Bursitis: Causes, Symptoms, and Treatment

Overview

Bursitis is a painful condition that affects the small, fluid-filled sacs — called bursae (plural of bursa) — that cushion the bones, tendons, and muscles near your joints. When these bursae become inflamed, the condition is known as bursitis.

Bursitis commonly occurs in the shoulders, elbows, hips, and knees, but it can also affect other areas like the heels, thighs, and buttocks. It is a frequent cause of joint pain and discomfort, especially in adults over the age of 40.

Prevalence: Bursitis is a common condition, with shoulder bursitis (subacromial bursitis) being one of the most frequent types. Studies suggest that bursitis accounts for approximately 0.4% of all primary care visits in the U.S. each year (NIH). The condition is more prevalent in individuals who engage in repetitive motions, such as athletes, manual laborers, and musicians.

Symptoms

The symptoms of bursitis can vary depending on the location and severity of the inflammation. Common symptoms include:

• Pain: Aching or sharp pain in the affected joint, especially during movement or pressure. The pain may worsen at night or when lying on the affected area.
• Swelling: Visible swelling or redness around the joint, which may feel warm to the touch.
• Stiffness: Reduced range of motion in the affected joint, making it difficult to perform everyday tasks.
• Tenderness: The area around the joint may feel tender or sore when touched.
• Weakness: Muscle weakness in the affected area due to pain and limited movement.

In some cases, bursitis can lead to a noticeable lump or swelling over the joint, which may be filled with fluid. This is particularly common in cases of olecranon bursitis (elbow) or prepatellar bursitis (knee).

Causes and Risk Factors

Bursitis is typically caused by repetitive motion, prolonged pressure, or injury to the bursae. Some of the most common causes include:

• Repetitive motions: Activities that involve repeated movements, such as throwing a ball, lifting objects, or playing musical instruments, can irritate the bursae.
• Prolonged pressure: Kneeling for long periods (e.g., gardening or carpet laying) can lead to bursitis in the knees (prepatellar bursitis).
• Trauma or injury: A direct blow or fall can cause the bursae to become inflamed.
• Infection: In rare cases, bursitis can be caused by a bacterial infection, particularly in the elbow or knee.
• Underlying conditions: Conditions like rheumatoid arthritis, gout, or diabetes can increase the risk of developing bursitis.

Risk Factors

Certain factors can increase your risk of developing bursitis, including:

• Age: Bursitis is more common in individuals over 40 due to the natural wear and tear on joints.
• Occupation: Jobs that require repetitive motions or prolonged pressure on joints (e.g., construction workers, athletes, musicians) increase the risk.
• Hobbies: Activities like gardening, painting, or playing sports can contribute to bursitis.
• Obesity: Excess weight puts additional stress on joints, particularly the hips and knees.
• Poor posture: Incorrect posture can lead to uneven pressure on joints, increasing the risk of bursitis.

Diagnosis

Diagnosing bursitis typically involves a physical examination and a review of your medical history. Your doctor may ask about your symptoms, recent activities, and any previous injuries. During the exam, they will check for tenderness, swelling, and range of motion in the affected joint.

Tests and Procedures

In some cases, additional tests may be needed to confirm the diagnosis or rule out other conditions:

• Imaging tests:
  • X-rays: While X-rays cannot visualize bursae, they can help rule out other causes of joint pain, such as fractures or arthritis.
  • MRI or ultrasound: These imaging tests can provide detailed images of the bursae and surrounding tissues, helping to confirm inflammation or fluid buildup.
• Lab tests: If an infection is suspected, your doctor may recommend a blood test or analysis of fluid from the bursa to check for bacteria or other signs of infection.

Treatment Options

The treatment for bursitis depends on the cause and severity of the condition. In many cases, bursitis can be managed with conservative measures. However, more severe or persistent cases may require medical intervention.

