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Bursitis

What is Bursitis?

Bursitis is defined as the inflammation of a bursa. A bursa is an enclosed sac that is lined with a membrane that secretes and absorbs fluid. The bursae provide cushioning and ease movement of skin across bone, muscle across muscle, muscle across bone, and tendon across bone. If a bursa gets overused, irritated or injured, it will fill with extra fluid, making the affected joint painful and more difficult to move. On occasion, a bursa can get infected and will become inflamed (get red, hot and swollen).

Bursitis resulting from irritation and overuse is common. It can be treated with rest, anti-inflammatory medications and, rarely, surgical removal of the bursa. Bursitis resulting from bacterial infection requires antibiotic treatment along with rest and anti-inflammatory medications to relieve the symptoms.

Anybody can develop bursitis, though it’s rare in people younger than 20 years. Whether you develop bursitis and what type of bursitis you get depends on which activities or occupations you participate.

What causes it?

There are three different causes of bursitis.

  • Overuse: The most common is cause of bursitis is repetitive physical stress to the bursa. This can be found in athletes (such as retrocalcaneal bursitis in runners) or in people with certain occupations (prepatellar bursitis in carpet layers).
  • Infection: The bursal sac can get infected with bacteria, resulting in septic bursitis.
  • Secondary: Bursitis can develop secondary to a variety of arthritic diseases, including osteoarthritis, rheumatoid arthritis, gout, CPPD crystal deposition and ankylosing spondylitis.

What are the symptoms/effects?

Whether your irritated and swollen bursa is in your shoulder, elbow, hip or knee, the symptoms generally are similar. You’ll experience pain, tenderness, sometimes swelling and, occasionally some limitation of ability to move the affected joint. It is not always easy to tell the difference between bursitis and tendonitis, which is inflammation of the structures which attach muscle to bones.

Bursitis is named according to the bursa that is affected or the occupation that may have caused it. Most forms of bursitis are mild, and can be chronic, but some can be quite severe and painful. If you experience acute bursitis with swelling and redness or have a fever with it, you should see a doctor right away, since the cause could be infectious.

  • Shoulder bursitis(subacromial-subdeltoid bursitis): Bursitis in the shoulder is difficult to distinguish from tendonitis in the shoulder, and both problems usually occur together. You will feel pain and tenderness at the outer side of the shoulder and you will have difficulty raising your arm overhead due to pain. This type of bursitis is often seen in people who do a lot of overhead work or who use a throwing motion (like baseball players)
  • Olecranon bursitis: This bursa is located at the tip of the elbow. Bursitis here will result in a swollen, tender knob (sometimes with pain, heat and redness) on the end of the elbow. It can be caused by repetitive low-grade trauma (leaning on the elbows), inflammatory conditions (such as rheumatoid arthritis, gout or CPPD crystal deposition) or infection
  • Trochanteric bursitis: This bursa is located over the prominent bone on the side of your hip and when irritated causes pain and aching in the hip and on the outside of the thigh. The pain will be worse while walking and while lying on the affected side. It occurs mainly in middle-aged to elderly people, and somewhat more often in women than in men. It often occurs in people who have one leg somewhat shorter or stiffer than the other, or osteoarthritis of the hip, lower spine or knee
  • Iliopsoas bursitis: This is a deep bursa thatis located at the front of the hip. When irritated, it  causes pain in the groin and front of the thigh. If the bursa becomes quite swollen, pressure on structures near the bursa can result in leg swelling, thigh muscle weakness and restricted blood flow to the leg. Iliopsoas bursitis can be due to repetitive trauma and overuse or can be due to rheumatoid arthritis or osteoarthritis of the hip
  • Ischial bursitis (weaver’s bottom, tailor’s seat): This bursa is located below the “sitting” bone in your buttock called the ischium. Pain in the buttock can be exquisite when sitting or lying down and can radiate down the back of the thigh. It is caused by an injury or by prolonged sitting on hard surfaces
  • Anserine bursitis: This bursa is located just below the knee on the inner part of the leg. Bursitis here produces pain and tenderness on the inside portion of the knee that is usually at its worst when climbing stairs. It is most common in overweight, older women with osteoarthritis of the knees or in people with knock-knees. Runners may also develop anserine bursitis from overuse or poor training techniques
  • Prepatellar bursitis (housemaid’s knee): This bursa is located beneath the skin in front of the kneecap. Swelling over the kneecap is the main symptom. Pain usually is mild unless you press directly on the swollen part. It usually is caused by an injury or repetitive low-grade trauma, such as kneeling. If there is redness, heat and increased pain, the bursitis may be caused by a bacterial infection or gout
  • Infrapatellar bursitis (clergyman’s knee): This condition is similar to prepatellar bursitis, except that the bursa is located just below the kneecap
  • Retrocalcaneal bursitis: This bursa is located between the heel bone and the Achilles tendon. Irritation and inflammation of this bursa result in pain, tenderness and swelling at the back of the heel. It may result from poorly fitting shoes, overuse (as in runners), or from various forms of arthritis (such as rheumatoid arthritis, ankylosing spondylitis or gout)
  • Retroachilles bursitis(pump bump bursitis): This bursa is located between the skin and the Achilles tendon. Irritation of this bursa results in pain, tenderness and swelling at the back of the heel. It usually is caused by shoes that rub against the bursa.

How is it diagnosed?

Bursitis usually can be diagnosed by your family physician through a simple physical exam and by asking you a few questions. If your symptoms suggest you may have septic bursitis or bursitis related to crystal deposition (such as in gout or CPPD), the doctor may try to remove some fluid from the bursal sac with a needle and will examine the fluid under a microscope. If your symptoms suggest you may have bursitis secondary to arthritis, the doctor may take X-rays and run a few laboratory tests.

What are the treatment options?

The basic treatment for bursitis is common to all types:

  • Rest: Stop performing activities that irritate the affected area.
  • Cold: Apply cold compresses or ice packs.
  • Medication:
    • Nonsteroidal anti-inflammatory drugs (NSAIDs) usually will relieve pain and inflammation.
    • Steroid injections directly into the affected bursa may be done and will usually quickly relieve pain and inflammation.

If your bursitis is caused by an infection, your doctor will prescribe antibiotics.

If your bursitis is caused by an underlying joint disease, your doctor will treat the arthritis and may refer you to a rheumatologist.

Rarely, if all other treatments fail to relieve the pain, the bursal sac can be surgically removed.  Most forms of bursitis resolve, but some can be chronic or recur

Who is at risk?/How can I prevent it?

Anyone can develop bursitis, but it is rarely seen in people younger than 20 years and becomes common in middle-aged and older adults. The different types of bursitis are seen more commonly among people with specific recreational or vocational activities that cause repetitive trauma to the bursae.