What is Bursitis?
Bursitis (bur-SY-tis) is a painful situation that affects the bursae (bur-SEE). These are small fluid-filled sacs present in your body and these ease rubbing and friction between tissues like bones, muscles, tendons, and skin. In bursitis these bursae become inflamed.
Bursitis is most common around major joints such as the shoulder, elbow, hip, and knee. But it may also occur at the heel and the base of the big toe. Bursitis occurs when a bursa becomes irritated by overuse or excess pressure. The pain due to an inflamed bursa may be sudden or build up over time.
Typical treatment comprises immobilizing and shielding the afflicted joint from additional stress. In most instances, bursitis pain resolves after a few weeks with the correct therapy, although recurrence is common.
What are the Causes of Bursitis?
Bursitis is generally common in adults, particularly after age 40. It may be caused by an injury, an infection, or a preexisting illness like gout, which can lead to the formation of crystals in a bursa.
1) Injury
The tissue inside a bursa may become irritated and inflamed as a result of trauma. This trauma may result from excessive usage of the joints, tendons, or muscles in the vicinity of the bursa or an impact injury. Normally, overuse is caused by repeated motions.
The cause of bursitis may decide the afflicted part of the body. Probable causes include:
a) Elbow
Elbow bursitis is a prevalent condition among golf and tennis players. Bending the elbow repeatedly may cause damage and swelling.
b) Buttocks
Bursae in the lower pelvis may get inflamed after prolonged sitting on a hard surface, like a bicycle seat. The individual may have pain in the buttocks and legs.
c) Knee
The bursae of the knee might become damaged and swollen due to repeated kneeling.
d) Hips
Hip bursitis may develop as a result of stair climbing, excessive jogging, or prolonged standing.
e) Ankle
Injuries to the ankle may develop from excessive walking in improper footwear.
f) Shoulder
Shoulder bursitis may be caused by reaching upward or repeated overhead lifting.
2) Infection
Bursae that are closer to the skin’s surface, like those present near the elbow are often affected by Septic (infectious) Bursitis. This type of bursitis usually occurs when bacteria are directly entered into the bursa through a wound in the surrounding skin. Skin infections, like cellulitis, may cause infectious bursitis.
As with other types of bursitis, the most prevalent causes of infectious bursitis are repetitive trauma and misuse of joints surrounding bursae (1). However, people with a weakened immune system may be more susceptible to infectious bursitis.
Symptoms of infectious bursitis are almost similar to those of aseptic bursitis. Your doctor may recommend you a bursal fluid analysis to diagnose infectious bursitis.
3) Health Conditions
Some health conditions increase the likelihood that crystals may grow inside the bursa. The crystals cause irritation and swelling in the bursa. This type of bursitis may be caused due to rheumatoid arthritis (RA), gout, and scleroderma.
What are the Symptoms of Bursitis?
Around the affected bone or tendon, bursitis may have the following signs and symptoms:
- Pain
- Tenderness or hurt more when you move the joint or press on it.
- The bursae sacs may get swollen, causing difficulty in movement.
Additional signs and symptoms of bursitis (according to the area) are:
1) Shoulder
- Shoulder Pain when arms are raised above the head
- Reduced range of motion
- Discomfort aggravates at night.
2) Elbow
- Increased pain when the elbow is bent
- This bursa often gets infected.
3) Hip
- Pain during walk
- Pain in front and middle thigh to knee, which is exacerbated by hip extension or rotation.
- Tenderness in the groin area
4) Knee
- The front of the kneecap is swollen.
- Pain intensifies at night
- Pain while bending the knee
When to see a doctor In Bursitis?
Most individuals treat bursitis at home, but if the symptoms are more severe, then they should seek medical help.
In the following conditions you must immediately consult your doctor:
- Fever
- Sudden inability to move a joint
- Joint pain that prevents all movement
- Pain lasting longer than 2 weeks
- Severe swelling, bruising, redness, or a rash in the affected joint
- Sharp or shooting pain, particularly when you exert yourself or exercise.
What are the Types of Bursitis?
There are above 150 bursae in the human body and bursitis may occur in any bursa in the body.
The following are the most common types of bursitis:
1) Posterior Achilles Tendon Bursitis
This form of bursitis is also known as Haglund deformity, this kind of bursitis affects the bursa situated between the skin of the heel and the Achilles tendon. This connects the calf muscles to the heel. It is exacerbated by walking styles that force the sensitive heel tissue against the firm back support of a shoe.
2) Retromalleolar Tendon Bursitis
This form of bursitis is also known as Albert disease. It is caused by factors such as illness, trauma, or shoes with stiff back support. These factors place additional strain on the lower part of the Achilles tendon, which connects the calf muscle to the back of the heel. This may cause inflammation of the bursa near the tendon’s attachment to the heel.
