Bursitis

What is bursitis?

Bursitis is inflammation of a bursa, which is a soft tissue space between 2 structures that creates a low friction surface.

Wherever the bones, tendons and ligaments move across each other, particularly near joints, these small sacs called bursae allow the tissues to move smoothly over each other. Bursitis results in the sac filling with fluid and thickening of the bursal walls.

What causes bursitis?

  • Bursitis is usually caused by overuse of a joint, or when a joint is under pressure or tension for extended periods of time, often associated with poor muscle strength or balance.
  • Bursitis can also be caused by trauma in the area of the bursa or by tightness and overload of adjacent tendons.
  • Repeated physical activities, such as swinging a golf club, can cause bursitis.
  • The conditions commonly known as ‘housemaid’s knee’ and 'clergyman's knee' occur as a result of inflammation of the bursae on the front of the knee caused by prolonged kneeling.
  • Infection or other conditions, such as arthritis or gout, cause inflammatory changes in the joints and tendons throughout the body that can involve the bursae. This type of injury may be accompanied by reduced mobility in the joint, redness, swelling and, occasionally, fever.

Which joints are affected?

One of the most common areas for bursitis is the shoulder, which has the greatest range of motion of all the body’s major joints. The pain is usually felt along the outside top of the shoulder. Other joints commonly affected by this condition are the elbows, hips, wrists, ankles and knees.

What are the symptoms of bursitis?

  • Pain and sometimes swelling in the area, particularly during movement of the joint, stretching or when exercising, lifting or otherwise pushing the joint beyond its normal limits.
  • Restricted range of motion in a joint, with or without immediate pain.
  • The overlying skin may become red or feel warm.

How is bursitis diagnosed?

Your doctor will ask about your recent physical activities and will conduct a physical examination. An ultrasound will accurately demonstrate the swollen bursa when required and many sports doctors now can perform this assessment in their office. Occasionally, they may also want to extract some fluid for testing, if there is concern the bursa might be infected. You may be sent for X-rays of the painful joint.

Self-care for bursitis

What you can do if you have bursitis.

  • Decrease activity involving the joint and rest to allow the inflammation to subside.
  • If the elbow is affected, place the arm in a sling to rest the joint.
  • Cold compresses can assist in relieving some of the pain.
  • When the acute pain has subsided, gentle exercise of the joint can be undertaken, slowly increasing the range of motion.
  • Anti-inflammatory creams (NSAIDs) can be massaged into the affected bursa.
  • Over-the-counter anti-inflammatory and analgesic oral medications can be used to reduce pain and inflammation.
  • If the condition has not settled within 7-10 days with these measures, seek advice from your doctor or physiotherapist.

Medical treatment of bursitis

  • Splinting may rest the joint by limiting its motion, but should only be done under the supervision of a doctor or physiotherapist.
  • Oral anti-inflammatory and analgesic medications may be prescribed to reduce pain and inflammation.
  • Corticosteroid injections to the involved bursa is an effective and safe method of treatment and they are often used when other measures have failed.
  • Physiotherapy may be advised to help correct any muscle tightness or strength imbalance that may have caused the bursitis.
  • In severe or recurrent cases, bursal drainage (when the fluid is drawn out of the swollen bursa) and
  • Rarely, bursectomy (in which the affected bursa is removed) may be considered.

Complications of bursitis

The main complication of bursitis is an infection of the bursa. As the bursa is frequently just under the skin it can also be affected by some types of skin bacteria. This would happen more commonly when a person has other medical conditions, such as diabetes, or they have had an injection into the bursa. This requires antibiotic treatment, and sometimes drainage.

Last Reviewed: 25 September 2015
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References

NHS Choices. Bursitis. Dec 2014. http://www.nhs.uk/conditions/Bursitis/Pages/Introduction.aspx (accessed Sept 2015).
Mayo Clinic. Bursitis. http://www.mayoclinic.org/diseases-conditions/bursitis/basics/definition/con-20015102 (accessed Sept 2015).
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