Bursitis (patient information)

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 * Assistant Editor-In-Chief: Amanda Chirlin, B.A.

Overview
Bursitis is a common condition involving inflammation of one of your bursa sacs, which are filmy-colored sacs that protect and cushion your joints. The inflammation may result from arthritis in the joint or injury or infection of a bursa. Bursitis produces pain and tenderness and may limit the movement of nearby joints.

What are the symptoms of Bursitis?
Bursitis most typically occurs in the elbow, shoulder, or hip, although it can also occur in the heel, the knee, or the base of the big toe.

Symptoms may include:
 * Stiff and aching joint
 * Swollen and red joint
 * Increased pain when the joint is pressed on or manipulated

What causes Bursitis?
A bursa is a small, fluid-filled sac that acts as a cushion between a bone and other moving parts: muscles, tendons, or skin. Bursae are found throughout the body. Bursitis occurs when a bursa becomes inflamed (redness and increased fluid in the bursa).

Injuries, overuse, and repetitive stress are common causes of bursitis. Certain diseases, such as arthritis and gout, might also cause it. Bursitis is also commonly caused by direct trauma to a joint. Bursitis may occur at the knee or elbow, from kneeling or leaning on the elbows longer than usual on a hard surface, for example. It occurs more often with age.

Who is at highest risk?
Factors that increase your risk for developing bursitis include:
 * Middle age
 * Diabetes
 * Rheumatoid arthritis
 * Osteoarthritis
 * Thyroid disease
 * Gout
 * Having a hobby or job that involves repetitive motions such as bicycling, playing baseball, gardening, or setting tiles.

When to seek urgent medical care?
Call your doctor to schedule and appointment if:
 * Joint pain significantly interferes with your daily activities
 * Joint pain lasts over two weeks
 * Joint is extremely swollen
 * Joint is red or bruised, or there is a rash on the joint
 * You experience piercing pain when you partake in physical activity
 * You develop a fever

Diagnosis
Your doctor can diagnose you with bursitis by pressing on specific areas of the joint to determine if it is an inflamed bursa sac that is affecting you.

That is usually sufficient for diagnosis, although if the doctor suspects something other than bursitis, s/he may take x-rays of the joint or order other lab tests.

Treatment options
Treatment focuses on healing the injured bursa. The first step is to reduce pain and inflammation with rest, compression, elevation, and anti-inflammatory medicines such as aspirin, naproxen, or ibuprofen. Ice may also be used in acute injuries, but many cases of bursitis are considered chronic, and ice is not helpful. When ice is needed, an ice pack can be applied to the affected area for 15–20 minutes every 4–6 hours for 3–5 days. Longer use of ice and a stretching program may be recommended by a health care provider.

Activity involving the affected joint is also restricted to encourage healing and prevent further injury.

The doctor or physical therapist may use ultrasound (gentle sound-wave vibrations) to warm deep tissues and improve blood flow. Iontophoresis may also be used. This involves using an electrical current to push a corticosteroid medication through the skin directly over the inflamed bursa. Gentle stretching and strengthening exercises are added gradually. Massage of the soft tissue may be helpful. These may be preceded or followed by use of an ice pack. The type of exercises recommended may vary depending on the location of the affected bursa.

If there is no improvement, the doctor may inject a corticosteroid medicine into the area surrounding the inflamed bursa. While corticosteroid injections are a common treatment, they must be used with caution because they may lead to weakening or rupture of the tendon (especially weight-bearing tendons such as the Achilles [ankle], posterior tibial [arch of the foot], and patellar [knee] tendons). If there is still no improvement after 6-12 months, the doctor may perform either arthroscopic or open surgery to relieve pressure on the bursae, although this is rare.

If the bursitis is caused by an infection, the doctor will prescribe antibiotics.

Where to find medical care for Bursitis?
Directions to Hospitals Treating bursitis

What to expect (Outlook/Prognosis)?
The outlook is generally very good for bursitis, although in rare cases your bursa may have to be removed surgically if other treatments are ineffective.

Prevention
Stretching before you exercise, strengthening your muscles and resting when you do repetitive tasks might help prevent bursitis.

To help prevent inflammation or reduce the severity of its recurrence:
 * Warm up or stretch before physical activity.
 * Strengthen muscles around the joint.
 * Take breaks from repetitive tasks often.
 * Cushion the affected joint. Use foam for kneeling or elbow pads. Increase the gripping surface of tools with gloves or padding. *Apply grip tape or an oversized grip to golf clubs.
 * Use two hands to hold heavy tools; use a two-handed backhand in tennis.
 * Don’t sit still for long periods.
 * Practice good posture and position the body properly when going about daily activities.