Bursitis

Janet D. Pearl, MD, MSc

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Bursitis

Bursitis is the inflammation or irritation of the bursa sac. The bursa is a sac filled with lubricating fluid (synovial fluid) and located between tissues such as bone, muscle, tendons, and skin and provides a cushion to prevent rubbing and friction which can cause irritation and produce excessive synovial fluid.  Bursitis can be caused by overuse or even arthritis (OA,RA), ankylosing spondylosis or gout or pseudo-gout. As we age our bursa sacs become less flexible and prone to injury and tears. Repetitive activities or a sudden impact on an area can cause a bursitis. Examples of high-risk activities include gardening, raking, carpentry, shoveling, painting, scrubbing, tennis, golf, skiing, throwing, and pitching.  Incorrect posture at work and home along with poor stretching before exercise can lead to bursitis.

Symptoms of Bursitis are aches or pain with gradual or sudden with localized swelling.

Septic Bursitis can be a serious medical condition and will need immediate attention to prevent spreading of the infection throughout your body.  If a bursa area feels warm to touch, appears reddened and is tender to touch along with a fever and/or chills; prompt medical attention is necessary and treatment with antibiotics may be required.

Common Location of Bursitis

Bursitis most frequently occurs in the elbow, shoulder, hip, knee and heels.

Shoulder bursitis causing Shoulder Pain: Symptoms include tenderness at the outer shoulder, especially when raising the arm above the head, such as getting dressed.  Applying pressure to the area can also cause pain. The subacromial bursa is the largest bursa in the body and susceptible to bursitis.

Elbow or olecranon bursitis causing Elbow Pain:  Symptoms include swelling of the outer elbow and appears like a egg or golf ball is under the skin.  These are often not painful unless infected and ROM (Range of Motion) is normal unless excessive swelling prevents normal movements.

Hip bursitis causing Hip Pain or Groin Pain or Leg Pain:  Symptoms include tenderness and pain (sharp initially then ache over time).   Less often pain my radiate down the outside of the thigh, buttock, groin and low back. Pain at bursa can be felt when getting out of a chair after sitting for a long period of time, walking, climbing stairs or lying on affected side.

      • Greater Trochanter (GT) bursitis is the most common hip bursa with pain at outer side of hip where the hip joint meets the thigh (femur).
      • Iliopsoas bursitis with pain felt more in the groin area and feels worse after sleeping or sitting for an extended period of time.

Knee Bursitis causing Knee Pain: swelling or inflammation at the front of the knee is visualized.  This can be the size of a golf ball up to a grapefruit sized.  Pain is limited with achy feelings until a large amount of fluid is present. ROM is maintained until large amounts of fluid restrict movement.  Knee bursitis is often referred to as “housemaid knees” because of repeated kneeling.  Gout or rheumatoid arthritis. (RA) can also cause knee bursitis.

Heel Bursitis causing Heel Pain or Foot  Pain:  Retrocalcaneal (pain when standing on toes) and retroachilles bursitis can be common and cause pain and swelling at the back of the foot above the heel.  This bursitis is often confused with Achilles tendon pain and Achilles tendonitis. Wearing proper shoes to prevent friction at the back of the heel area and supportive footwear can prevent occurrence.  Some people have a “Haglund” deformity or prominent shape at the top of their heel which can cause irritation and bursitis.   This pain (ache) and tenderness usually develop slowly.  Pain can be exacerbated pointing or flexing the foot. Repetitive trauma to ankle by walking, jumping or running (especially uphill) which cause the foot to flex  or recent increase in intensity to a workout without adequate stretching can increase retrocalcaneal bursitis.  Other conditions such as Achilles tendon, OA, RA, gout and pseudo gout must be ruled out and treated.

Bursitis prevention:

Gradually build up exercise routine and vary exercises to prevent overuse of a single joint. Strengthen and stretch the muscles around the joint. Avoid the activity causing the pain, ice the area, NSAIDS (ibuprofen, Aleve, Naprosyn), Compression to area (ace wrap) and elevate above your heart to improve swelling.  Steroid injections are used to decrease inflammation directly at the site, Aspiration of the fluid can relieve pain from increased fluid.  Treat the underlying cause of the bursitis. Physical Therapy can be helpful. Lift properly.  Wear cushion pads at elbow and knees to prevent trauma. Low heeled cushioned shoes can help prevent bursitis of the foot. Take frequent breaks. Maintain a healthy weight.  Always warm up and stretch before exercise or strenuous activities to protect joints from injury.

With all bursitis other causes must be ruled out such as:  damage to tendons or muscles.  Bone spurs or calcium deposits can cause irritation to surrounding tissue and cause bursitis.  Low back problems like spinal stenosis, degenerative disc disease and hip osteoarthritis.  Osteonecrosis, stress fracture, a tumor or infection can cause a bursitis.  Certain medical conditions and medications can suppress some people’s immune systems and make them more susceptible to septic bursitis.  Ex: those with cancer, HIV/AIDS, lupus, alcoholism, COPD, DM may be more likely to get septic

Shoulder bursitis

Shoulder bursitis

Elbow bursitis

Elbow bursitis

Hip bursitis

Hip bursitis

Knee bursitis

Knee bursitis

Ankle bursitis

Ankle bursitis

Treatment

  • (RICE) Rest area of pain and inflammation, Ice, Compression to area (ace wrap), Elevate extremity.
  • Medications: Take NSAID’s like Ibuprofen, Advil, and Naprosyn.
  • A steroid injection to the affected area can decrease inflammation and pain.  Aspiration of fluid can decrease pain and allow a specimen to be sent to the lab for analysis if septic bursitis is suspected.
bursa injection

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