What is Bursitis?
Bursitis is when swelling occurs in the small cushions between the bone joints and soft tissue, called bursa.
This condition can affect any place on the body where they are present, although it’s most commonly seen in the shoulder, elbow, wrist or knee.
It generally occurs with prolonged repetition of movements or just general overuse of a joint. Bursitis can also develop from trauma, following an injury.
It’s a common condition, yet certain professions put people at higher risk, such as; gardeners, carpenters or athletes. The chances of bursitis will also increase with age. (1)
Symptoms
The muscles in the body are linked by tendons. These can best be described as cords, connecting the muscle to a bone. Wherever tendons are present, a bursa will coincide. The reason being, a bursa acts as a shock absorber for the tendons.
It’s located between the bone and soft tissue where it minimizes friction and enables the joint to move freely.
When inflammation occurs, the bursa fills up with excess fluids and becomes red and irritated. This causes swelling, pain and eventually restricts movement in the area.
Bursitis can sometimes occur because of other conditions, such as; rheumatoid arthritis, gout, infections and diabetes. However, sometimes doctors find it hard to pinpoint the exact cause. (2)
If bursitis was caused by an infection (septic bursitis), it most likely causes a fever and other similar symptoms. It often occurs if an injury, penetrates the skin, making it vulnerable for infections. (3)
Fortunately, in most cases, bursitis can be easily treated from home.
Common symptoms can include the following:
Pain
This a typical sign to see when overusing either a muscle or joint. In cases of bursitis, the pain can be in one area or it can spread.
It’s generally felt when moving the joint as the protective bursa is compromised, although some may feel the pain is worse at night, during rest. (4)
Bursitis can also present in the joints as tenderness or pain when you put light pressure on the area. (5)
Stiffness
Stiffness can be explained as a feeling of restriction or difficulty when trying to move a muscle or joint.
It’s usually related to joint pain and can be caused by exercise without stretching properly. (6)
Swelling
Swelling is a telltale sign of bursitis. It occurs when the bursa becomes inflamed and fills with excess fluids.
The swelling can be “pitting” or “non-pitting”, which means if you put pressure on it, a dent will be visible. In cases of non-pitting, the skin will remain swollen. (7, 8)
Warmth and Redness
If the area of the swelling appears red and warm to touch, it could be a clue of septic bursitis (infection).
If you suffer an injury within the region of a bursa it could become infected. This is because if the surface of the skin is broken, it can increase risk of germs getting through. Alternatively, it could occur if an infection is present in the body and travels to the bursa. (9)
Stages
Bursitis has been divided into four stages of progression, starting at a “normal” stage and ending in a “late” stage. (10)
Stage #0
The bursa is still in its normal size, without signs of inflammation. It contains a small amount of fluid and has a thin lining.
Stage #1
This stage marks the beginning of inflammation within the bursa.
Excessive fluid has started to fill the cushion and the build up is now causing swelling. When examining the joint area this symptom will be apparent.
Stage #2
The bursa wall is starting to thicken in response to the additional fluids which are being produced.
Stage #3
This is marked as the “last stage” of bursitis.
During this stage, the excess production of fluid subsides and it will begin to absorb back into the body.
This causes the swelling to recede. However, the wall of the bursa will still remain thicker than usual. In fact, it can take several months for it to shrink back to normal size.
Treatment
Treatment of bursitis is typically aimed at minimizing symptoms while the bursa heals. For example, reducing pain and swelling, plus avoiding infections. (11)
However, it’s important to seek direct medical advice if symptoms of infection occurs. This septic bursitis requires different treatment which involves antibiotics. (12)
The general treatment for bursitis can include rest, ice, elevation and different forms o medication. Surgery is typically only done in cases where other treatments are unsuccessful. (13)
Rest
It’s important to rest the affected area as much as possible. (14)
For example, if the condition has aggravated the hips, try not to stand for long periods at a time.
A good way to reduce pain while lying down on the side, could be by putting a pillow between the legs, preferably by the knees. And not resting on the side of the inflammation.
Ice
Bursitis can be quite painful at times and it will continue to cause discomfort while healing.
Ice is a preferable way to reduce both initial swelling and pain. Doctors will typically recommend you put ice on the affected area for the first few days. (15)
It’s important when applying ice, always keep a towel in between the skin and ice, plus never leave it on for too long as this can cause further damage.
However, it should be noted ice is only a temporary “band aid” and not a long term solution.
Compression
If bursitis was caused by an injury, it’s important to keep it as still as possible while it heals.
This means your doctor might suggest placing a splint or band on the area for support. This can help reduce the pain and keep it steady. (16)
Elevation
Elevating your legs while resting is a good way to minimize swelling. When the legs are higher than the heart, circulation increases which will help alleviate the problem.
When lying down, try to keep your legs and feet elevated on a pillow.
Exercise
It’s important to begin gentle exercise and stretches to regain strength in the muscles and tendons. (17)
Your doctor might also recommend you see a physiotherapist to help you find suitable exercise and stretch techniques.
Other Treatments
If none of the above remedies work, your doctor might prescribe medication to reduce pain and swelling.
In case of an infection you will most likely be prescribed antibiotics.
Where the condition doesn’t appear to be improving, other treatments include injections administered directly into the affected area to reduce pain or swelling.
However, this practice can have adverse effects on the tendons.
FAQ
What is bursitis? Bursitis is when the small sacs or cushions between tendons and bones become inflamed.
What are the signs of bursitis? Telltale signs are pain, stiffness and swelling. If an infection has occurred, the person might also experience fever, redness and warmth in the area.
How do you develop bursitis? Bursitis is generally caused by constant repetition of movement, overuse or extensive pressure. It can also occur as a result of illness such as rheumatoid arthritis, diabetes and gout. It can also develop from an injury which breaks the skin, exposing tissue to infection.
How are you diagnosed for bursitis? Doctors will check medical history, ask you to describe your symptoms and where you are experiencing them. A physical examination is likely to follow, where the doctor will check for swelling and pain. Further tests can be performed to rule out infections or other conditions, this may include: x-ray, MRI test or a fluid sample from the swollen area. (18)
What is the best treatment of bursitis? Symptoms often improve if you take time to rest, apply ice, compression and keep legs elevated when lying down. If the condition does not appear to show signs of recovery over time, you could be prescribed medication. In the case of infection, antibiotics will be administered.
What are the long term complications of bursitis? Once the condition has healed it is possible for it to reoccur. Therefore it’s important to take preventative measures. Other complications can include frozen shoulder, restricted movement and chronic pain. (19, 20, 21)
Is bursitis considered a disability? Bursitis is not considered a disability, but chronic pain can be disabling. Alterations may be necessary, especially in the workplace. (22)
Is there any cure for bursitis? Yes, with the right treatment it can be cured. Stretching and maintaining an active lifestyle can help prevent it. (23)
Is bursitis life threatening? No, bursitis in itself is not considered life threatening.
Summary
Bursitis occurs when the small cushion-like sacs called bursa become inflamed. This can happen after an injury or due to infections and illnesses.
It will cause pain and swelling near the joints and tendons, where it can become stiff, thereby restricting movement. If it becomes infected, you may develop a fever, and the area might become red and warm to touch.
In some cases, the condition can become chronic where the pain and swelling will last for long periods.
Fortunately, for most cases the condition is usually treated easily at home with rest and cold patches. However, it’s important to keep an active lifestyle to prevent it from returning.