Medications

• Nonsteroidal anti-inflammatory drugs (NSAIDs): Over-the-counter medications like ibuprofen (Advil, Motrin) or naproxen (Aleve) can help reduce pain and inflammation.
• Corticosteroids: Injections of corticosteroids into the affected bursa can provide rapid relief from inflammation and pain. These are typically used for more severe cases.
• Antibiotics: If bursitis is caused by an infection, your doctor may prescribe antibiotics to treat the underlying bacterial infection.

Procedures

• Aspiration: In cases where the bursa is filled with excess fluid, your doctor may use a needle to drain the fluid, which can relieve pressure and pain.
• Physical therapy: A physical therapist can help you strengthen the muscles around the affected joint and improve your range of motion through targeted exercises.
• Surgery: In rare cases where bursitis does not respond to other treatments, surgical removal of the bursa may be necessary. This is typically a last resort.

Lifestyle and Home Remedies

In addition to medical treatments, the following self-care measures can help manage bursitis symptoms:

• Rest: Avoid activities that worsen your symptoms. Give the affected joint time to heal.
• Ice: Apply ice packs to the affected area for 15-20 minutes several times a day to reduce swelling and pain.
• Compression: Use an elastic bandage or brace to compress the area and reduce swelling.
• Elevation: Elevate the affected joint to help reduce swelling.
• Padding: Use cushions or pads to protect the bursa from further irritation, especially if the bursitis is caused by prolonged pressure (e.g., knee pads for gardening).

Living with Bursitis

If you have chronic or recurrent bursitis, managing the condition may require long-term strategies to prevent flare-ups and maintain joint health. Here are some tips for living with bursitis:

• Modify activities: Avoid or modify activities that put stress on the affected joint. For example, if you have shoulder bursitis, avoid overhead movements.
• Strengthen muscles: Engage in regular exercises to strengthen the muscles around the affected joint. Strong muscles can provide better support and reduce strain on the bursae.
• Maintain a healthy weight: Excess weight can put additional stress on your joints, so maintaining a healthy weight can help reduce symptoms.
• Use assistive devices: If necessary, use tools or devices to reduce strain on the affected joint. For example, a cane or knee brace can help with mobility.
• Stay active: Gentle, low-impact exercises like swimming or walking can help maintain joint flexibility and overall health.

Prevention

While not all cases of bursitis can be prevented, you can take steps to reduce your risk:

• Take breaks: If your job or hobby involves repetitive motions, take frequent breaks to rest your joints.
• Use proper technique: Whether you're lifting weights, playing sports, or performing manual labor, use proper form to avoid unnecessary strain on your joints.
• Warm up and stretch: Before engaging in physical activity, warm up your muscles and stretch to prepare your joints for movement.
• Use protective gear: Wear knee pads, elbow pads, or other protective equipment if your activities put you at risk for joint injury.
• Strengthen muscles: Regular strength training can help support your joints and reduce the risk of bursitis.
• Avoid prolonged pressure: If you need to kneel or lean on your elbows for extended periods, use padding to reduce pressure on the bursae.

Complications

If left untreated, bursitis can lead to several complications, including:

• Chronic pain: Persistent inflammation can lead to long-term pain and discomfort, making it difficult to perform daily activities.
• Reduced mobility: Chronic bursitis can limit your range of motion, affecting your ability to move the joint freely.
• Infection: In rare cases, untreated bursitis can lead to an infection in the bursa (septic bursitis), which may require antibiotics or drainage.
• Muscle atrophy: Prolonged disuse of the affected joint can lead to weakening of the surrounding muscles.
• Bursa calcification: In some cases, chronic inflammation can cause the bursa to harden or calcify, leading to further pain and stiffness.

Early treatment and proper management can help prevent these complications and improve your quality of life.

When to Seek Emergency Care

Sources and Further Reading

• Mayo Clinic
• Centers for Disease Control and Prevention (CDC)
• National Institutes of Health (NIH)
• World Health Organization (WHO)
• Cleveland Clinic