3) Elbow Bursitis
Elbow bursitis is an inflammation of the bursa between the skin and bones of the elbow (the olecranon bursa). Bursitis of the elbow may be caused by injury or persistent pressure on the elbow (for example, when leaning on a rigid surface).
4) Kneecap Bursitis
Kneecap bursitis, also known as prepatellar bursitis, is prevalent in those who are often on their knees, such as plumbers or carpet layers.
5) Hip Bursitis
This type of bursitis is also known as trochanteric bursitis. It is often caused by spinal abnormalities, injury, arthritis, or surgery. This form of bursitis is more prevalent among women and middle-aged and elderly individuals.
6) Knee Bursitis
Bursitis of the knee is often referred to as goosefoot bursitis or Pes Anserine bursitis. On the inside of the knee, the Pes Anserine bursa is situated between the tibia and the three tendons of the hamstring muscles. This form of bursitis may be caused by a lack of stretching before exercise, being obese, tight hamstring muscles, arthritis, or knee or lower leg outward rotation.
These conditions may be chronic (i.e. they occur on a regular basis), or, they may be acute (i.e. they appear abruptly).
Classification Based on Cause of Inflammation of Bursitis
Bursitis can also be classified on the basis of the cause of inflammation:
Aseptic (nonseptic or noninfectious) bursitis
Aseptic bursitis is generally caused by repetitive minor trauma to the joint area or strain injury.
Septic (infectious) bursitis
Septic bursitis is caused by an infection and mostly occurs when the skin around the bursa is punctured, permitting the infectious organism to enter. In infectious bursitis, the bursa becomes hot, red, or swollen. It may also cause fever, chills, and other symptoms of infection.
What are the Complications of Bursitis?
Possible complications of bursitis include:
1) Muscular Atrophy
Reduced usage of a joint over an extended period of time may result in decreased physical activity and atrophy of surrounding muscle.
2) Chronic Pain
Untreated bursitis may cause permanent enlargement or thickening of the bursa, which can result in chronic pain and swelling.
What are the Risk Factors for Bursitis?
Anyone may get bursitis, and there are several risk factors for this condition. Although specific risk factors that can contribute to bursitis are:
1) Rheumatoid Arthritis
Inflammatory conditions like rheumatoid arthritis may cause your immune system to attack your joints and raise your risk for bursitis. They may also exacerbate pre-existing bursitis.
2) Bone Spurs or Calcium Deposits
Irritation caused by bone spurs or calcium deposits near the bursa may result in bursitis. Both bone spurs and bursitis may impede your mobility.
3) Surgery
Irritation due to surgical procedures or prosthetic joint implants may lead to bursitis. This occurs due to the restricted range of motion after surgery.
4) Age
The older you are, the greater your chance of developing bursitis. Your joints become less flexible as you age, which may result in painful illnesses such as bursitis.
5) Obesity
If you weigh more than the recommended for your height, then your hips and knees have to bear additional stress. That may lead to bursitis.
6) Other Health Conditions
Different health conditions may raise the chance of developing bursitis in some areas. For instance, a leg that is much shorter than the other might induce hip bursitis, and some spinal problems can cause hip or back bursitis. Diabetes might also increase your risk.
7) Physical Activity
Bursitis can also be caused by any hobby, employment, or activity that requires repetitive motion or prolonged pressure. Examples of these physical activities include tile setting, gardening, carpet laying, sports, or painting.
Diagnosis of Bursitis
When bursitis is suspected, a physical examination and symptom-related inquiries often confirm the diagnosis. Sophisticated diagnostic procedures and technologies can help to diagnose, determine treatment, and to monitor bursitis. Common diagnostic techniques might include:
1) X-rays
This standard imaging test of bones or joints doesn’t help in the diagnosis of bursitis, but it may be used to rule out other causes of inflammation and pain in the joint.
2) MRI
Magnetic Resonance Imaging (MRI) produces images of the affected joint by using a huge magnet, radio waves, and a computer.
3) Ultrasound
An ultrasound may help to detect tears in soft tissues such as tendons or inflammation or problems with ligaments and joints.
4) Joint Aspiration and Analysis
During this test, fluid is extracted from a joint and tested for compounds that may suggest gout and other forms of arthritis, infection, pseudogout, or inflammation.
5) Blood Tests
Blood tests may be used to look for infection or rheumatoid arthritis.
What is the Treatment of Bursitis?
Bursitis is treated based on its location, severity, and underlying cause. Principal bursitis treatments include:
Self-treatment Of Bursitis
You may be able to treat bursitis at home with the help of over-the-counter (OTC) treatments and some self-care techniques.
