Bursitis, or inflammation of the bursa

Bursitis (pronounced: bur-ZY-tis) is a painful condition caused by inflammation of the fluid-filled sacs located near the joints—so-called bursae. These bursae act like cushions between bones, tendons and muscles. Their role is to reduce friction between structures that move against each other. There are approximately 160 bursae in your body. Cells in their inner lining produce a substance that reduces friction. Bursitis is the inflammation of these bursae; the joint becomes painful and movement becomes difficult. The most common sites are the shoulder, elbow and hip. However, it can also develop at the knee, the heel, and even at the base of the big toe. Bursa inflammation often occurs in people who perform repetitive, monotonous movements.

Symptoms of bursitis

With bursitis the affected joint can be:

• painful and/or stiff
• painful to pressure or movement
• swollen and possibly red.

Causes of bursa inflammation

Most often bursitis is triggered by repetitive movements or positions that put pressure on the bursae around the joint:

• repetitive throwing motions
• repetitive overhead reaching
• prolonged leaning on the elbows
• prolonged kneeling during work, for example tiling or scrubbing floors.

Another cause can be an injury to the affected area. In addition, it may be part of inflammatory joint diseases such as rheumatoid arthritis, gout, or it can be caused by an infection.

Risk factors

Bursitis can develop in anyone, but the following increase the risk:

• Age: it becomes more common with aging. Once it has occurred, it tends to recur, especially after the age of 40.
• Occupations or hobbies: repetitive movements or prolonged pressure on a bursa increase the risk. Bursitis is common among floor layers, but gardening can also trigger it.
• Certain systemic diseases—such as rheumatoid arthritis, gout and diabetes—increase the risk. Excess weight increases the tendency for hip and knee bursitis.

Preventing bursitis

Although not all types of bursitis are preventable, changing how you perform certain tasks can reduce the risk and severity of flare-ups. For example, the following may help:

• Kneeling pad: use some padding to reduce pressure on your knees if your work involves a lot of kneeling.
• Bend your knees when lifting. Failing to do so places extra strain on the bursae of the hips and knees.
• Heavy loads stress the bursa in the shoulder. Instead of carrying, use a wheelbarrow or a cart with wheels.
• Alternate repetitive tasks with rest or different activities.
• Excess weight increases joint load—aim to maintain or restore a healthy body weight.
• Muscles provide joint stability. Regular exercise strengthens the muscles and helps protect the affected joint and prevents bursa overload.
• Always warm up and stretch the muscles before strenuous activities. This helps protect your joints from injury.

When to see a doctor?

• in cases of severe joint pain
• sudden onset of restricted joint movement
• noticed swelling, redness, or bruising around the joint
• sharp or stabbing pain, especially during sports or physical work
• if you also have a fever.

Diagnosis

An experienced physician can often diagnose bursitis based on the location and onset of symptoms and the physical examination.

Imaging tests may be needed to confirm the diagnosis. X-rays cannot reliably diagnose bursitis but can help rule out other causes of the symptoms, such as a fracture. Ultrasound or MRI can provide more information. These are indicated when the physical examination does not clearly establish the inflammation.

In some cases lab tests can help determine the cause of the pain. This may be a blood test or analysis of fluid aspirated from the bursa. The latter is performed if there is suspicion that the bursa has been infected by pathogens (for example through a cut or injury).

Treatment

The most important part of treatment is resting the affected joint and protecting it from further trauma. A cane or crutch reduces the load on the joint, so it is worth using temporarily. With appropriate treatment, bursitis usually resolves within a few weeks, but recurrent flare-ups are common, especially if you continue to "provoke" it due to your work.

Doctors commonly prescribe non-steroidal anti-inflammatory drugs. Others often inject corticosteroid into the bursa. Steroids do reduce pain and inflammation, but because of their systemic effects it is worth considering and preferably choosing more natural approaches.

In severe and recurrent cases the accumulated fluid in the inflamed bursa may be aspirated, or surgical removal may even be recommended. Only consider this as a last resort, because the bursa exists for a reason. If it is removed, it will be missed. Of course, sometimes removal is unavoidable.

Antibiotic treatment is necessary if the bursitis is caused by an infection—for example when bacteria enter the bursa through a wound or injury.

Physical therapy methods work naturally and support your body's healing processes. Their effect is slower but more lasting. You can choose from several methods that act in different ways. You can use several at once to reinforce each other's effects.

Icing, for example, relieves pain. Apply cold in the first 2–3 days after symptoms appear. It reduces pain and inflammation, but overcooling can also slow the healing processes.

Anti-inflammatory physical therapy methods—therapeutic ultrasound, softlaser, microcurrent, pulsed electromagnetic field therapy—on the other hand stimulate, accelerate and strengthen healing. If you have such a device, you can perform the daily required treatments at home without spending half a day waiting at the clinic.

To prevent recurrences you need to strengthen the muscles of the affected area. Of course, do this only after the acute pains have subsided! Regular exercise is very important in preventing bursitis as well.