Rehab Articles

Bursitis is a painful condition that affects the joints. Bursae are fluid-filled sacs that act as a cushion between bones, tendons, joints, and muscles. When these sacs become inflamed it is called bursitis.

It is a relatively common condition, but many people treat it at home and do not see a doctor, so it is hard to know how common it is.

There are over 150 bursae in the human body. They cushion and lubricate points between the bones, tendons, and muscles near the joints.

The bursae are lined with synovial cells. Synovial cells produce a lubricant that reduces friction between tissues. This cushioning and lubrication allows our joints to move easily.

When a person has bursitis, or inflammation of the bursa, movement or pressure is painful.
Overuse, injury, and sometimes an infection from gout or rheumatoid arthritis may cause bursitis. Tennis elbow is one type of bursitis.

TYPES
Any bursa can become affected, but bursitis is more likely in certain places. People with bursitis will feel pain at the site of inflammation.

The areas where bursitis most commonly occurs are the:
•    shoulders
•    elbows
•    ankles
•    knees
•    buttocks
•    hips
•    thighs

When bursitis affects the knee, it is sometimes called "clergyman's knee," or "housemaid's knee," and when it affects the elbow, it is "tennis elbow."

TREATMENT
Treatment will depend on the severity of the symptoms.

Self-treatment
Most cases of bursitis cases can be treated at home, with the help of a pharmacist and some self-care techniques.

Self-care normally involves:
•    Protecting the affected area: Padding can protect the affected bursae from contact.
•    Rest: Not using the joints in the affected area unless necessary. Bursitis responds well to rest.
•    Ice packs: Placing ice packs wrapped in a towel on the affected area can help reduce pain and inflammation.

Alternatively, a small pack of frozen vegetables will do. The ice should not be placed directly on the skin. Ice packs for injuries are available for purchase online.
•    Raising the affected area: Less blood will gather if it is elevated, and this may help reduce inflammation.
•    Painkillers: Ibuprofen is effective as a painkiller and to reduce inflammation. Ibuprofen is available to buy over-the-counter or online.

Medical treatment
Medical treatment may be needed for more severe symptoms.

Steroids
The doctor may inject steroids into the affected area. Steroids block a body chemical called prostaglandin. Prostaglandin causes inflammation. Steroids should be used with care, as they may raise the patient's blood pressure if used for too long, and increase the risk of getting an infection.

Antibiotics
If a fluid test confirms a bacterial infection, the doctor will probably prescribe antibiotics. These will be administered orally, for example as tablets, or intravenously, in more severe cases.
Very rarely, the bursa may have to be surgically drained.

SYMPTOMS
A person with bursitis can have one or more of the following symptoms:
•    Pain that increases with movement or pressure
•    Tenderness, even without movement
•    Swelling
•    Loss of movement

If the bursitis is caused by an infection, it is called septic bursitis. A patient with septic bursitis may have the following additional symptoms:
•    Fever
•    Redness in the affected area
•    The affected area feels hot when touched

WHEN TO SEE A DOCTOR
Many people treat bursitis at home, but if symptoms are more severe, they should seek medical help.
More severe symptoms include:
•    Joint pain that prevents all movement
•    Pain lasting longer than 2 weeks
•    Sharp, shooting pains
•    Excessive swelling, bruising, rash, or redness in the affected region
•    Fever

These may be signs of septic bursitis, a potentially serious medical condition.

CAUSES
Bursitis can result from an injury, an infection, or a pre-existing condition in which crystals can form in the bursa.

Injury
An injury can irritate the tissue inside the bursa and cause inflammation. Doctors say that bursitis caused by an injury usually takes time to develop. The joints, tendons, or muscles that are near the bursa may have been overused. Most commonly, injury is caused by repetitive movements.

Some causes of bursitis include:
•    Tennis elbow: Bursitis is a common problem among tennis players and golfers. Repetitive bending of the elbow can lead to injury and inflammation.
•    Clergyman's knee: Repeated kneeling can cause injury and swelling to the bursae in the knee area.
•    Shoulder: Repeated overhead lifting or reaching upwards can cause bursitis in the shoulder.
•    Ankle: Injury to the ankle can result from walking too much and with the wrong shoes. It is common among ice skaters and athletes.
•    Buttocks: The bursae in this area can become inflamed after sitting on a hard surface for a long time, such as on a bicycle.
•    Hips: Some runners and sprinters can develop hip bursitis.
•    Thigh: Bursitis can be caused by stretching.

Bursitis can also be caused by a hard blow to the area.

Infection
Infection that causes bursitis tends to be in bursae that are nearer the surface of the skin, such as those near the elbow. A cut on the skin is an opportunity for the bacteria to get in.

Most healthy people are not affected by bacteria entering through the skin, but people with a weakened immune system are more at risk. Examples are those with diabetes or HIV/AIDS, those who are receiving chemotherapy or radiotherapy for cancer treatment, people taking steroids, and heavy consumers of alcohol.

Health conditions
People with certain health conditions are more likely to have crystals form inside the bursa. The crystals irritate the bursa and make it swell. Conditions that may cause this include gout, rheumatoid arthritis, and scleroderma.

DIAGNOSIS
To diagnose bursitis, a doctor will examine the affected area and ask the patient about their recent activities.

If the patient has a high temperature, the physician may take a small sample of fluid from a bursa near the affected body part. The sample will be tested for bacteria, and perhaps also crystals.

If treatment is not effective, the doctor may carry out further tests to eliminate the possibility of a more serious condition.

Tests include:
•    An X-ray, to check for broken or fractured bones
•    Blood tests, to assess for rheumatoid arthritis
•    A CT scan or MRI scan to see if there is a torn tendon

PREVENTION
The following tips are commonly recommended for preventing bursitis:
•    Protect vulnerable parts of the body: Individuals who kneel a lot could get knee pads. Elbow braces can protect tennis and golf players. Athletes or avid walkers should invest in some good walking or running shoes.
•    When doing repetitive tasks, take breaks: Apart from taking regular breaks, varying movements to use different parts of the body can help.
•    Maintain a healthy weight: Being overweight or obese puts extra stress on the joints.
•    Warm up before exercise: Before vigorous exercise, it is best to warm up for at least 5 to 10 minutes. Activities could include walking at a good speed, slow jogging, or a cycling machine.
•    Strong muscles add extra protection to the area: Strengthening the muscles in an area where bursitis has occurred, especially around the joint, will provide extra protection from injury.

Exercises to strengthen muscles should only be done after the bursitis has gone completely.

Article By: Christian Nordqvist (Reviewed By: William Morrison, MD)