Topic Overview
What is bursitis?
Bursitis is a painful swelling
of a small sac of fluid called a bursa. Bursae (plural of bursa) cushion and
lubricate areas where tendons, ligaments, skin, muscles, or bones rub against
each other. People who repeat the same movement over and over or who put
continued pressure on a joint in their jobs, sports, or daily activities have a
greater chance of getting it.
What causes bursitis?
Bursitis is commonly caused
by:
- Overuse and repeated movements. These can
include daily activities such as using tools, gardening, cooking, cleaning, and
typing at a keyboard.
- Long periods of pressure on an area. For
example, carpet layers, roofers, or gardeners who work on their knees all day
can develop bursitis over the kneecap.
- Aging, which can cause the
bursa to break down over time.
- Sudden injury, such as a blow to
the elbow.
Bursitis can also be caused by other problems, such as
arthritis or infection (septic bursitis).
What are the symptoms?
Bursitis usually causes a
dull pain, tenderness, and stiffness near the affected bursa. The bursa may
swell and make the skin around it red and warm to the touch.
Bursitis is most common in the shoulder, elbow, hip, and knee. Bursitis may
also occur near the Achilles tendon or in the foot.
Symptoms of
bursitis may be like those of
tendinopathy. Both occur in the tissues in and
around the joints.
How is bursitis diagnosed?
Your doctor will check
for bursitis by asking questions about your past health and recent activities
and by examining the sore area.
If bursitis continues or gets
worse even after treatment, your doctor may drain fluid from the bursa through
a needle (aspiration) and test it for infection.
How is it treated?
Home treatment is often enough
to reduce pain and let the bursa heal. It usually includes resting the joint,
applying ice, and taking pain medicine. After 3 days, you can try heat, or alternate heat and ice. Gentle exercises and stretching can
help prevent stiffness. Your doctor may suggest physiotherapy to strengthen
the muscles around your joints.
If you have severe bursitis, your
doctor may use a needle to remove extra fluid from the bursa. Or you might wear
a pressure bandage on the area. Both treatments are sometimes used together.
Your doctor may also give you a shot of medicine to reduce swelling. Some
people need surgery to drain or remove the bursa.
Sometimes the
fluid in the bursa can get infected. If this happens, you may need
antibiotics.
How can you prevent bursitis?
You may be able to
prevent bursitis from happening or coming back.
- Rest the area, and avoid any activity or
direct pressure that may cause pain.
- Apply ice or cold packs as
soon as you notice pain and tenderness.
- Take pain relievers you
can buy without a prescription such as ASA, ibuprofen, or
naproxen.
- Change the way you do activities with repeated movements
that may strain your muscles or joints.
- Protect your joints from
pressure. Cushion knees or elbows on hard surfaces, and wear shoes that fit you well and have good support.
Frequently Asked Questions
Learning about bursitis and tendinopathy: | |
Being diagnosed: | |
Getting treatment: | |
Ongoing concerns: | |
Symptoms
Symptoms of
bursitis can include:
- Pain, tenderness, redness, warmth, and/or
swelling near the inflamed bursa. Pain may increase with activity or pressure.
Symptoms of bursitis may:
- Radiate out from the joint area, unlike
arthritis pain, which tends to be confined to the
joint.
- Affect the precise area where the inflamed
bursa is located.
- Pain and stiffness that may be worse during the
night or when getting up in the morning.
- Stiffness in the joint
near the affected area. Movement or mild exercise of the joint usually reduces
the stiffness. (Too much movement may make existing symptoms worse or bring back
the pain and stiffness.)
See pictures of bursitis of the shoulder,
bursitis of the elbow, bursitis of the hip, and
bursitis of the knee.
Bursitis typically gets worse if the affected
bursa is not allowed to rest and heal.
Symptoms of bursitis may
be similar to those of tendon injuries. Tendon injuries are also known as
tendinopathy. For more information, see the topic
Tendon Injuries (Tendinopathy).
