Bursitis

Bursitis is an easily treatable disease caused by inflammation of a bursa. Bursae (plural form) are small fluid-filled sacs that function as cushions between bone and other moving tissues of the musculoskeletal system. It is estimated that there are over 150 bursae in the human body, with about 50 of them actually named. ^[1]. Although any bursa can get inflamed, the bursae of the larger joints are the ones most commonly affected. These include joints such as the shoulders, elbows, hips, knees, ankles, and feet.

Common Types of Bursitis

• Subacromial/subdeltoid busitis - lateral shoulder
• Trochanteric bursitis - lateral hip
• Olecranon bursitis - elbow
• Prepatellar bursitis - anterior knee
• Pes Anserine bursitis - anterior/medial knee ^[2]
• Ischial bursitis - lower/posterior pelvis (buttock area)
• Retrocalcaneal bursitis - posterior foot (back of the heel)
• Achilles bursitis - posterior ankle

Signs and Symptoms

• Joint pain
• Joint stiffness
• Tenderness
• Swelling
• Warmth over the affected joint

Causes

Bursitis is commonly caused by overuse or direct trauma to the area around a joint. Bursitis may occur in the shoulder of a tennis player; for example, from repetitive overhead serves. Or bursitis may occur in the elbow after falling from a bicycle as a result of direct trauma. Overuse trauma is often called repetitive micro-trauma and as such, often causes painful inflammation. People such as carpenters, gardeners, musicians, and athletes who perform activities that require repetitive motions or place stress on joints are at higher risk for bursitis, as well as tendinitis.

Other causes of bursitis, although not as common, include: infections, arthritis, gout, thyroid disease, and diabetes.

Diagnosis

Bursitis is a clinical diagnosis and can be obtained with only a thorough history and physical examination. The patient will describe the pain and circumstances in which the pain occurs. The location and onset of pain, whether it varies in severity throughout the day, and the factors that relieve or aggravate the pain are all important diagnostic clues. X rays are not helpful in the diagnosis of bursitis, but may be helpful in ruling out possible problems with the bones (fractures, dislocations, spurs, degeneration).

On physical exam, the clinician may touch the affected area and feel for warmth or tenderness. The bursa which is inflamed will almost always be tender when firmly pressed. A skilled clinician will then easily be able to locate the exact area.

Treatment

• NSAID course
• Avoidance of aggravating movements
• Cold compress
• Corticosteroid injection

Treatment focuses on healing the inflammation of the bursa. The goals of treatment are to reduce pain, cool the inflammation, and allow the body to heal. Anti-inflammatory medications, such as naproxen (Aleve, Naprosyn) or ibuprofen (Advil, Motrin), help with reducing the inflammation. They also worked pretty well in reducing pain. It is important to note that once an anti-inflammatory drug regimen is stated, it should be taken regularly for 7 to 14 days depending on the severity and duration of the bursitis. Taking these medicines on an as needed basis could possibly prolong the healing effect.

The avoidance of any aggravating motions is crucial in the healing phase. Once an area of the body is inflamed, it means the healing cascade has already begun and puts the affected area in a very vulnerable state. As such, re-injury is very easy.

Cold compresses or ice packs are helpful in controlling inflammation in acute injuries, but most cases of bursitis are probably chronic, and therefore, ice generally not helpful.

Pain is often controlled while on the anti-inflammatory medicine and with relative rest of the affected area. However, if additional pain relief is required, acetaminophen (Tylenol) can be taken.

Most cases of bursitis resolve within 10 to 14 days with the treatment described above. However, sometimes the inflammation is just not resolved. In these cases, the doctor may inject a more potent anti-inflammatory medicine (a corticosteroid) directly into the inflamed bursa. The corticosteroid is often mixed together with an anesthetic agent (lidocaine) to provide instantaneous relief. Bursa injections are extremely effective, quick, and relatively safe. T^[3]

Prevention

• Warm up or stretch before physical activity.
• Strengthen muscles around the joint.
• Take frequent breaks from repetitive tasks.
• Cushion the affected joint. Use foam for kneeling or elbow pads. Increase the gripping surface of tools with gloves or padding. Apply grip tape or an oversized grip to golf clubs.
• Use two hands to hold heavy tools; use a two-handed backhand in tennis.
• Don’t sit in one position for long periods.
• Practice good posture and position the body properly when going about daily activities.
• Begin new activities or exercise regimens slowly. Gradually increase physical demands following several well-tolerated exercise sessions.
• And the general rule of thumb, "If it hurts, don't do it!"

^[4]

Notable Experts

A primary care physician is usually the one who treats most cases of bursitis. Complicated cases or those resistant to conservative therapies may require referral to a specialist, such as an orthopaedist or rheumatologist.

Other Resources

• National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
  Information Clearinghouse
  National Institutes of Health

1 AMS Circle
Bethesda,  MD 20892-3675
Phone: 301-495-4484
Toll Free: 877-22-NIAMS (226-4267)
TTY: 301–565–2966
Fax: 301-718-6366
Email: NIAMSinfo@mail.nih.gov
Website: http://www.niams.nih.gov

• American Academy of Orthopaedic Surgeons (AAOS)

P.O. Box 2058
Des Plaines,  IL 60017
Toll Free: 800-824-BONE (2663)
Email: pemr@aaos.org
Website: http://www.aaos.org (orthoinfo.aaos.org).

• American College of Rheumatology (ACR)

1800 Century Place, Suite 250
Atlanta,  GA 30345-4300
Phone: 404-633-3777
Fax: 404-633-1870
Website: http://www.rheumatology.org

• American Physical Therapy Association

1111 North Fairfax Street
Alexandria,  VA 22314-1488
Phone: 703–684–2782
Toll Free: 800–999–2782, ext. 3395
Website: http://www.apta.org

• Arthritis Foundation

P.O. Box 7669
Atlanta,  GA 30357-0669
Phone: 404-872-7100
Toll Free: 800-283-7800
Website: http://www.arthritis.org

References

1. ↑ Hollinshead, W. Henry and Rosse, Cornelius 1985 Textbook of Anatomy, 4E, Harper & Row, Publishers, Philadelphia, p. 19
2. ↑ Rennie and Saifuddin; "Pes anserine bursitis : incidence in symptomatic knees and clinical presentation;" Skeletal radiology 2005, vol. 34, no7, pp. 395-398 [4 page(s) (article)]; Abstract
3. ↑ Shbeeb et al; "Evaluation of glucocorticosteroid injection for the treatment of trochanteric bursitis;" Journal of rheumatology 1996, vol. 23, no12, pp. 2104-2106 Abstract
4. ↑ Adapted from MayoClinic.com