Bursitis: Causes, Symptoms, Diagnosis, and Treatment Options

What is Bursitis?

Bursitis is an inflammatory condition affecting the bursae, small fluid-filled sacs located near joints that act as cushions to reduce friction between bones, tendons, and muscles.

What is a Bursa?

To understand bursitis, it's crucial to first understand the bursa itself. A bursa (plural: bursae) is a small, thin, slippery sac filled with synovial fluid. These remarkable anatomical structures are strategically positioned throughout the body, particularly around major joints such as the shoulders, elbows, hips, and knees. Their primary function is to reduce friction between moving parts of the musculoskeletal system, acting as a natural cushion that allows muscles, tendons, and skin to glide smoothly over bones. Without bursae, repetitive movements would cause excessive wear and tear on tissues, leading to pain and damage.

Understanding Bursitis: Definition and Mechanism

Bursitis is the medical term for the inflammation of a bursa. When a bursa becomes inflamed, it swells and produces excess fluid, which can then press on surrounding structures, leading to pain, tenderness, and restricted movement. This inflammation is typically a response to irritation or injury. The smooth, frictionless gliding that bursae usually facilitate is disrupted, resulting in discomfort and impaired joint function.

Common Causes of Bursitis

Bursitis can arise from a variety of factors, often related to mechanical stress or underlying systemic conditions:

• Repetitive Motion or Overuse: This is the most common cause. Engaging in activities that involve repetitive movements, especially those that put stress on a particular joint, can irritate the bursa. Examples include throwing sports (shoulder), kneeling (knee, "housemaid's knee"), prolonged leaning on elbows (elbow, "student's elbow"), or repeated lifting.
• Direct Trauma or Injury: A sudden impact or fall directly onto a bursa can cause it to become inflamed.
• Prolonged Pressure: Sustained pressure on a joint, such as kneeling for extended periods or prolonged sitting on a hard surface, can also irritate the underlying bursa.
• Infection (Septic Bursitis): Bacteria can enter a bursa through a cut, scrape, or puncture wound near the joint, leading to an infection. This type of bursitis is often more severe, characterized by warmth, redness, and fever.
• Systemic Conditions: Certain underlying medical conditions can predispose individuals to bursitis. These include:
  • Rheumatoid Arthritis: An autoimmune disease causing chronic inflammation of joints.
  • Gout: A form of arthritis caused by the accumulation of uric acid crystals in joints.
  • Pseudogout: Similar to gout but caused by calcium pyrophosphate crystals.
  • Diabetes: Can increase susceptibility to infections, including septic bursitis.
• Poor Biomechanics or Posture: Imbalances in muscle strength, poor posture, or abnormal gait patterns can place undue stress on certain bursae, contributing to inflammation.

Common Locations of Bursitis

While bursitis can occur in any bursa, certain locations are more frequently affected due to their exposure to repetitive motion or pressure:

• Shoulder (Subacromial Bursitis): Located under the acromion bone and deltoid muscle, cushioning the rotator cuff tendons. Often caused by overhead activities, lifting, or repetitive arm movements.
• Elbow (Olecranon Bursitis): Located at the tip of the elbow (olecranon process). Commonly known as "student's elbow" or "miner's elbow" due to prolonged leaning on hard surfaces.
• Hip (Trochanteric Bursitis): Located on the outer part of the hip, over the greater trochanter of the femur. Often associated with running, cycling, prolonged standing, or leg length discrepancies.
• Knee: Several bursae around the knee can become inflamed:
  • Prepatellar Bursitis: At the front of the kneecap ("housemaid's knee" or "carpet layer's knee").
  • Infrapatellar Bursitis: Below the kneecap ("clergyman's knee").
  • Pes Anserine Bursitis: On the inner side of the knee, below the joint line. Common in runners or those with tight hamstrings.
• Heel (Retrocalcaneal Bursitis): Located at the back of the heel, where the Achilles tendon inserts into the calcaneus. Often irritated by tight shoes or Achilles tendon overuse.

Signs and Symptoms

The symptoms of bursitis typically develop gradually but can sometimes appear suddenly. Common signs include:

• Pain: Usually localized to the affected area, often sharp initially, then becoming a dull ache. The pain typically worsens with movement or pressure on the bursa.
• Swelling: The affected area may appear visibly swollen or puffy, forming a soft lump.
• Tenderness: The bursa will be painful to touch or palpate.
• Redness and Warmth: Especially prominent in cases of septic (infected) bursitis, the skin over the bursa may feel warm and appear red.
• Limited Range of Motion: Pain and swelling can restrict the ability to move the affected joint fully.
• Stiffness: The joint may feel stiff, particularly after periods of inactivity.

