inflammatory drug or NSAID. Ibuprofin, which is sold under a number of brand names including Motrin and Advil, or naproxen, which is sold as Aleve, among other brand names. The recommended dose will be found on the packaging of the drugs, which can be purchased over the counter at a drug store in the US.

Naproxen was first marketed as a prescription only drug in the US, until it became available over the counter in 1994. In some parts of the world, it still requires a prescription. An NSAID can relieve both the pain and the inflammation. Pain relief medication such as paracetamol or acetaminophen that does not reduce inflammation will be less helpful for a case of bursitis.

It is not advisable to wear a bandage or use any other form of support that will place an increased pressure upon the affected joint. This sort of compression can worsen the bursitis.

Physical Therapy

In some cases, the doctor may suggest that the patient undergoes some physical therapy or performs some exercises in order to strengthen the muscles of the joint that has been affected. This may help to prevent a relapse. The doctor may also decide to inject the affected bursa with a corticosteroid drug. This medication can reduce he inflammation and rapidly relieve the pain of bursitis. Generally, if this treatment is offered it will only require a single injection.

If the doctor determines that the cause of the bursitis is an infection rather than a physical strain or injury, then they will also prescribe a course of antibiotics. The doses and type of antibiotics can vary, but it is essential to take every dose in order to get the full benefit of the medication.

In some rare cases, the bursa may need to be drained, or even removed surgically. This will only be necessary if the problem does not clear up when the other treatments are used. Most cases that require surgery were the result of a traumatic injury or an infected bursa. The procedure is carried out under a local anesthetic.

Traditional Remedies

In addition to the home remedies that form a part of the treatment for bursitis that is recommended by doctors, it is also possible to use other remedies to relieve the pain, swelling and inflammation. Boswellia and white willow bark may help to reduce inflammation and pain. Acupuncture is also believed to be able to alleviate the symptoms of bursitis.

Prognosis

With proper rest and care, a case of bursitis usually clears up within about three weeks. The treatments are usually very effective. However, it is very common for a patient to experience bursitis again in the future, usually due to performing the same actions that caused the problem in the first place, particularly when these actions are associated with the patient’s job or a sport that they enjoy playing.

Complications

Most cases of bursitis are resolved within a few weeks. It is common for the problem to recur, however, since the patient is likely to continue placing a strain upon their joints and so cause another bout of bursitis. Preventative measures may be able to help the patient to avoid a relapse.

If the patient is receiving medication such as antibiotics or corticosteroids, or if they will be undergoing a surgical procedure to drain fluid or remove the affected bursa, then there may be some side effects, such as an allergic reaction to the medication, a postoperative infection, or an adverse reaction to the medication.

Steroids or corticosteroids are not suitable for use in recurring bursitis, since it is not safe to give repeated doses of these drugs that less than four months apart. Side effects are very rare when a single dose is given, however, so bursitis treatment with an injection of corticosteroids is very safe.

Cost

The costs of bursitis treatments are usually minimal. The patient generally only requires some rest and over the counter painkillers, which should cost less than $10.

It will be necessary to pay for an appointment with the doctor in order to get a diagnosis, or for additional treatment in a severe case, for example if the bursa is infected. This could increase the costs significantly.