Bursa Injection: Understanding the Procedure, Benefits, and Risks

What is a bursa injection?

A bursa injection is a medical procedure involving the precise delivery of medication, typically a corticosteroid and a local anesthetic, directly into an inflamed bursa to reduce pain and inflammation caused by bursitis.

Understanding Bursae: The Anatomical Context

To comprehend a bursa injection, one must first understand the anatomy and function of bursae. What are Bursae? Bursae (plural of bursa) are small, fluid-filled sacs lined with a synovial membrane, similar to the lining of joints. Their primary function is to reduce friction and cushion pressure points between bones, tendons, muscles, and skin around joints. They act as natural gliding surfaces, allowing structures to move smoothly over one another during activity. Where are they Found? While there are over 150 bursae in the human body, they are most notably found in areas subject to high friction or pressure. Common locations include:

• Shoulder: Subacromial bursa (deltoid bursa)
• Hip: Trochanteric bursa, iliopsoas bursa
• Knee: Prepatellar bursa, infrapatellar bursa, anserine bursa
• Elbow: Olecranon bursa
• Heel: Retrocalcaneal bursa

What is Bursitis?

Bursitis is the inflammation of a bursa. When a bursa becomes inflamed, the synovial fluid within it can increase, and the lining can thicken, leading to pain, swelling, and tenderness in the affected area. Common Causes: Bursitis often results from:

• Repetitive motion or overuse: Activities that involve repeated rubbing or pressure on a bursa (e.g., throwing, kneeling, prolonged sitting).
• Direct trauma: A sudden impact or fall onto a bursa.
• Prolonged pressure: Sustained pressure on a bursa (e.g., "housemaid's knee" from kneeling).
• Infection: Bacterial infection of the bursa (septic bursitis), which requires immediate medical attention.
• Systemic conditions: Certain inflammatory conditions like rheumatoid arthritis, gout, or pseudogout can also cause bursitis. Symptoms: Typical symptoms include localized pain, tenderness to touch, swelling, redness, and restricted range of motion in the adjacent joint or limb.

The Purpose of a Bursa Injection

The primary goal of a bursa injection is to provide targeted relief from the pain and inflammation associated with bursitis. When conservative treatments such as rest, ice, activity modification, anti-inflammatory medications (NSAIDs), and physical therapy have proven insufficient, a bursa injection may be considered. It aims to break the cycle of inflammation, allowing the bursa to heal and facilitating a return to normal function and rehabilitation exercises.

Components of a Bursa Injection

A bursa injection typically consists of two main components:

• Corticosteroid: This is a potent anti-inflammatory medication (e.g., triamcinolone, methylprednisolone, betamethasone). Corticosteroids work by suppressing the immune response and reducing the production of inflammatory chemicals in the body, thereby decreasing swelling, pain, and redness in the bursa. Their effects are not immediate but can last for weeks to months.
• Local Anesthetic: A fast-acting numbing agent (e.g., lidocaine, bupivacaine) is usually mixed with the corticosteroid or injected first. The anesthetic provides immediate pain relief, helping to confirm accurate needle placement and making the procedure more comfortable for the patient.

The Procedure: What to Expect

A bursa injection is an outpatient procedure usually performed in a clinic or doctor's office.

• Preparation: The injection site will be thoroughly cleaned with an antiseptic solution to minimize the risk of infection. In many cases, especially for deeper bursae or complex anatomy, imaging guidance (e.g., ultrasound or fluoroscopy) is used to ensure precise needle placement, increasing efficacy and reducing risks.
• Injection Process:
  1. The healthcare provider will identify the exact location for the injection.
  2. A fine needle is carefully inserted into the bursa. If a local anesthetic is not mixed with the corticosteroid, it may be injected first to numb the area.
  3. Once the needle is confirmed to be within the bursa (often confirmed by imaging or a "give" sensation as the needle enters the sac), the corticosteroid and anesthetic solution are slowly injected.
  4. The needle is then withdrawn, and a small bandage is applied.
• Post-procedure Immediate Care: Patients are typically advised to apply ice to the injection site for 15-20 minutes to help minimize post-injection soreness or swelling.

Benefits and Expected Outcomes

When successful, a bursa injection can offer significant benefits:

• Rapid Pain Relief: The local anesthetic provides immediate, albeit temporary, pain relief.
• Reduced Inflammation: The corticosteroid works to decrease the underlying inflammation, leading to more sustained pain reduction.
• Improved Range of Motion: As pain and swelling subside, movement in the affected area can improve, facilitating daily activities and exercise.
• Facilitating Physical Therapy: By alleviating pain, the injection can allow patients to more effectively participate in physical therapy, which is crucial for long-term recovery, strengthening surrounding muscles, and preventing recurrence.

Potential Risks and Side Effects

While generally safe, bursa injections carry some potential risks and side effects:

• Common, Mild Side Effects:
  • Post-injection flare: A temporary increase in pain or soreness at the injection site for 24-48 hours after the procedure, often called a "steroid flare," as the steroid begins to crystallize. This usually resolves with ice and rest.
  • Temporary bruising or bleeding at the injection site.
• Less Common, More Serious Risks:
  • Infection: Although rare with sterile technique, any injection carries a risk of introducing bacteria into the bursa (septic bursitis), which is a serious complication requiring antibiotics.
  • Nerve damage: Accidental injury to a nearby nerve, leading to temporary or, rarely, permanent numbness or weakness.
  • Skin atrophy/depigmentation: Thinning or lightening of the skin at the injection site, particularly with superficial injections.
  • Tendon weakening or rupture: Repeated corticosteroid injections into or too close to a tendon can weaken it, increasing the risk of rupture. This is why injections are typically limited in frequency.
  • Systemic effects: While rare with localized injections, some corticosteroids can be absorbed into the bloodstream, potentially causing temporary increases in blood sugar (especially relevant for diabetics), facial flushing, or mood changes.
• Contraindications: Bursa injections may not be suitable for individuals with active infections, bleeding disorders, uncontrolled diabetes, or those who have recently received other steroid injections.

Recovery and Post-Injection Care

• Immediate Post-Injection: It's generally advised to avoid strenuous activity and heavy lifting for 24-48 hours after the injection to allow the medication to take effect and minimize irritation. Ice packs can help manage any initial soreness.
• Activity Modification: Depending on the severity of bursitis and the location of the injection, your healthcare provider may recommend temporary modifications to activities that aggravate the bursa.
• Follow-up and Physical Therapy: The injection is often just one component of a broader treatment strategy. Once pain is reduced, a structured physical therapy program is vital to address underlying biomechanical issues, strengthen supporting muscles, improve flexibility, and prevent recurrence.

Is a Bursa Injection Right for You?

A bursa injection is a medical intervention that should be discussed thoroughly with a qualified healthcare professional, such as an orthopedic specialist, sports medicine physician, or physiatrist. They will assess your condition, consider your medical history, and determine if a bursa injection is the most appropriate and safest course of action as part of a comprehensive treatment plan for your bursitis.