What is bursitis?
Bursitis is a painful condition that happens when you have inflammation of a bursa. Bursae are small fluid-filled pads (or sacs) found near your joints. They act like cushions, reducing friction by allowing tendons and muscles to move smoothly over bones and other structures.
One of the most common areas for bursitis is the shoulder joint, which has the greatest range of motion of all the body’s major joints. The pain is usually felt along the outside top of the shoulder. Other joints commonly affected by this condition are the elbows, hips, knees and heels.
Bursitis can usually be treated with self-care measures and pain relievers, but sometimes corticosteroid injections or (rarely) surgery may be recommended.
What are the symptoms of bursitis?
Bursitis symptoms include pain and sometimes swelling in the area. Pain is often particularly noticed during movement of the joint, when stretching or exercising, lifting or otherwise pushing the joint beyond its normal limits.
Sometimes there may be restricted range of motion (reduced mobility) in a joint, with or without pain.
The overlying skin may be red or feel warm. If there is an infection, you may develop a fever.
The inflammation in bursitis may be acute (short-term) or chronic (ongoing). Chronic bursitis may last several months, flaring up from time to time.
Common types of bursitis
Among the most common types of bursitis are:
- prepatellar bursitis – ‘housemaid’s knee’;
- infrapatellar bursitis – ‘clergyman’s knee‘;
- olecranon bursitis – ‘student’s elbow’;
- trochanteric bursitis of the hip; and
- subacromial or subdeltoid bursitis of the shoulder.
What causes bursitis?
Bursitis is usually caused by overuse of a joint, or when a joint is under pressure or tension for extended periods of time, often associated with poor muscle strength or balance. Repeated physical activities, such as swinging a golf club, can cause bursitis.
Bursitis can also be caused by injury or trauma in the area of the bursa or by tightness and overload of adjacent tendons.
Repetitive stress from work (for example production-line work, laying floors or tiling), sports (such as tennis or jogging) or other activities (gardening, playing a musical instrument) can cause bursitis. ‘Housemaid’s knee’ and ‘clergyman’s knee’ occur as a result of inflammation of the bursae on the front of the knee caused by the repeated stress of prolonged kneeling.
Rotator cuff disease affecting the shoulder can be associated with subacromial bursitis.
Infection can cause bursitis in a bursa that’s close to the surface of the skin (such as the knee and elbow).
How is bursitis diagnosed?
If you have a painful joint that you think may be due to bursitis, see your GP (general practitioner). Your doctor will ask about your symptoms and recent physical activities and will examine the affected area looking for signs of bursitis and possible causes. Tests are often not needed to make the diagnosis.
Your doctor may recommend some tests to help with the diagnosis or refer you to a specialist for further assessment. An ultrasound scan can show a swollen bursa. Many sports doctors now can perform this test in their rooms. X-rays or an MRI may sometimes be recommended if the diagnosis is uncertain.
If there is concern the bursa might be infected, your doctor may recommend extracting some fluid from the bursa for testing. This would involve having a small needle inserted into the bursa, sometimes under ultrasound guidance, and sending the fluid to a laboratory for testing.
Self-care for bursitis
Most people recover from bursitis with simple self-care measures such as rest, cool packs and bandaging.
It’s important to avoid any activities that are aggravating the pain. Decrease activity involving the joint and rest to allow the inflammation to subside. If the elbow is affected, place the arm in a sling to rest the joint. Crutches or a walking stick may be needed if the hip or knee is affected.
You should protect the area as much as possible. (For example, if your you have bursitis affecting your knee, wearing knee pads may help.)
Cold compresses can assist in relieving some of the pain and reducing swelling over the first day or two. Using a compression bandage may also provide some relief.
When the acute pain has subsided, gentle exercise of the joint can be undertaken, slowly increasing the range of motion.
If your symptoms haven’t settled within 7-10 days with these measures, seek advice from your doctor or physiotherapist. If you develop a fever or the joint becomes extremely painful and tender, see your doctor straight away.
Treatments for bursitis
Non-steroidal anti-inflammatory drugs (NSAIDs) available as creams can be massaged into the skin over the affected bursa to help with pain relief. Oral NSAIDs (such as ibuprofen) and pain-relievers such as paracetamol also reduce pain and inflammation.
Splinting may rest the joint by limiting its motion, but should only be done under the supervision of a doctor or physiotherapist.
Corticosteroid injections to the involved bursa can provide relief and are often used when other measures have failed.
Physiotherapy may be advised to help correct any muscle tightness or strength imbalance that may have caused the bursitis.
In severe or recurrent cases, bursal drainage (when the fluid is drawn out of the swollen bursa) may be recommended. Rarely, bursectomy (in which the affected bursa is removed surgically) may be considered.
Complications of bursitis
The main complication of bursitis is an infection of the bursa. As the bursa is frequently just under the skin it can be infected with some types of skin bacteria. Infectious bursitis is more common in people with other medical conditions, such as diabetes. There is also a risk of infection after having an injection into the bursa.
Infection needs to be treated with antibiotics and drainage of the infected fluid.
If you’ve had an episode of bursitis related to repetitive activities (such as kneeling or specific sporting activities) it’s important that you avoid or minimise that activity to prevent a recurrence. This will help relieve ongoing stress on the bursa.
Protective padding may be a good way to help protect the area when activities can’t be avoided altogether.
An occupational therapist can help if you have ongoing problems with bursitis related to repetitive movements.