Diagnosis

Diagnosing bursitis typically involves a combination of clinical assessment and, sometimes, imaging studies:

• Clinical Examination: A healthcare professional will take a detailed medical history and perform a physical examination. This includes assessing the affected area for tenderness, swelling, warmth, and evaluating the range of motion of the adjacent joint.
• Imaging Studies:
  • X-rays: Primarily used to rule out other conditions like fractures or arthritis, as bursae are not visible on X-rays.
  • Ultrasound: Can effectively visualize the inflamed bursa, showing fluid accumulation and swelling.
  • MRI (Magnetic Resonance Imaging): Provides detailed images of soft tissues and can help differentiate bursitis from other conditions affecting tendons or ligaments.
• Fluid Aspiration (Bursa Aspiration): If an infection (septic bursitis) is suspected, a small amount of fluid may be drawn from the busa with a needle. This fluid is then sent to a laboratory for analysis to identify bacteria or crystals (e.g., uric acid crystals in gout).
• Blood Tests: May be performed to check for signs of infection (e.g., elevated white blood cell count) or to screen for systemic inflammatory conditions like rheumatoid arthritis.

Treatment Approaches

The primary goals of bursitis treatment are to reduce inflammation, alleviate pain, and restore normal function. Treatment strategies vary depending on the cause and severity:

• Conservative Management (RICE Protocol):
  • Rest: Avoid activities that aggravate the bursa.
  • Ice: Apply ice packs to the affected area for 15-20 minutes several times a day to reduce swelling and pain.
  • Compression: Light compression may help reduce swelling (avoid if painful).
  • Elevation: Elevating the affected limb can help reduce fluid accumulation.
• Medications:
  • NSAIDs (Nonsteroidal Anti-inflammatory Drugs): Over-the-counter options like ibuprofen or naproxen can help reduce pain and inflammation. Prescription-strength NSAIDs may be used for more severe cases.
  • Pain Relievers: Acetaminophen can help manage pain, though it doesn't address inflammation.
  • Antibiotics: Crucial for treating septic bursitis; prescribed based on the identified bacteria.
• Physical Therapy: A physical therapist can design a program to:
  • Reduce pain and inflammation through modalities (e.g., ultrasound, electrical stimulation).
  • Restore range of motion and flexibility.
  • Strengthen surrounding muscles to improve joint stability and biomechanics.
  • Educate on proper movement patterns and ergonomic adjustments.
• Corticosteroid Injections: A corticosteroid, a powerful anti-inflammatory medication, can be injected directly into the bursa to rapidly reduce inflammation and pain. This is typically done if conservative measures are insufficient.
• Aspiration: If the bursa is significantly swollen with excess fluid, it may be aspirated (drained) with a needle to relieve pressure and pain.
• Surgery (Bursectomy): Surgical removal of the b bursa (bursectomy) is rarely necessary and is reserved for chronic, severe cases that do not respond to other treatments, or for recurrent septic bursitis.

Prevention Strategies

Preventing bursitis often involves modifying activities and improving biomechanics:

• Proper Warm-up and Cool-down: Always warm up before exercise and cool down afterward to prepare muscles and joints.
• Gradual Progression: Increase the intensity, duration, or frequency of activities gradually to avoid overloading joints and bursae.
• Correct Biomechanics and Technique: Ensure proper form during sports, exercise, and occupational tasks to minimize stress on joints. Consider professional coaching or ergonomic assessments.
• Ergonomic Adjustments: Use ergonomic equipment at work or home, such as padded chairs, kneeling pads, or wrist rests, to reduce prolonged pressure.
• Protective Padding: Use knee pads or elbow pads when engaging in activities that involve prolonged kneeling or leaning.
• Strength and Flexibility: Maintain balanced muscle strength around joints and ensure adequate flexibility to support healthy movement patterns.
• Listen to Your Body: Avoid pushing through pain. If an activity causes discomfort, modify it or take a break.

When to Seek Medical Attention

While many cases of bursitis resolve with rest and self-care, it's important to seek medical attention if you experience:

• Severe, sudden pain that limits your ability to move the joint.
• Excessive swelling, redness, or warmth over the bursa, especially if accompanied by red streaks extending from the area.
• Fever or general malaise (feeling unwell), which could indicate an infection (septic bursitis).
• Symptoms that do not improve within a few days of rest and home care.
• Recurrent episodes of bursitis.

Early diagnosis and appropriate treatment can prevent chronic pain and further complications, allowing for a quicker return to normal activities.