Bursitis

Topic Overview

What is bursitis?

Bursitis is a painful swelling of a small sac of fluid called a bursa. Bursae (plural of bursa) cushion and lubricate areas where tendons, ligaments, skin, muscles, or bones rub against each other. People who repeat the same movement over and over or who put continued pressure on a joint in their jobs, sports, or daily activities have a greater chance of getting bursitis.

What causes bursitis?

Bursitis is commonly caused by:

• Overuse and repeated movements. These can include daily activities such as using tools, gardening, cooking, cleaning, and typing at a keyboard.
• Long periods of pressure on an area. For example, carpet layers, roofers, or gardeners who work on their knees all day can develop bursitis over the kneecap.
• Aging, which can cause the bursa to break down over time.
• Sudden injury, such as a blow to the elbow.

Bursitis can also be caused by other problems, such as arthritis or infection (septic bursitis).

What are the symptoms?

Bursitis usually causes a dull pain, tenderness, and stiffness near the affected bursa. The bursa may swell and make the skin around it red and warm to the touch.

Bursitis is most common in the shoulder, elbow, hip, and knee. Bursitis may also occur near the Achilles tendon or in the foot.

Symptoms of bursitis may be like those of tendinopathy. Both occur in the tissues in and around the joints.

Check with your doctor if your pain is severe, if the sore area becomes very hot or red, or if you have a fever.

How is bursitis diagnosed?

Your doctor will check for bursitis by asking questions about your past health and recent activities and by examining the area.

If your symptoms are severe or get worse even after treatment, you may need other tests. Your doctor may drain fluid from the bursa through a needle (aspiration) and test it for infection. Or you may need X-rays, an MRI, or an ultrasound.

How is it treated?

Home treatment is often enough to reduce pain and let the bursa heal. Your doctor may suggest physical therapy to strengthen the muscles around your joints.

• Rest the affected area. Avoid any activity or direct pressure that may cause pain.
• Apply ice or cold packs as soon as you notice pain in your muscles or near a joint. Apply ice 10 to 15 minutes at a time, as often as twice an hour, for 3 days (72 hours). You can try heat, or alternating heat and ice, after the first 72 hours.
• Use pain relievers. Use nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, to reduce pain and inflammation. NSAIDs come in pills and also in a cream that you rub over the sore area. Acetaminophen (such as Tylenol) can also help with pain. Don't rely on medicine to relieve pain so that you can keep overusing the joint.
• Do range-of-motion exercises each day. If your bursitis is in or near a joint, gently move the joint through its full range of motion, even during the time that you are resting the joint area. This will prevent stiffness. As the pain goes away, add other exercises to strengthen the muscles around your joint.
• Avoid tobacco smoke. Smoking delays wound and tissue healing.

If you have severe bursitis, your doctor may use a needle to remove extra fluid from the bursa. You might wear a pressure bandage on the area. Your doctor may also give you a shot of medicine to reduce swelling. Some people need surgery to drain or remove the bursa.

Sometimes the fluid in the bursa can get infected. If this happens, you may need antibiotics.

Bursitis is likely to improve in a few days or weeks if you rest and treat the affected area. But it may return if you don't stretch and strengthen the muscles around the joint and change the way you do some activities.

How can you prevent bursitis?

You may be able to prevent bursitis from happening or coming back.

• Continue your home treatment with rest, ice, pain relievers, and gentle exercises.
• When you are ready to try the activity that caused the pain, start slowly and do it for short periods or at a slower speed. Warm up before and stretch after the activity. Increase your activity slowly, and stop if it hurts. Use ice afterward to prevent pain and swelling.
• Change the way you do activities with repeated movements that may strain your muscles or joints. For example:
  • If using a certain tool has caused bursitis, start switching hands or change the grip size of your tool.
  • If sitting for long periods has caused bursitis, get up and walk around every hour.
  • If a certain sport is causing bursitis, consider taking lessons to learn proper techniques. Have an expert check your equipment to make sure it's well suited to your size, strength, and ability.
  • If certain activities at work may be causing bursitis, talk to your human resources department about other ways of doing your job, equipment changes, or other job assignments.
• Protect your joints from pressure. Cushion knees or elbows on hard surfaces, and wear shoes that fit you well and have good support.