Picture of a man with bursitis of the knee.
- Bursitis is inflammation of a bursa, a tiny fluid-filled sac that functions as a gliding surface to reduce friction between bone and overlying soft tissues of the body.
- An injury, infection, or an underlying rheumatic condition can cause bursa inflammation.
- Bursitis is diagnosed by identifying swelling, tenderness, and pain with motion in the affected area.
- Treatment of bursitis is directed toward reducing inflammation and treating any infection present.
What Is Bursitis?
Bursitis is inflammation of a bursa. A bursa (the plural form is bursae) is a tiny fluid-filled sac that functions as a gliding surface to reduce friction between bone and soft tissues of the body. There are 160 bursae in the body. The major bursae are located adjacent to the tendons near the large joints, such as the shoulders, elbows, hips, and knees.
What Are Signs and Symptoms of Bursitis?
The symptoms of bursitis are directly related to the degree of inflammation present in the bursa and the location of the bursa involved.
- The inflamed bursa can cause Localized pain and tenderness.
- If the bursa is so inflamed that swelling occurs, it can cause local swelling and stiffness, sometimes associated with local redness and warmth.
- The inflammation can make it painful to support body pressure. For example:
- Hip bursitis can make it difficult to lie on the affected side of the hip
- Bursitis of the inner knee (anserine bursitis) can make it painful to lie with the knees touching each other.
Because there are 160 bursae in the body, there are many different areas of the body that can be affected by bursitis. The symptoms may affect the side of the hip (trochanteric bursitis), shoulder (subacromial or sub deltoid bursitis), the elbow (olecranon bursitis), the knee (pes anserine bursitis on the inner aspect of the knee, prepatellar bursitis on top of the kneecap), the ischial tuberosity in the buttock (ischial bursitis), or the foot and heel (calcaneal bursitis, intermetatarsal bursitis).
What Are the Types of Bursitis?
Because there are 160 bursae in the body, there are many different areas of the body that can be affected by bursitis. Examples of the types of bursitis include the:
- Hip (trochanteric bursitis)
- Shoulder (subacromial or sub deltoid bursitis)
- Elbow (olecranon bursitis)
- Knee (pes anserine bursitis on the inner aspect of the knee)
- Prepatellar bursitis (on top of the kneecap)
- Ischial tuberosity in the buttock (ischial bursitis)
- Foot and heel (calcaneal bursitis, intermetatarsal bursitis)
What Causes Bursitis?
A bursa can become inflamed from injury, infection (rare in the shoulder), or due to an underlying rheumatic condition. Examples of bursitis include
- injury as subtle as lifting a bag of groceries into the car to inflame the shoulder bursa (shoulder bursitis),
- infection of the bursa in front of the knee from an abrasion or puncture wound (septic prepatellar bursitis), and
- inflammation of the elbow bursa from gout crystals (gouty olecranon bursitis).
Sometimes tendonitis occurs associated with bursitis, especially in the shoulder.
What Are Risk Factors and Causes of Flares From Bursitis?
Risk factors for bursitis include gout, repetitive motion, and overuse of a joint, certain occupations, injury, rheumatoid arthritis, spine problems, and metabolic conditions such as diabetes. Gout flares can inflame a bursa, most commonly the elbow bursa, called gouty olecranon bursitis. Certain activities, such as gardening, involve repetitive motions that can cause bursitis. Likewise, occupations such as carpet laying and tile setting are risk factors for bursitis due to repetitive motion injury. Orthopedic injuries, such as an ankle sprain, can throw off body mechanics and cause bursitis of the knee or hip. Similarly, poor posture and spine problems may affect body mechanics and predispose to bursitis.
What Procedures and Tests Diagnose Bursitis?
Bursitis is typically identified by localized pain or swelling, tenderness, and pain with motion of the tissues in the affected area. X-ray testing can sometime detect calcifications in the bursa when bursitis has been chronic or recurrent. While MRI scanning can be used to identify bursitis, it is not always necessary.
What Is the Treatment for Bursitis?
The treatment of any form of bursitis depends on whether or not it involves infection. Bursitis that is not infected (from injury or underlying rheumatic disease), bursitis can be treated with:
- Ice compresses.
- Anti-inflammatory and pain medications.
- Occasionally, it requires aspiration of the bursa fluid.
If the procedure is performed in a doctor's office, the doctor will remove of the fluid with a needle and syringe under sterile conditions. Sometimes the fluid is sent to the laboratory for further analysis.
Noninfectious bursitis can be treated with a cortisone injection into the swollen bursa. This is sometimes done at the same time as the aspiration procedure and typically rapidly reduces the inflammation of the swollen bursa.
Infectious (septic) bursitis requires even further evaluation and aggressive treatment. The bursal fluid can be examined in the laboratory to identify the microbes causing the infection. Septic bursitis requires antibiotic therapy, sometimes intravenously. Repeated aspiration of the infected fluid may be required. Surgical drainage and removal of the infected bursa sac (bursectomy) may also be necessary. Generally, the adjacent joint functions normally after the surgical wound heals. If treatment is delayed, complications include damage to the adjacent joint or spread of infection.
Several different type of physicians may treat bursitis, including family medicine doctors, general practitioners, internists, rheumatologists, and orthopedists. Physical therapists are an important part of treatment of chronic bursitis and when an underlying injury or spine problem is causing the bursitis.
What Home Remedies Relive Pain From Bursitis?
Simple bursitis, such as that caused by a minor injury, may respond well to home remedies.
- Resting the affecting area and avoiding activities that make the pain worse are very important.
- Ice or cold compresses may be applied for 20 minutes twice a day.
- Topical and oral anti-inflammatory medications can be effective.
If symptoms include fever, or there is concern for infection or an underlying condition, then home treatment is not appropriate, and a health-care professional should be consulted immediately.
Can Bursitis Be Cured with Treatments or Surgery?
- The prognosis of bursitis is usually very good. Sometimes adjustment of activities ultimately leads to the best outcome.
- Infectious bursitis can require surgical resection of the bursa and antibiotics for cure.
- Gouty and calcific bursitis can often recur, and if chronic, may require excision of the bursa.
Tips to Prevent Joint Bursitis
Bursitis that is caused by injury can be prevented by avoiding or minimizing trauma to the area. Roofers will often wear protective shields on their knees to prevent prepatellar bursitis. If gout is treated long term, gouty bursitis will eventually no longer occur.
Jameson, J. Larry, et al. Harrison's Principles of Internal Medicine, 20th Ed. New York: McGraw-Hill Education, 2018.