Bursitis

Bursitis is the medical term for inflammation of bursae, the small, fluid-filled sacs that act as cushions to minimize the friction of movement. Bursae most commonly occur at the interface between joints and surrounding structures, such as ligaments, tendons, or muscles. Bursae may also be found between muscles that slide against each other during movement. Bursitis often affects the knees, hips, shoulders, elbows, heels, or big toes. Healthy bursae help to smooth joint and muscle movement. In someone with bursitis, the bursae become irritated and swollen, often from repetitive joint movements, and fill up with extra fluid, making joint movements painful.

The condition is more likely to occur in older adults, including those with arthritis or other chronic musculoskeletal conditions; men and women are affected equally.

A number of treatments for bursitis are available, ranging from at-home measures (such as icing the affected joint) to surgery (in rare cases).

Bursitis may recur over time, especially if a person does not change their activity level, posture, or form when performing the activity that initially led to bursitis.

What is bursitis?

Bursitis is the term used to describe inflammation or irritation of one or more fluid-filled sacs (known as bursae) located at joint and muscle interfaces. Bursitis causes joint pain, swelling, and stiffness, as well as a loss of range of motion.

All people have more than 150 bursae at numerous joints around their bodies. (Some joints have more than one bursa.) These tiny sacs are made of a thin membrane and filled with fluid. When a joint is in motion, the fluid-filled bursae act as a liquid coating that moves between bones, muscles, ligaments, and tendons, keeping these structures from rubbing together.

Repetitive motions or putting too much pressure on a joint may lead to bursae inflammation. As a result, the bursae may fill with additional fluid, making the sac larger than it should be. The expanded bursae increase friction at the joint site, making joint movements painful and stiff rather than painless and smooth.

Chronic bursitis, often due to joint overuse over time, may not cause pain; the effects on the joint are ongoing, which enables the bursae to adjust to their larger size. Although a person may experience little to no discomfort, the bursae are still enlarged, which causes other symptoms, such as redness and swelling.

What causes bursitis?

There are several reasons why a person may develop bursitis, including:

• Repetitive joint movements, such as trimming bushes
• Putting pressure on a joint, such as kneeling on a hard floor, for prolonged periods
• Overuse injuries affecting a joint, such as pitching a baseball
• Trauma, such as a fall onto a joint
• Infectious diseases, such as Staphylococcus aureus
• Crystalline joint diseases, such as gout
• Inflammatory disorders, such as rheumatoid arthritis
• Poor form and posture during movement
• Leg length differences
• Muscle weakness and poor core stability

What are the symptoms of bursitis?

People with bursitis experience one or more of the following symptoms:

• Joint pain, whether or not the joint is in motion
• Joint swelling and/or stiffness
• Difficulty moving a joint
• Redness and/or warmth at the affected joint or muscle
• Pain surrounding the joint
• Fever

What are the risk factors for bursitis?

People are at increased risk of bursitis if they:

• Are older adults
• Perform manual labor for a living
• Play certain sports with repetitive motions
• Sit for prolonged periods

Additionally, people with the following health conditions are at increased risk of bursitis:

How is bursitis diagnosed?

Doctors can diagnose bursitis after obtaining a medical history, performing a physical exam, and offering diagnostic tests.

During the medical history part of the visit, share details about your joint pain, telling the doctor how long you have experienced discomfort, which activities cause pain, and how the condition impacts your ability to move freely. Also let the doctor know If you have gout, arthritis, lupus, or another chronic health condition. Be sure to mention any activities you do that involve heavy use of the affected joints, whether at home or work and/or while playing sports or participating in a hobby.

During a physical exam, the doctor will look for joint swelling, redness, warmth at the site of inflammation, and decreased range of motion.

Certain tests may be used to check for the presence of bursitis, including:

• Blood work to check for infection
• Analysis of bursa fluid. Remove fluid from a bursa with a needle, then analyze it to check for infection, crystals in the fluid, or blood (due to trauma)
• Imaging tests that can show whether the bursae are irritated or inflamed, including ultrasound, magnetic resonance imaging (MRI) scan, or X-ray

How is bursitis treated?

Bursitis often heals on its own within a week or two, but it’s possible to aid in the recovery process. For instance, doctors may recommend resting and elevating the joint, wrapping the joint in a compression bandage, and applying ice. They may also recommend special home exercises and stretching programs.

The type of treatment also depends on the cause of bursitis.

• If bursitis is due to repetitive motion, overuse, or prolonged pressure on joints and muscles, doctors can show patients how to change their behaviors to alleviate the problem. This may involve putting padding on the ground before kneeling, wearing more comfortable footwear, or learning a more ergonomic way to move the joints. Doctors may recommend physical therapy, where patients may benefit from stretching and practicing exercises that will help to improve the affected joint’s range of motion.

• Infection. When bursitis is caused by a bacterial infection, doctors will prescribe antibiotics.

To help alleviate bursitis pain, doctors may offer the following options:

• Over-the-counter or prescription pain relievers may be recommended or prescribed to ease discomfort. Non-steroidal anti-inflammatory drugs (NSAIDs) may help to reduce inflammation, in addition to relieving pain.
• Corticosteroids. If a patient experiences ongoing pain that doesn’t respond to oral medication, doctors may give them a corticosteroid or glucocorticoid injection in the affected bursa. They’ll also receive a local anesthetic to decrease the pain associated with the procedure. Steroid injections are only recommended for bursitis of deep joints, such as the hip, not those located close to the surface of the skin, such as the elbow, heel, or knee.
• Fluid removal to relieve pressure. When initial measures don’t help relieve pain, doctors may use a needle to remove some of the fluid from an irritated, inflamed bursa to reduce pressure within the fluid-filled sac and ease discomfort. After the procedure, the affected area will be wrapped in a compression bandage.
  
• Surgery. In rare cases, if bursitis does not respond to other treatments, doctors may surgically remove an aggravated bursa to provide relief. This is usually performed using a minimally invasive arthroscopic procedure.

What is the outlook for people with bursitis?

People with bursitis often experience symptom relief within one or two weeks, although some people experience long-term discomfort. When people don’t change their behaviors, including their activity level or posture, their bursitis may recur regularly. People may also experience recurrences if their bursitis is caused by another medical condition, such as untreated gout, osteoarthritis, or rheumatoid arthritis.

What makes Yale unique in its treatment of bursitis?

“The Yale Orthopaedics and Rehabilitation department has several nationally recognized physiatrists and musculoskeletal experts who provide word-class care for bursitis and related conditions,” says Yale Medicine physiatrist Charles Odonkor, MD, MA. “In addition to standard treatment, Yale is conducting research on innovative treatments for bursitis including therapeutic modalities such as ultrasound, transcutaneous electrical nerve stimulation, high frequency sinusoidal neuromodulation, extracorporeal shock wave therapy, and pulsed electromagnetic field therapy. Yale’s team of experts is leading the way in advancing our understanding of this condition and continues to offer many treatment options to help patients regain function and quality of life.”