Examinations and Tests
To diagnose
bursitis, your doctor will review your
medical history and daily activities and conduct a physical examination to check your
overall health, areas of pain and tenderness, and strength and range of motion.
Your examination may also include checking your nerve function (feeling and reflexes)
and blood circulation (pulses). If your symptoms are related to use of a tool
or sports equipment, your doctor may want you to demonstrate how
you use it.
If your medical history and physical examination point to
bursitis, you will probably not need more testing. But if you have a
swollen bursa, fluid may need to be removed from the bursa (aspiration) to
check for infection.
If your symptoms are severe or have not
improved with treatment, more tests may be helpful. These may
include:
Treatment Overview
Treatment for
bursitis most often includes rest, ice, and taking
pain relievers.
Acetaminophen can reduce pain. Non-steroidal
anti-inflammatory drugs (NSAIDs) can reduce both pain and
inflammation.
Bursitis is likely to improve in a few days or weeks
if you immediately rest and treat the affected area. Take the following steps
to treat bursitis:
- Rest the affected area. And avoid any activity or direct pressure that may cause pain. Get enough
sleep.
- Apply ice or
cold packs as soon as you notice pain and tenderness in your muscles or near
a joint. Apply ice 10 to 15 minutes at a time, as often as twice an hour, for
72 hours. Continue applying ice (15 to 20 minutes at a time, 3 times a day) as
long as it relieves pain. Although heating pads may feel good, ice will relieve
pain and inflammation. You can try heat, or alternating heat and ice, after 3 days (72 hours).
- Take pain relievers.
Use acetaminophen, or non-steroidal anti-inflammatory drugs
(NSAIDs) such as ibuprofen, naproxen, or ASA, as
directed for pain relief. NSAIDs may also reduce bursitis inflammation. (Do not give ASA to anyone younger than age 20 because of
the risk of Reye syndrome, a central nervous system complication in children.)
Do not rely on medicine to relieve pain in order to continue overusing a
joint.
- Do range-of-motion exercises each day. If your bursitis is in or near a joint, gently move your joint
through its full range of motion, even during the time that you are resting the
joint area. This will prevent stiffness in your joint. As the pain goes away,
continue
range-of-motion exercises and add other exercises to
strengthen the muscles around your joint.
- Gradually resume your activity at a lower intensity than you maintained before
your symptoms began. Warm up before and stretch after the activity. Increase
your activity slowly, and stop if it hurts. After the activity, apply ice to
prevent pain and swelling. To avoid reoccurrence, try changing the way you do
the activity that caused the pain and tenderness.
- Avoid tobacco smoke. Smoking delays wound
and tissue healing.
Check with your doctor if bursitis is severe
or does not respond to several days of home treatment, if the sore area becomes
very hot or red, or if you have a fever. You may also want to call your doctor if you are more likely to get an infection because you have other
health conditions such as diabetes, rheumatoid arthritis, lupus, or HIV/AIDS,
or you take medicines such as corticosteroids or immunosuppressants.
Severe or long-lasting bursitis is sometimes treated by removing excess
fluid from a swollen bursa with a needle and syringe (aspiration), applying a
pressure bandage to the area, or both. If the fluid shows signs of bacterial
infection (septic bursitis),
antibiotic treatment is needed, possibly including
a hospital stay for intravenous (IV) antibiotic therapy. Bursitis may also be
treated with an injection of corticosteroid medicine to reduce inflammation.
Sometimes a bursa is surgically removed if it has not responded to treatment
and is causing significant pain and disability.
Bursitis may
return if you do not stretch and strengthen the muscles around the joint and
change the way you do some activities. Your doctor may recommend
physiotherapy.
Home Treatment
You can prevent
bursitis from developing or recurring by taking steps
at home, work, and during activities to promote healing and protect your
bursae.
