What is Bursitis?

Bursitis occurs when a bursa, or small fluid-filled sac that acts as a cushion to reduce friction in many joints, becomes inflamed due to overuse of the joint. Bursitis is most common in the shoulder, elbow, hip and knee, but can also occur in the wrist, ankle, upper back, big toe and other joints that perform frequent repetitive motions.

Types of Bursitis

You can get bursitis anywhere in your body. However, the most common types of bursitis develop in your hips, knees, or elbows.

Common types of bursitis:

• Knee bursitis—If you have bursitis in the knee, this means that there is swelling behind the knee and near the three tendons of your hamstrings. This type of bursitis is also called Pes Anserine bursitis or goosefoot bursitis. Causes of bursitis in the knee include not stretching, obesity, arthritis, twisting your knee, or tense hamstring muscles.
• Kneecap—Bursitis in the prepatellar bursa is a common condition for plumbers, carpet layers, or anyone else who spends extended time on their knees.
• Hip bursitis—This type of bursitis is usually caused by surgery, injury, arthritis, extreme use, and abnormalities of the spine. Middle-aged or older individuals and women are more at risk.
• Elbow bursitis—Elbow bursitis can develop from an injury or from consistently applying pressure on your elbow. You might notice inflammation between the bones and skin on your elbow.
• Retromalleolar tendon bursitis—This type of bursitis occurs on your Achilles tendon, which connects the lower half of your calf muscle to your heel. It could be caused by disease, injury, or shoes with stiff back support. You might hear doctors refer to this type as Albert's disease.
• Posterior Achilles tendon bursitis—Known as the Haglund deformity, this bursitis is associated with a form of walking that forces your soft heel tissue into the rigid back of a shoe.

Signs and Symptoms

The most common symptoms of bursitis are pain and swelling in the affected joint. The pain may be sharp and intense at first, and later become a dull deep ache that spreads over a larger area. The pain may be more intense after putting repeated stress or pressure on the joint, or when first using the joint after periods of rest. Visible swelling is more common in joints where the bursae are closer to the surface such as the elbow or kneecap. Symptoms of bursitis may include: 

• Limited range of motion
• Stiffness and pain with movement of the affected joint
• Joint pain and tenderness when feeling around the joint
• Pain while at rest
• Pain may spread to the nearby areas
• Swelling, warmth or redness over the joint and fever

Causes

Preventable causes of bursitis can include:

• Overuse of the affected joint, especially repetitive motion
• Prolonged stress or pressure on the affected joint
• Trauma to the affected joint
• Infection 

Risk Factors

There are several risk factors for bursitis. Risk factors that can contribute to bursitis include:

Rheumatoid arthritis, gout or pseudogout: These inflammatory diseases can cause your immune system to attack your joints and can increase your risk for bursitis. They can also aggravate bursitis that you already have.

Previous surgery: Surgery or prosthetic joint implants can cause irritation that leads to bursitis. This happens because of the limited range of motion post-surgery. 

Bone spurs or calcium deposits: Bone spurs or calcium deposits near the bursa can cause irritation that leads to bursitis. Both bone spurs and bursitis can affect your ability to move freely.

Other conditions: Different conditions can increase the risk for bursitis in certain areas. For example, one leg being significantly shorter than the other can cause bursitis of the hip, and certain spinal diseases can cause bursitis of the hip or back. Diabetes can also put you at higher risk.

Age: The older your age, the more at risk you are for bursitis. As we age, our joints become less flexible, which can lead to painful conditions like bursitis.

Physical Activity: Any occupation, hobby, or activity that involves repetitive motion or extended pressure can result in bursitis. Examples of these activities include sports, gardening, laying carpet, or painting.

Obesity: If your weight is greater than what's recommended for your height, your body can place added pressure on your hips and knees.

Diagnosis

If bursitis is suspected, a physical examination and questions about symptoms commonly confirms the diagnosis. Advanced diagnostic procedures and technology may be used to diagnose, determine treatment and monitor the bursitis. Common diagnostic procedures can include:

Joint aspiration and analysis: During this test, fluid is removed from a joint and analyzed for substances that can indicate infection, bleeding in the joint, gout and other types of arthritis, pseudogout or inflammation.

Magnetic Resonance Imaging (MRI): A large magnet, radio waves and a computer are used to produce pictures of the affected joint.

Ultrasound: An ultrasound device can show if there is swelling or tears in soft tissues like tendons or problems with joints and ligaments.

X-rays: This common imaging test of bones or joints cannot be used to diagnose bursitis, but may be used to quickly rule out other conditions causing pain or swelling in the joints. 

Prevention

While some factors cannot be controlled, you can help prevent bursitis in these ways:

Increase exercise gradually: When first beginning a new exercise routine, start slowly and limit increases in speed, distance, length or amount of activity to 10 percent per week. If you push yourself too hard, too fast, you risk getting an injury.

Warm up and warm down: Proper stretching, warm-up and warm-down exercises reduce the risk of developing bursitis. These warm-up exercises that work the large muscles can help with your mobility and range of motion. They also help prevent injuries.

Take regular breaks: When engaging in activities that involve repetitive movements that may be stressful on joints, makes sure to take regular breaks. Even short breaks can relieve the pressure and prevent complications.

Pads, cushions and supports: Using pads and cushions for frequent kneeling or sitting, shoe inserts, athletic tape and custom-fitted braces and compression gear can help prevent different types of bursitis. These pads alleviate the pressure and strain on your body, including your knees and feet.

Maintain good posture: Good posture helps prevent or reduce bursitis pain. Stand up straight with your shoulders back. Avoid hunching or slouching. Being in the correct position when sitting, standing, or sleeping prevents unnecessary stress on your nerves and muscles.

Maintain a healthy weight: A healthy body weight will reduce pressure in the areas of your body where bursitis is most likely to develop. Maintaining your weight will likely mean balancing your nutritional intake and physical exercise, both of which can help prevent injury and infections.

Visit your doctor: Schedule a visit with your doctor anytime you experience repeated, prolonged, or significant pain in your body. If possible, stop repeating the movement, activity, or other source of your pain.

Prognosis

The prognosis for people with bursitis depends upon the severity and cause of the bursitis. In many cases, bursitis can be treated with rest and over-the-counter medications. More severe cases may require injection or fluid drainage. 

Treatment and Recovery

Treatment depends on the location, severity and cause of the bursitis. The main bursitis treatments are:

Therapies 

• Rest: Discontinuing the activity that caused the bursitis and reducing the stress on the joint will reduce inflammation.
• Ice and heat: Applying ice at regular intervals several times a day will help reduce swelling, while heat can loosen up the joint and reduce pain during use. 
• Physical therapy: Physical therapy may include exercises designed to stretch and strengthen surrounding muscles and ultrasound treatments to reduce pain and swelling and relax the joint. 

Medications

• Anti-inflammatory medication: Aspirin or ibuprofen may reduce the inflammation and ease pain.
• Injections: A steroid injection that may also include a mild anesthetic quickly reduces inflammation and relieves pain (used only if infection is not suspected). 
• Antibiotics: Bursitis caused by infections are treated with antibiotics.

Fluid Removal

Excess fluid can be removed from the bursa using a needle, reducing inflammation. 

Complications

Complications of bursitis may include:

Chronic pain: Untreated bursitis can lead to a permanent thickening or enlargement of the bursa, which can cause chronic inflammation and pain. 

Muscle atrophy: Long term reduced use of joint can lead to decreased physical activity and loss of surrounding muscle.