A bursa is a small sac filled with fluid which allows joints, muscles and tendons to glide over surrounding bone and tissue easily. When one of these bursae becomes inflamed, it can become enlarged and painful, causing friction and irritation.
The condition can affect almost any part of the body, but some joints seem to be affected more than others. For example, elbow bursitis is commonly seen by medical practitioners along with inflamed bursae in the knee, hip and shoulder. Although bursitis can occur as a result of an underlying condition such as rheumatoid arthritis or gout, it is more commonly found in anyone who performs repetitive movements.
Sports people are particularly prone to this painful condition due to the repetitive movements that occur when running, jumping, throwing and even kneeling. Using adequate protection beneath the knees when kneeling and warming up the joints thoroughly before undertaking sporting activities can help to minimise the risks of developing the condition. Taking regular breaks from repetitive movements and strengthening the muscles surrounding previously affected joints can also help to avoid inflammation of the bursae.
The principal symptoms of an inflamed bursa include redness, heat and swelling in the surrounding tissues. A dull aching feeling is likely to made worse by any movement of the affected joint. If it occurs in the hip, knee or other weight-bearing joint, this can make movement difficult and painful. The presence of calcium deposits at the site of the inflammation can cause more severe pain and movement of the joint may be severely inhibited.
Injury as a cause
If caused by an injury, bursitis generally develops over time as the tendons, muscles and joints around the bursae suffer from over-use. Elbow bursitis is a particularly common form of the condition, as this area is often affected by repetitive strain or movement. The condition caused by an injury is usually due to the bursa or small sacs filled with fluid swelling and becoming irritated, and this can be exceptionally painful.
An injury that occurs from sudden impact can lead to the condition appearing, and there are a number of ways a sufferers can injure the bursa. Injuries can be caused by reaching or lifting overhead, leading to elbow bursitis. Another cause is repeated stretching and straightening or falling on an arm. If the condition occurs in the leg, it is usually caused by repeated bending or kneeling or excessive walking or sporting activities. Bursitis in the spinal area is also possible and this is a more severe form of the condition.
Health conditions as a cause
There are numerous health conditions that can lead to bursa becoming irritated and inflamed. One of the most common causes of the condition is gout, which is a result of uric acid building up within the blood. Scleroderma can also cause this condition as it causes hardening of the skin, and systematic lupus erythematosus may also lead to inflammation of the bursa as it affects the body’s organs and tissues.
Rheumatoid arthritis can also lead to the condition as the immune system breaks down and attacks the joint linings. Another type of long-term arthritis, ankylosing spondylitis, can lead to the condition occurring in various parts of the back and neck. When the condition affects the bursae of the back and neck, a sufferer will be far more debilitated than if their knee or elbow was affected.
Infection as a cause
The bursae nearer the surface of the skin, such as those in areas like the elbow, can easily become infected if a cut or graze is open and lets bacteria in. This is a septic type of the condition and usually affects those with a compromised immune system. Their bodies do not have the strength to fight off illness or injury. Those who suffer from immune deficiencies caused by AIDS, HIV or certain types of cancer are susceptible to this type of infection, especially if they are taking corticosteroids or undergoing chemotherapy.
Bursitis typically arises from one of these three causes, and knee or elbow bursitis is particularly common in older people, those with a weakened immune system or anyone engaging in a repetitive action that causes undue strain on the joints in the arms and legs.
The human body contains around 160 bursae, each of which has a lining of synovial cells. These cells produce fluid that lubricates the moving parts of the body and reduces friction between the surfaces. Any of the bursa can become painful, swollen and inflamed, but the shoulder, elbow, knee and hip are more commonly affected than other areas.
Who is affected by the condition?
Athletes and sports people have an increased risk of developing bursitis because their physical activities often involve repetitive movement. A runner, for example, might be prone to inflammation of the bursa in the ankle and a darts player might experience elbow bursitis. Sporting or other injuries can also often play a part in causing a bursa to become inflamed and painful. People who kneel a lot, such as carpet fitters, may be more likely to develop the condition in their knee.
How the condition is diagnosed?
The diagnosis is usually made on the basis of your symptoms and by the doctor examining the affected area. The area may be warm, red and visibly inflamed or swollen and the doctor may ask about any pain or stiffness you are experiencing. They will also be able to assess whether the area is tender when pressure is applied to it. Sometimes supporting your weight can also be painful and difficult. The doctor will also take into account any history of falls or injuries and whether repetitive use of the affected area may have played a part in the development of bursitis.
