Bursitis

Definition

Bursitis is the painful inflammation of one or more bursae, which are padlike sacs found in parts of the body that are subject to friction. Bursae cushion the movements between the bones, tendons and muscles near the joints. Bursitis is most often caused by repetitive movement and is known by several common names, including weaver's bottom, clergyman's knee, housemaid's knee, and miner's elbow, depending on the area of injury.

Description

There are over 150 bursae in the human body. Usually bursae are present from birth, but they may form in response to repeated pressure. Each sac contains a small amount of synovial fluid, a clear liquid that acts as a lubricant. The bursae may become inflamed through traumatic injury, infection, or the development of arthritis. The inflammation then causes pain whenever the joint is moved. The most common site for bursitis to occur is the shoulder joint (subdeltoid), but it also is seen in the elbows (olecranon), hips (trochanteric), knees, heels (Achilles), and toes. The affected area may be referred to as "frozen," because movement is so limited. In the knee there are four bursae, and all can become inflamed with overuse.

Causes & symptoms

The most common cause of bursitis is repeated physical activity, but it can flare up for no known reason. It can also be caused by trauma, rheumatoid arthritis, gout, and acute or chronic infection.

Pain and tenderness are common symptoms of bursitis. If the affected joint is close to the skin, as with the shoulder, knee, elbow, or Achilles tendon, swelling and redness are seen and the area may feel warm to the touch. The bursae around the hip joint are deeper, and swelling is not as obvious. Movement may be limited and is painful. In the shoulder, it may be difficult to raise

An x-ray image of the knees of a patient with cysts caused by rheumatoid arthritis. The cysts appear as dark areas just below the knee joints. (Custom Medical Stock Photo. Reproduced by permission.)

the arm outward from the side of the body. Putting on a jacket or combing the hair, for example, become troublesome activities.

In acute bursitis symptoms appear suddenly; with chronic bursitis, pain, tenderness, and limited movement reappear after exercise or strain.

Diagnosis

When a patient has pain in a specific joint, a careful physical examination is needed to determine what type of movement is affected and if there is any swelling present. Bursitis will not show up on x rays, although sometimes there are also calcium deposits in the joint that can be seen. Inserting a thin needle into the affected bursa and removing (aspirating) some of the synovial fluid for examination can confirm the diagnosis. In most cases, the fluid will not be clear. It can be tested for the presence of microorganisms, which would indicate an infection, and for crystals, which could indicate gout. In instances where the diagnosis is difficult, a local anesthetic (a drug that numbs the area) is injected into the painful spot. If the discomfort stops temporarily, then bursitis is probably the correct diagnosis.

Treatment

Nutritional therapy

Naturopaths and nutritionists emphasize the role of diet as underlying causes of bursitis. They believe that the faulty use of calcium by the body, magnesium deficiencies, and food allergies may play a role. Their recommended diet may include the following:

  • fresh fruits, vegetables and whole grains
  • avoidance of foods that may cause allergies or digestive problems.
  • multivitamin and mineral supplements
  • vitamins A, C and E, selenium, and zinc supplements

Herbal therapy

Herbalists have recommended the following herbs or plant products for treatment of bursitis:

  • curcumin (turmeric)
  • bromelain (an enzyme found in pineapple)
  • ginger
  • grape-seed extract
  • pine-bark extract
  • citrus bioflavonoids

Homeopathy

Homeopathic remedies for bursitis include Belladonna, Bryonia and Rhus toxicodendron.

Hydrotherapy

The application of ice soon after an injury helps decrease the inflammation of acute bursitis. After two days of treatment with ice, however, heat instead of ice is more helpful. A warm heating pad or hot showers or baths can also relieve the symptoms of bursitis.

Acupuncture

Acupuncture has been proven effective in treating hip and shoulder pain caused by bursitis and other conditions.

Chiropractic

Spinal manipulation by a chiropractor may help improve movement in the affected joints by relieving some of the pressure on them.

Body work

Body work starts with adequate rest and massage of the bursitic area. Massage can increase blood circulation in the area, reducing the inflammation and pain. Following the initial phase of body work, patients may participate in yoga exercises that help to improve joint mobility and strengthen the muscles surrounding the joints.

Allopathic treatment

Conservative treatment of bursitis is usually effective. The application of heat, rest, and immobilization of the affected joint area is the first step. A sling can be used for a shoulder injury; a cane is helpful for hip problems. The patient can take nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen, and naproxen to relieve the pain and inflammation. Once the pain decreases, exercises of the affected area can begin. If the nearby muscles have become weak because of the disease or prolonged immobility, then exercises to build strength and improve movement are best. A doctor or physical therapist can prescribe an effective regimen.

If the bursitis is related to an inflammatory condition like arthritis or gout, then management of that disease is needed to control the bursitis.

When bursitis does not respond to conservative treatment, an injection into the joint of a long-acting corticosteroid preparation like prednisone can bring immediate and lasting relief. The drug is mixed with a local anesthetic and works on the joint within five minutes. Usually one injection is all that is needed.

Surgery to remove the damaged bursa may be performed in extreme cases.

If the bursitis is caused by an infection, then additional treatment is needed. Septic bursitis is caused by the presence of a pus-forming organism, usually Staphylococcus aureus. Septic bursitis requires treatment with antibiotics, which can be taken by mouth, injected into a muscle, or injected directly into a vein (intravenously). The bursa will also need to be drained by needle two or three times over the first week of treatment.

Expected results

Bursitis usually responds well to treatment, but it may develop into a chronic condition if the underlying cause is not corrected.

Prevention

Aggravating factors should be eliminated to prevent bursitis. Overexercising or the repetition of a movement that triggers the condition should be avoided. Doing exercises to strengthen the muscles around the joint will also help. When doing repetitive tasks, the patient should take frequent breaks and alternate the repetitive activity with others that use different parts of the body. To cushion the joints, it is a good idea to use cushioned chairs when sitting and foam kneeling pads for the knees. Leaning on the elbows, kneeling, or sitting on a hard surface for a long period of time should be avoided. Not wearing high heels can help prevent bursitis in the heel, as can changing to new running shoes as soon as the old ones are worn out.

Resources

BOOKS

Bennett, J. Claude, and Fred Plum. Cecil's Textbook of Medicine. Philadelphia: W. B. Saunders Co., 1994.

Bennett, Robert M. "Bursitis, Tendinitis, Myofascial Pain, and Fibromyalgia." In Conn's Current Therapy. Edited by Robert E. Rakel. Philadelphia: W. B. Saunders Co., 1998.

"Bursitis" In The Medical Advisor: The Complete Guide to Alternative and Medical Treatments. Richmond, VA: Time-Life Inc., 1997.

The Burton Goldberg Group. Alternative Medicine: The Definitive Guide. Fife, WA: Future Medicine Publishing, 1995.

Murray, Michael, and Joseph Pizzorno. Encyclopedia of Natural Medicine, revised 2nd ed., Rocklin, CA: Prima Health, 1998.

OTHER

Applied Medical Infomatics Inc., 1997. "Bursitis." http://www.healthanswers.com.

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