Bursitis

Whether you're at work or at play, if you overuse or repetitively stress the area around your body's joints, you may eventually develop a painful inflammation called bursitis.

You have more than 150 bursae in your body. These small, fluid-filled sacs lubricate and cushion pressure points between your bones and the tendons and muscles near your joints. They help your joints move with ease. Bursitis occurs when one of the bursae becomes inflamed. When inflammation occurs, movement or pressure is painful.

Bursitis often affects the areas around the joints in your shoulders, elbows or hips. But you can also have bursitis by your knee, heel and even in the base of your big toe. Bursitis pain usually goes away within a week or so with proper treatment, but recurrent flare-ups are common and can be frustrating.

 

Signs and symptoms

If you have bursitis, you may notice:

bulletA dull ache or stiffness in the area of your elbow, hip, knee, shoulder, big toe or other joint
bulletA worsening of pain with movement or pressure
bulletAn area that feels swollen or warm to the touch
bulletOccasional skin redness in the area of the inflamed bursa

Bursitis of the hip doesn't cause any visible swelling or skin redness because the bursae are located beneath some of your body's bulkiest muscles. In this type of bursitis, pain is primarily over the greater trochanter, a portion of your thighbone (femur) that juts out just below where the bone joins the hip.

 

Causes

Common causes of bursitis are overuse, stress or direct trauma to a joint, such as with repeated bumping or prolonged pressure from kneeling. Bursitis may also result from an infection, arthritis or gout. Many times, the cause is unknown.

The cause of other forms of bursitis is repetitive motion related to certain activities. These forms, which may be named after the profession or trade associated with certain motions of the joints, include:

bulletWeaver's bottom. This type of bursitis describes an inflamed bursa over the bone in your buttocks. It may result from sitting on a hard surface and swaying back and forth, such as sitting at a loom. The pressure from standing for a prolonged time may lead to bursitis of the hip.
bulletHousemaid's knee. In this form, a soft, egg-shaped bump occurs on the front of your knee, the result of kneeling while installing tiles, scrubbing a floor, gardening or doing other activities that place pressure on your knees.
bulletMiners' elbow. This form results from swinging a pick. You may get a similar inflammation by pushing a vacuum cleaner back and forth. Throwing a baseball and swinging a tennis racket or a golf club are other examples of repeated physical activities that may lead to bursitis or tendonitis of the elbow or shoulder. Simple repeated leaning on your elbows could lead to bursitis over the tip of your elbow.

You may not be able to pinpoint a specific incident or activity that led to your bursitis. In fact, in some cases the inflammation may stem from a staphylococcal infection or, rarely, tuberculosis.

 

Risk factors

If you work in a profession or have a hobby that requires repetitive motion, you're at an increased risk of developing bursitis. The occurrence of bursitis also increases with age. In addition, certain diseases and conditions increase your risk of developing bursitis, such as:

bulletArthritis
bulletGout
bulletStaphylococcal infection
bulletTuberculosis, although rarely

 

When to seek medical advice

Usually bursitis responds well to home treatment. However, consult your doctor if:

bulletBursitis pain is disabling or doesn't subside after 10 days of home treatment
bulletYou notice excessive swelling, redness, bruising or a rash in the affected area
bulletPain is sharp or shooting, especially when you exercise or exert yourself
bulletYou have a fever
bulletYou have other medical conditions that may increase your risk of an infection, such as diabetes, rheumatoid arthritis or an autoimmune disease, such as lupus
bulletYou take medications that increase your risk of infection, such as corticosteroids or immunosuppressants

 

Screening and Diagnosis

Your doctor may have you undergo a physical examination and ask about your recent activities. By feeling the painful joint and surrounding area, your doctor may be able to identify a specific area of tenderness.

If it appears that something else may be causing the discomfort, your physician may request an X-ray of the affected area. If bursitis is the cause, X-ray images can't establish the diagnosis, but they can help to exclude other causes of your discomfort.

Although you usually can trace bursitis to events of overuse or pressure, there may be no obvious cause. In the latter case, your doctor may want to perform additional screening or tests to rule out other causes of joint inflammation and pain. These may include blood tests or an analysis of fluid from the inflamed bursa.

 

Treatment

Treatment for bursitis is usually simple and includes resting and immobilizing the affected area, applying ice to reduce swelling and taking nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve pain and reduce inflammation. With simple self-care and home treatment, bursitis usually disappears within a week or two.

Sometimes, your doctor may recommend physical therapy or exercise to strengthen the muscles in the area. Additionally, your doctor may inject a corticosteroid drug into the bursa to relieve inflammation. This treatment generally brings immediate relief and, in many cases, one injection is all you'll need.

If NSAIDs don't relieve your pain and inflammation, or if you're concerned about possible gastrointestinal side effects from NSAIDs, your doctor may prescribe a COX-2 inhibitor such as celecoxib (Celebrex) to relieve both pain and inflammation. COX-2 inhibitors may have less risk of stomach upset and stomach bleeding compared with NSAIDs. People who are allergic to sulfa, aspirin or NSAIDs shouldn't take COX-2 inhibitors.

If your bursitis is caused by an infection, you'll need to take antibiotics. Sometimes the bursa must be surgically drained, but only rarely is surgical removal of the affected bursa necessary.

 

Prevention

To help prevent bursitis or reduce the severity of flare-ups:

bulletDo your stretches. Warm up or stretch before physical activity.
bulletStrengthen your muscles. Strengthening can help protect your joints. Wait until the pain and inflammation are gone before starting to exercise a joint that has bursitis.
bulletTake frequent breaks from repetitive tasks. Alternate repetitive tasks with rest or other activities.
bulletCushion your joint. Use cushioned chairs, foam for kneeling or elbow pads. Avoid resting your elbows on hard surfaces. Avoid shoes that don't fit properly or that have worn-down heels.
bulletDon't sit still for long periods. Get up and move about frequently.
bulletPractice good posture. For example, avoid leaning on your elbows.

If your bursitis is caused by a chronic underlying condition, such as arthritis, it may recur despite these preventive measures.

 

Self-care

To take care of your bursitis at home:

bulletTake nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs such as aspirin, ibuprofen (Advil, Motrin, others) or naproxen sodium (Aleve) can provide relief. Use as directed. Consult your doctor if you need NSAIDs for an extended period of time.
bulletApply ice packs. Use them for 20 minutes several times a day during the first few days, or for as long as the joint area is warm to the touch.
bulletApply heat. Use heat after the affected joint is no longer warm or red to help relieve muscle and joint pain and stiffness. But don't overdo it. Don't apply heat for more than 20 minutes at a time. Sometimes moist heat seems to penetrate deeper and give you more relief than dry heat.
bulletPerform stretching exercises. Stretching can help restore full range of motion.
bulletElevate the affected joint. Raising your knee or elbow can help reduce swelling.
bulletKeep pressure off your joint. If possible, use an elastic bandage, sling or soft foam pad to protect a joint until the swelling goes down.

 


By Mayo Clinic staff