Bursitis

Bursitis is the painful inflammation of a bursa – a fluid-filled sack that cushions joint movement. Bursitis most commonly affects the shoulder but is also common in bursae located near other major joints, including the hips, elbows, knees, and heels.

Common symptoms include pain and swelling, arising from a range of causes such as strenuous physical activity and injury. Treatment typically involves resting the affected joint and preventing further irritation.

What are bursae?

Bursae (singular = bursa) are small, fluid-filled sacs found in areas of the body that are subject to movement and friction (rubbing). Bursae contain a small amount of synovial fluid – a clear lubricating fluid – and act to cushion the movement between the bones, tendons, and muscles near the joints.

Bursitis can occur in any of the approximately 160 bursae throughout the body. “Student’s elbow” and “Housemaid’s knee” are colloquial terms used to describe two common forms of bursitis.

Causes

Bursitis can occur for a variety of reasons, including:

• Strenuous or repeated physical activity
• Injury or trauma
• Infection
• Underlying rheumatic conditions such as pseudogout and gout
• Inflammatory disorders such as rheumatoid arthritis, ankylosing spondylitis, and systemic lupus erythematosus.

Too much friction and/or pressure on a bursa can cause irritation and swelling. Repetitive motions or positions that can irritate the bursae around a joint include frequent and/or prolonged kneeling and leaning on one's elbows. Additionally, a sharp blow to the front of the knee, back of the elbow, or to the heel bone can cause a bursa to bleed or produce too much fluid, which results in swelling.

Bursitis caused by infection (septic bursitis) is uncommon. Infection may be introduced as a result of a break or puncture, scratch, or insect bite, to the overlying skin. Rarely, bacteria circulating in the blood can infect a chronically inflamed bursa. Occasionally bursitis can occur for no known reason.

Chronic (long-term) bursitis that is left untreated can result in a build-up of calcium deposits (calcific bursitis) in the soft tissues, resulting in permanent loss of movement to the area.

Signs and symptoms

Common symptoms of bursitis include:

• Tenderness or pain
• Heat
• Redness
• Swelling
• Stiffness
• Restricted movement.

Symptoms, especially the tenderness or pain caused by bursitis, may be worse in the mornings and after exercise or strenuous activity.

Diagnosis

A doctor may undertake the following to diagnose bursitis:

• Physical examination and full medical history
• X-rays
• Ultrasound scanning
• Blood tests
• Taking a sample of the fluid in the affected bursae to rule out infection or underlying conditions.

Treatment

The treatment of bursitis will depend on whether or not there is infection present. In cases where there is no infection treatment will focus on reducing inflammation, including:

• Ice packs applied to the area to reduce swelling and discomfort
• Resting the affected area (it may be necessary to restrict or stop the activity that has caused the bursitis)
• Wearing a support on the injured joint. eg: a sling for shoulder or elbow bursitis
• Reducing pressure on the affected area by wearing pads around the bursa and well-fitted shoes for heel bursitis
• Anti-inflammatory pain-relieving medications, eg: ibuprofen, naproxen
• Cortisone (corticosteroid) injections into the affected area
• Occasionally, the fluid may need to be aspirated (removed using a needle and syringe) from the affected bursa to relieve pressure. This may need to be done more than once
• Weight loss may be recommended in some cases in order to help to relieve pressure on the affected joint(s)
• Physical therapy or exercises to strengthen the muscles around the affected joint.

When infection is present (septic bursitis) antibiotics may need to be given. In severe cases, this may involve hospitalisation for the antibiotics to be given intravenously (through a drip into a vein).

In severe, chronic cases, surgical removal of the damaged bursa (bursectomy) may be necessary.

Prevention

The risk and severity of flare-ups of bursitis can be reduced by changing the way that certain tasks are performed, for example:

• Using kneeling pads for jobs or hobbies that require a lot of kneeling
• Bending the knees when lifting something, which will reduce stress on the bursae of the hips
• Wheeling rather than carrying heavy loads, which will reduce stress on the bursae of the shoulders
• Taking frequent breaks from repetitive tasks
• Maintaining a healthy bodyweight to reduce stress on the joints
• Exercising to strengthen muscles (which can help to protect affected joints)
• Warming up and stretching before strenuous activities to prevent joint injury
• Cleaning scratches or cuts on elbows and knees to prevent infection.

References

Lohr, K.M. (2018). Bursitis (Web page). Medscape Drugs and Diseases. New York, NY: WebMD LLC. http://emedicine.medscape.com/article/2145588-overview [Accessed: 31/03/20]
Mayo Clinic (2017). Bursitis (Web Page). Rochester, MN: Mayo Foundation for Medical Education and Research. http://www.mayoclinic.org/diseases-conditions/bursitis/basics/definition/con-20015102 [Accessed: 31/03/20]
NHS (2017). Bursitis (Web Page). Redditch: National Health Service (NHS)
England. https://www.nhs.uk/conditions/bursitis/ [Accessed: 31/03/20]
O’Toole, M.T. (Ed.) (2017). Bursitis. Mosby’s Dictionary of Medicine, Nursing & Health Professions (10th ed.). St Louis, MI: Elsevier.

Last Reviewed – March 2020

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