If you have a high temperature or feel shivery in addition to the other symptoms, you may have septic bursitis. In this condition there may also be cellulitis or the skin over the area may be broken. Diagnosis in this case is by testing some fluid from the bursa. A needle is used to aspirate a small amount of fluid which is then tested for bacteria. If you do have a bacterial infection you will be treated with the appropriate antibiotic(s). The sample of fluid may also be tested for crystals to rule out conditions such as gout that can present with similar symptoms. Following aspiration, the area will be covered with a sterile dressing and you should take it easy for a while.
If your condition fails to respond to treatment further tests may be carried out to exclude other conditions that may be causing your symptoms. These tests include x-rays to check that a fracture is not responsible for the symptoms. You may also have a blood test to rule out rheumatoid arthritis and similar conditions, and possibly an MRI scan. This is magnetic resonance imaging and can rule out conditions such as torn tendons or other tissue damage.
Bursitis can often be treated fairly easily at home with pain killers and self-care techniques, but you may need treatment from your doctor if your symptoms are severe or do not improve in a few weeks. You can help conditions such as elbow bursitis that are caused by repetitive movements from recurring by using an elbow support, ensuring you warm up before exercising and taking regular breaks in your activity.
In most instances, the condition will respond well to over-the-counter medicines and some basic self-care, such as rest and icing the affected area. Mild cases should resolve within a few weeks, although the associated swelling may linger for longer. The recovery time will be dependent on both the location and its nature — whether it is caused by an injury or infection or is connected to another health condition.
Treatment at home
There are several measures you can take to help to reduce down the swelling. You should aim to rest the affected area and also avoid any activities such as running or, in the case of elbow bursitis, playing tennis until the symptoms start to reduce. Wearing a support or strap may also aid in protecting the joint from any further damage. The frequent application of ice has been shown to be an excellent way of reducing both pain and inflammation. Whilst sleeping, you should try to lie on your good side and raise the painful area to about your heart level, as this can reduce any inflammation. Ibuprofen will help with both the pain and the swelling, or your GP will be able to prescribe a stronger drug such as diclofenac or naproxen.
If the swelling is significant, your doctor may decide to aspirate the bursa. This is a procedure to drain out the build-up of fluid. It can successfully improve the joint’s range of motion and should also provide pain relief. This is done via a thin needle. After aspiration your GP will dress the area and advise you to avoid vigorous exercise for a few days.
If the symptoms are acute, or unresponsive to other treatment, you may need a course of corticosteriod injections. These contain a steroid (hormone) that should act to reduce the inflammation. Your GP will inject these straight into the affected joint. Side effects can include a discoloration of the skin in the area and, rarely, a wasting away of some of the tissue in the surrounding area. This treatment is not suitable for cases of septic bursitis, or if you have had three or more corticosteroid injections within the last twelve months in the same area.
If you are suffering from septic bursitis, you are likely to be prescribed a course of antibiotics such as erythromycin or flucloxacillin. After a week your GP will review your progress. If necessary, they may prescribe a further course of treatment.
If these treatments don't work, you may be referred on to a specialist at the hospital. This could be a rheumatologist or an orthopaedic surgeon.
In some severe cases, surgery may be required to either completely remove the bursa or to drain it via an incision. This can be necessary in cases of septic elbow bursitis that are unresponsive to antibiotics.
The condition can be prevented by taking some of the following precautions.
Protecting the joints
It is recommended that those who have hobbies or jobs that require them to do lots of kneeling wear padding around the knee. Likewise, elbow pads can be worn for repetitive arm movements.
Runners or regular walkers should ensure they have suitable trainers or walking shoes which fit properly. These will not only help keep feet and ankles healthy, but will also ensure knees, hips and the back are not put under additional strain. When you are buying running shoes a specialist running shop can carry out tests such as a gait assessment and offer advice as to the most appropriate style.
A podiatrist can offer expert advice for those who have ongoing problems with their feet and lower limbs.
Take regular breaks
Repetitive movement can place a lot of extra strain on the muscles and joints involved. To minimise this when undertaking activities that require a lot of repetition, frequent rest breaks should be taken. In addition, varying the activity by swapping tasks regularly can help ensure that one area of the body is not overused.
Always warm up prior to exercising. About six minutes of low-impact aerobic exercise, such as light jogging or walking, before a more vigorous exercise routine can help prevent injury. Some stretching exercises are also a good idea to get the muscles warm and moving smoothly.
Similarly, taking the time to properly warm down will minimise the risk of any adverse effects.
A muscle-strengthening programme can provide increased protection for joints that have been affected by bursitis in the past. Ensure all symptoms of the bursitis have completely cleared up before starting any sort of strengthening regime. Following an episode of elbow bursitis or injury to other areas of the body, it is sensible to talk to a medical professional before starting any new activities or exercises.