1) Protection
Protecting the affected area can prevent the affected bursae from painful contact.
2) Rest
Stopping the activity that triggered bursitis and minimizing joint tension can decrease the inflammation.
3) Ice and Heat
Application of ice at regular intervals several times a day can assist in decreasing the inflammation, while heat may loosen up the joint and alleviate pain during usage.
4) Elevation
Raising the affected area reduces blood pooling and may help in decreasing inflammation.
5) Pain Relievers
Taking pain relievers, like ibuprofen can help in relieving the pain, and may also reduce inflammation.
6) Physical Therapy
Physical therapy may include exercises meant to stretch as well as strengthen surrounding muscles. It can also include ultrasound treatments to relieve pain and inflammation and relax the joint.
Although the majority of instances of bursitis may be treated at home, severe cases may need prescribed medicines.
Medical Treatment Of Bursitis
Most cases of bursitis can be treated at home, but an individual with severe bursitis may need prescription medications.
1) Steroids
For alleviating the symptoms, the doctor may inject steroids into the affected area. Steroids inhibit an inflammatory substance called prostaglandin in the body. These medications usually work quickly and, in most cases, one injection is required.
Physicians should prescribe steroids with caution, as long-term usage of these medications may cause high blood pressure and increase the chance of contracting an infection.
In addition to alleviating a patient’s symptoms, steroid injections may delay the diagnosis of various disorders related to the bursae (2). Due to this surgeons may miss the best time frame for some surgical procedures
2) Antibiotics
If a fluid test of bursa shows the presence of a bacterial infection, then the physician will prescribe antibiotics. Mostly, oral antibiotics are prescribed by the physician, but intravenous administration of antibiotics may be required in more severe cases.
Surgery For Bursitis
Sometimes an inflamed bursa may be required to drain surgically.
In chronic or severe cases where treatment does not help, surgical removal of the affected bursa may be required.
Prevention of Bursitis
While some causes cannot be avoided, you can prevent bursitis by following these tips:
1) Gradually Increase Exercise
While starting a new exercise routine, you must begin gently and increase the pace, distance, or quantity of activity by no more than 10 percent each week. If you push yourself too hard or too quickly, you may increase your risk of getting an injury.
2) Lifting properly
Bend your knees when you lift, otherwise, you will put extra stress on the bursae in your hips.
3) Warm Up and Warm Down
Proper stretching, warm-up, and warm-down activities lower the likelihood of developing bursitis. These large-muscle-targeting warm-up exercises may help with your mobility and range of motion and thus help in preventing injury.
4) Wheeling Heavy Loads
Carrying heavy loads also puts stress on the bursae in your shoulders, so use a wheeled cart instead to prevent injury.
5) Take Regular Breaks
While performing activities that require repetitive motions and that are stressful on joints, then it is important to take regular breaks. Even little pauses may alleviate stress and avoid injuries.
Apart from taking regular breaks, varying movements to use different parts of the body can also help you to prevent bursitis.
6) Performing Muscle-Strengthening Exercises
Strengthening the muscles in an area where bursitis has occurred previously, may give you extra protection from injury.
7) Always Try to Maintain a Good Posture
Good posture aids in the prevention or reduction of bursitis pain. Being in the proper posture while standing, sitting, and sleeping avoids unnecessary nerve and muscle strain.
8) Pads, Cushions, and Supports
Using pads and cushions for repetitive kneeling or sitting, athletic tape, shoe inserts, and custom-fitted braces and compression gear may aid in the prevention of various forms of bursitis. These pads and cushions reduce the strain and pressure on your body, particularly your feet and knees.
9) Manage Your Body Weight
A healthy weight can reduce pressure in the areas of the body where bursitis most commonly develops. Maintaining your proper weight will also need a balance between your dietary consumption and physical activity, both of which may aid in the prevention of injuries and illnesses.
10) Consult your Doctor
You must schedule an appointment with your doctor if you suffer recurrent, persistent, or severe pain in the body. If possible, avoid repeating the activity, movement, or other cause of your pain.
What is the Prognosis for Individuals with Bursitis?
The prognosis for individuals with bursitis totally depends upon the cause and severity of bursitis. In most cases, bursitis will resolve with periods of rest and over-the-counter (OTC) medications. However, some people may require an injection or fluid drainage to cure the symptoms.
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References:
1) Septic Bursitis
https://www.ncbi.nlm.nih.gov/books/NBK470331/
2) Bursitis
https://www.ncbi.nlm.nih.gov/books/NBK513340/
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Disclaimer: This article is intended for informational purposes only. Any information associated with this article should not be considered as a substitute for prescriptions suggested by local health care professionals.
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