Bursitis is the painful inflammation of the bursa, a padlike sac that cushions the movement between the bones, tendons and muscles near the joints. Bursitis is most often caused by repetitive movement, and is also known by severalcommon names including weaver's bottom, clergyman's knee, and miner's elbow.

There are over 150 bursae in the human body. Each sac contains a small amountof synovial fluid, a clear liquid that acts as a lubricant. Inflammation of the bursae causes pain on movement. The most common site for bursitisto occur is the shoulder (subdeltoid), but it also is seen in the elbows, hips, knees, heels, and toes.

The most common cause of bursitis is repeated physical activity, but it can flare up for no known reason. It can also be caused by trauma, rheumatoid arthritis, gout, and acute or chronic infection.

Pain and tenderness are common symptoms. If the affected joint is close to the skin, as with the shoulder, knee, elbow, or Achilles tendon, swelling and redness are seen and the area may feel warm to the touch. The bursae around the hip joint are deeper, and swelling is not obvious. Movement may be limitedand is painful. In the shoulder, it may be difficult to raise the arm out from the side of the body.

In acute bursitis symptoms appear suddenly; with chronic bursitis, pain, tenderness, and limited movement reappear after exercise or strain.

When a patient has joint pain, a careful physical examination is needed to determine what type of movement is affected and if there is any swelling present. Bursitis will not show up on x rays, although sometimes calcium deposits in the joint may be visible. Inserting a thin needle into the affected bursa and removing (aspirating) some of the synovial fluid for examination can confirm the diagnosis. In most cases, the fluid will not be clear. It can be tested for the presence of microorganisms, which would indicate an infection, andcrystals, which could indicate gout. In instances where the diagnosis is difficult, a local anesthetic (a drug that numbs the area) is injected into the painful spot. If the discomfort stops temporarily, then bursitis is probably the correct diagnosis.

Conservative treatment of bursitis is usually effective. The application of heat, rest, and immobilization of the affected joint area is the first step. Asling can be used for a shoulder injury; a cane is helpful for hip problems.The patient can take nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofin, and naproxen. They can be obtained without a prescription andrelieve the pain and inflammation.

When bursitis does not respond to conservative treatment, an injection into the joint of a long-acting corticosteroid preparation, like prednisone, can bring immediate and lasting relief. A corticosteroid is a hormonal substance that is the most effective drug for reducing inflammation. The drug is mixed with a local anesthetic and works on the joint within five minutes. Usually oneinjection is all that is needed. In cases where both anti-inflammatory and corticosteroid medications are not effective in relieving bursitis pain, surgery to remove the damaged bursa may be performed

If the bursitis is related to an inflammatory disease like arthritis or gout,or to an infection, then management of that condition is needed to control the bursitis. Septic bursitis is caused by the presence of a pus-forming organism, usually staphylococcus aureus. This condition requires treatment with antibiotics. The bursa will also need to be drained by needle twoor three times over the first week of treatment. When a patient has such a serious infection, there may be underlying causes such as diabetes or an inefficient immune system.

Once the pain caused by the bursitis decreases, exercise of the affected areacan begin. If the nearby muscles have become weak, a doctor or physical therapist can recommend exercises to build strength and improve movement.

The use of vitamin supplements, herbs, homeopathy, aromatherapy, and hydrotherapy can help relieve the symptoms of bursitis. Calcium and magnesium supplements may help prevent the condition, and ginger is useful in reducing inflammation. Acupuncture has been proven effective in treating hip and shoulder pain caused by bursitis. Other therapies that deal effectively with musculoskeletal problems (relating to the muscles and skeleton), may also be helpful, such as naturopathic medicine, chiropractic, and applied kinesiology.

To prevent a reoccurence of bursitis, overexercising and repetitive movementsthat trigger the condition should be avoided. When doing repetitive tasks, frequent breaks should be taken. To protect the joints, use cushioned chairs when sitting and foam kneeling pads for the knees. Leaning on the elbows, kneeling or sitting on a hard surface for a long period of time should be avoided. Wearing low heeled shoes can help prevent bursitis in the heel, as can changing to new running shoes as soon as the old ones are worn out.

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