Movement is usually painful, and bursae near the skin may become swollen and tender.
Pain around bursae suggests the diagnosis, but sometimes analysis of fluid removed from a bursa or imaging tests are needed.
Rest followed by physical therapy, splinting, nonsteroidal anti-inflammatory drugs, and sometimes corticosteroid injections usually relieve symptoms.
A bursa normally contains a small amount of fluid, which provides cushioning. Bursae reduce friction and prevent the wear and tear that can occur when one structure rubs over the other. Some bursae are located just beneath the skin (superficial bursae). Others are located under muscles and tendons (deep bursae). If injured or overused, a bursa may become inflamed, and extra fluid may collect in it.
Bursitis is usually caused by
Irritation from unusual use or overuse
It may also be caused by injury, gout Gout Gout is a disorder in which deposits of uric acid crystals accumulate in the joints because of high blood levels of uric acid (hyperuricemia). The accumulations of crystals cause flares (attacks)... read more , pseudogout Calcium Pyrophosphate (CPP) Arthritis Calcium pyrophosphate (CPP) arthritis (previously called pseudogout) is a disorder caused by deposits of calcium pyrophosphate dihydrate crystals in the joint cartilage, leading to intermittent... read more , rheumatoid arthritis Rheumatoid Arthritis (RA) Rheumatoid arthritis is an inflammatory arthritis in which joints, usually including those of the hands and feet, are inflamed, resulting in swelling, pain, and often destruction of joints.... read more , or certain infections, especially those caused by Staphylococcus aureus Staphylococcus aureus Infections Staphylococcus aureus is the most dangerous of all of the many common staphylococcal bacteria. These gram-positive, sphere-shaped (coccal) bacteria (see figure How Bacteria Shape Up)... read more . Often, the cause of bursitis is unknown.
The shoulder is most susceptible to bursitis, but bursae in the elbows, hips (trochanteric bursitis), pelvis, knees, toes, and heels (Achilles tendon bursitis Achilles Tendon Bursitis Achilles tendon bursitis is inflammation of the fluid-filled sac (bursa) located either between the skin of the back of the heel and the Achilles tendon (called posterior Achilles tendon bursitis)... read more ) are commonly affected. People with bursitis of the shoulder usually also have inflammation of tendons around the shoulder (rotator cuff tendinitis Rotator Cuff Tendinitis Tendinitis is inflammation of a tendon. Tenosynovitis is tendinitis accompanied by inflammation of the protective covering around the tendon (tendon sheath). The cause is not always known. Tendons... read more —the tendons and other structures that move, rotate, and hold the shoulder in place are called the rotator cuff).
Symptoms of Bursitis
Bursitis usually causes pain and tends to limit movement, but the specific symptoms depend on the location of the inflamed bursa. For example, when a bursa in the shoulder becomes inflamed, raising the arm out from the side of the body (as when putting on a jacket) is painful and difficult. However, bursitis in the elbow may cause swelling but little or no discomfort or limited movement.
Acute bursitis develops over hours or days. The inflamed area is usually painful when moved or touched. The skin over bursae located near the surface, such as those near the knee and elbow, may appear red and swollen. Acute bursitis that is caused by an infection or gout Gout Gout is a disorder in which deposits of uric acid crystals accumulate in the joints because of high blood levels of uric acid (hyperuricemia). The accumulations of crystals cause flares (attacks)... read more may be particularly painful, and the affected area may be red and warm.
Chronic bursitis may result from repeated or persistent bouts of acute bursitis or repeated injuries. Sometimes the walls of the bursa become thick. If damaged bursae are subjected to unusual exercise or strain, inflammation tends to worsen. Long-standing pain and swelling can limit movement, making muscles weak. Flare-ups of chronic bursitis may last several months and may return frequently.
Diagnosis of Bursitis
A doctor's evaluation
Sometimes examination of bursa fluid
Sometimes imaging tests
A doctor suspects bursitis if the area around a superficial bursa is sore when touched or when certain joint movements that move or put pressure on deep bursae are painful.
If a superficial bursa, particularly at the knee or elbow, is noticeably swollen, a doctor may remove a sample of fluid from the bursa with a needle. The sample is tested for causes of the inflammation, such as an infection or gout Gout Gout is a disorder in which deposits of uric acid crystals accumulate in the joints because of high blood levels of uric acid (hyperuricemia). The accumulations of crystals cause flares (attacks)... read more .
X-rays Plain X-Rays X-rays are high-energy radiation waves that can penetrate most substances (to varying degrees). In very low doses, x-rays are used to produce images that help doctors diagnose disease. In high... read more are usually done if bursitis does not get better with treatment or keeps coming back, or if the doctor suspects a problem in an underlying joint such as arthritis.
Magnetic resonance imaging Magnetic Resonance Imaging (MRI) In magnetic resonance imaging (MRI), a strong magnetic field and very high frequency radio waves are used to produce highly detailed images. MRI does not use x-rays and is usually very safe... read more (MRI) or ultrasonography Ultrasonography Ultrasonography uses high-frequency sound (ultrasound) waves to produce images of internal organs and other tissues. A device called a transducer converts electrical current into sound waves... read more may be used to help confirm bursitis in a deep bursa.
Treatment of Bursitis
Pain relievers, anti-inflammatory drugs, and rest
Treatment of any gout or infection
Sometimes injections of corticosteroids
Acute bursitis, if not caused by an infection, is usually treated with the following:
Temporary rest and immobilization (such as with a splint) of the affected joint
Ice applied to the painful area
Physical therapy after rest and immobilization
Occasionally, stronger pain relievers are needed. Often, a doctor may inject a local anesthetic and a corticosteroid directly into the bursa, particularly if the shoulder is affected. This treatment frequently provides relief a few days after the injection. The injection may have to be repeated after a few months. Removing the fluid with a needle also may help reduce pain.
People who have severe acute bursitis are occasionally given a corticosteroid, such as prednisone, by mouth for a few days. As the pain subsides, people can do specific exercises to increase the joint’s range of motion.
Chronic bursitis, if not caused by an infection, is treated in a similar way, although rest and immobilization are less likely to help. Rarely, surgery is done to remove the bursa.
Often, physical therapy Physical Therapy (PT) Physical therapy, a component of rehabilitation, involves exercising and manipulating the body with an emphasis on the back, upper arms, and legs. It can improve joint and muscle function, helping... read more can help restore function. Exercises can help strengthen weakened muscles and reestablish the joint’s full range of motion.
Infected bursae must be drained, and appropriate antibiotics, often against Staphylococcus aureus, are given.
Bursitis often recurs if the cause, such as gout Gout Gout is a disorder in which deposits of uric acid crystals accumulate in the joints because of high blood levels of uric acid (hyperuricemia). The accumulations of crystals cause flares (attacks)... read more , rheumatoid arthritis Treatment Rheumatoid arthritis is an inflammatory arthritis in which joints, usually including those of the hands and feet, are inflamed, resulting in swelling, pain, and often destruction of joints.... read more , or chronic overuse, is not treated or corrected.