Bursitis

Bursitis is inflammation of a bursa, a small fluid-filled sac that acts as a cushion between bone and muscle, skin or tendon. The type of bursitis depends on where the affected bursa is located. This soft tissue condition commonly affects the shoulder, elbow, hip, buttocks, knees and calf.  Athletes, the elderly and people who do repetitive movements like manual laborers and musicians are more likely to get bursitis.  

Bursitis is sometimes mistaken for arthritis because the pain occurs near a joint.

Bursitis causes swelling, tenderness and pain in areas around a joint. It will be painful to move the affected joint through its full range of motion. The pain of bursitis can occur suddenly, may last for days or longer and usually gets better with rest or treatment. Bursitis can also happen in the same area more than once.

Bursitis often results from sport injuries or repetitive movements. But it can also be caused by:

• A bruise or cut getting infected.
• Bad posture or walking habits.
• Stress on soft tissues from an abnormal or poorly positioned joint or bone (such as leg length differences or joint deformities).
• Some types of arthritis and related conditions (rheumatoid arthritis, osteoarthritis or gout.)
• Metabolic conditions such as diabetes.

Diagnosis is based on review of symptoms, medical history and a physical exam. Persistent redness or swelling around a joint, along with fever or chills, should be evaluated immediately. These symptoms can be caused by an infection.

Bursitis may go away over time with self-care. If it doesn't, a primary care doctor will focus on reducing pain and inflammation and preserving mobility. The doctor may refer you to a rheumatologist, an orthopedic surgeon or a physical therapist for specialized treatment. When properly treated, bursitis doesn't result in permanent joint damage or disability.

Common bursitis treatment options include:

Splints and Braces
Many soft tissue conditions are caused by muscle overuse, so the first treatment may include resting the painful area or avoiding a particular activity for a while. Splints, braces or slings provide added support to the affected area until the pain eases.

Medications
The doctor may recommend a pain reliever, such as acetaminophen or a nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen or naproxen.  You may begin using over-the-counter (OTC) versions. If the pain is severe or the OTC version doesn’t help, the doctor may prescribe a stronger version.  If necessary, an anti-inflammatory drug called a corticosteroid may be injected into the bursa. Learn more about the medications used to treat bursitis at the arthritis drug guide.

Physical Therapy
A physical therapist can provide the following:

• Hot/cold treatments, ultrasound, laser and water therapy
• Soft tissue manual therapy
• Orthotics or pressure-relieving devices for the arms and legs
• A personalized exercise program
• Analysis of posture and walking
• Education on ways to avoid overuse injuries

Occupational Therapy
An occupational therapist can different ways to do daily activities and work habits to prevent stress or injury to an affected area. The therapist can also create hand and wrist splints and suggest assistive devices to help make your daily activities easier.

Surgery
Surgery may be required if symptoms don’t improve between six months and a year.

The best way to prevent or reduce the pain and swelling of bursitis is to: 

• Use hot and cold therapy. A cold pack can help reduce initial swelling and pain. Cold therapy is most effective during the first 48 hours after pain and swelling begin. After 48 hours or for chronic pain, dry or moist heat (e.g., warm bath) is more helpful.
• Avoid or adjust activities that cause the problem.
• Maintain a healthy weight to take pressure off painful and swollen joints.
• Do range-of-motion exercises to improve flexibility and reduce stiffness.
• Cushion the affected area when adding pressure (e.g. while kneeling or leaning on elbows).