Home treatment for bursitis includes the following
strategies:
- Rest the affected area,
and avoid any activity or direct pressure that may cause pain. Get enough
sleep. To maintain your overall health and fitness, continue exercising but
only in ways that do not stress the affected area. Do not resume an aggravating
activity as soon as the pain stops. When you resume normal activities, change
the way you do the activity that caused the pain and tenderness.
- Apply ice or
cold packs as soon as you notice pain and tenderness in your muscles or near
a joint. Apply ice 10 to 15 minutes at a time, as often as twice an hour, for
72 hours. Continue applying ice (15 to 20 minutes at a time, 3 times a day) as
long as it relieves pain. Although heating pads may feel good, ice will relieve
pain and inflammation. You can try heat, or alternating heat and ice, after 3 days (72 hours).
- Take pain relievers.
Use acetaminophen or non-steroidal anti-inflammatory drugs
(NSAIDs), such as ibuprofen, naproxen, or ASA, as
directed for pain relief. NSAIDs may also reduce bursitis inflammation. (Do not give ASA to anyone younger than age 20 because of
the risk of Reye syndrome, a central nervous system complication in children.)
Do not rely on medicine to relieve pain in order to continue overusing a
joint.
- Do range-of-motion exercises each day. If your bursitis is in or near a joint, gently move your joint
through its full range of motion, even during the time that you are resting the
joint area. This will prevent stiffness in your joint. As the pain goes away,
continue
range-of-motion exercises and add other exercises to
strengthen the muscles around your joint. A
physiotherapist, an athletic trainer, or your doctor can teach you specific exercises for strengthening the
shoulder, elbow, wrist, hip, knee, or ankle.
- Gradually resume your activity at a lower intensity than you
maintained before your symptoms began. Warm up before and stretch after the
activity. Increase your activity slowly, and stop if it hurts. After the
activity, apply ice to prevent pain and swelling.
- Avoid tobacco smoke. Smoking delays wound
and tissue healing.
To prevent bursitis from developing or happening
again:
- Evaluate and change daily activities that tend to aggravate your symptoms. Change activities
involving repeated movements that may strain your muscles or joints. For
example, start alternating hands or change the grip size of your tool. Sitting
in one position for long periods may also cause bursitis. If you sit at a desk
for long periods, get up and walk around every hour.
- If you suspect that certain activities at
your workplace are causing bursitis, talk to your human resources department
for information on alternative ways of doing your job, equipment modifications,
or other job assignments.
- If a certain sport is causing bursitis,
consider taking lessons to learn proper techniques. Have an athletic trainer or
person who is familiar with sports equipment check your equipment to ensure
that it is well suited to your size, strength, and ability. Demonstrate how you
use your equipment, and ask for feedback about any mistakes you might be
making.
- Protect your joints and pressure areas. Bursitis that is caused by pressure may be prevented by sitting
or kneeling on a cushion, not resting your elbows on hard surfaces such as
desks, and wearing supportive shoes that fit you well.
Specific tips
See the following for more ideas on
how to ease problems in specific areas:
Other Places To Get Help
Organization
| Canadian Orthopaedic Foundation |
| PO Box 7029 |
| Innisfil, ON L9S 1A8 |
|
References
Other Works Consulted
- Deane K (2009). Bursitis, tendonitis, myofascial
pain, and fibromyalgia section of The locomotor system. In RE Rakel, ET Bope,
eds., Conn's Current Therapy 2009, pp. 994–998.
Philadelphia: Saunders Elsevier.
Credits
| By | Healthwise Staff |
|---|
| Primary Medical Reviewer | William H. Blahd, Jr., MD, FACEP - Emergency Medicine |
|---|
| Primary Medical Reviewer | Andrew Swan, MD, CCFP, FCFP - Family Medicine |
|---|
| Specialist Medical Reviewer | Kenneth J. Koval, MD, MD - Orthopedic Surgery, Orthopedic Trauma |
|---|
| Last Revised | February 2, 2011 |
|---|
