Our bodies were constructed to withstand a certain level of pressure; however, with repetitive stress or excessive pressure, inflammation can occur.
Bursitis refers to inflammation of the fluid-filled sacs (bursa) that function as a cushioning surface to reduce friction between tissues of the body. In all, there are more than 150 bursae in the body which help joints move with ease(Figure 1). Bursitis (Figure 2) usually affects the joints in the shoulders, elbows, hips, and knees, although it can also occur in heels and at the base of big toes. Roughly 8.7 million people in the United States have bursitis.
There are several causes of bursitis, including overuse, stress or direct trauma to a joint such as repeated bumping or prolonged pressure. Bursitis can also be the result of arthritis, infection or gout.
Different parts of the body can develop bursitis in different ways. Bursitis of the shoulder (Figure 3) is often the result of injuries to the rotator cuff which connects the upper arm to the shoulder blade. Here, causes include falling, repetitive overhead activities and lifting.
Bursitis of the elbow (Figure 4) is associated with actions which require repeated bending and extending of the elbow, such as throwing a ball or Frisbee®.
Hip bursitis (Figure 5) is usually associated with arthritis or a hip injury and results from falls or standing or sitting for prolonged periods.
Knee bursitis (Figure 2) is usually caused by repetitive pressure, such as kneeling, or a sharp blow. Knee bursitis is often the result of impact sustained during athletic activities. It is usually characterized by an egg shaped bump on the front of the knee.
There is a risk that an inflamed bursa can become infected. This is often a major concern for patients with elbow bursitis because the inflamed bursa is close to the skin. For patients with hip or shoulder bursitis, the chance of infection is less of a concern because inflammation occurs much deeper in the body. Signs of infection include open wounds around the area of bursitis, fever, chills and redness or increasing warmth around the skin. If infection is suspected, fluid from the swollen bursa will be obtained using a needle and syringe.
While an infected bursa may require surgery, it can often be treated with antibiotics.
Patients with bursitis will likely experience stiffness or an ache in the inflamed area. Pain is usually intensified with movement or pressure. Other symptoms include swelling and redness in the area of inflammation.
Bursitis of the hip, however, may be more difficult to identify because the hip is not as close to the surface as other joints, thus there may be no visible swelling or skin redness. Doctors are typically able to diagnose bursitis with a combination of physical examination and x-ray imaging. By feeling the painful joint and surrounding area, doctors are able to identify points of tenderness. While x ray imaging is not tantamount in identifying bursitis, it can help exclude other possible causes of inflammation.
Bursitis is usually treated conservatively (Figure 6) with rest, immobilization, ice application, or anti-inflammatory medications. Physical therapy and injections into the bursa are also commonly used to relieve inflammation. Occasionally, bursitis requires aspiration of the bursa fluid. This involves removing the fluid with a needle and syringe. Of course, there are precautions that can be taken to lessen the chance of developing bursitis. First, proper stretching and strengthening of muscles will help prevent bursitis. Strengthening is an important factor in helping protect joints. Providing cushioning for joints is also an essential method for protecting joints from bursitis. Finally, taking breaks from repetitive tasks will lessen the chance of developing bursitis.
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