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Bursitis

 

What Is Bursitis?

Wherever your bones, tendons, and ligaments move against each other, particularly near joints, the points of contact are cushioned by small fluid-filled sacs called bursae. By reducing friction, each of the more than 150 bursae in your body helps the joints operate smoothly through the full range of natural movement. But when a bursa becomes irritated and swollen, it's called bursitis -- or inflammation of the bursa.

What is a Bursa?

A bursa is a closed, fluid-filled sac that functions as a cushion and gliding surface to reduce friction between tissues of the body. Every person has hundreds of bursa scattered throughout the body. The function of a bursa is to decrease friction between two surfaces that move in different directions. The bursa can be thought of as a Ziplock bag with a small amount of oil and no air inside. The major bursae are located adjacent to the tendons near the large joints, such as in the shoulders, elbows, hips, and knees. When the bursa becomes inflamed, the condition is known as bursitis.

What Causes Bursitis?

When a joint is overused or injured suddenly, or when it remains under pressure for a long time, a nearby bursa can become inflamed. The sac fills with excess fluid, causing pressure on surrounding tissue. The immediate signal is pain, often accompanied by inflammation, swelling, and tenderness in the area. This is different from tendonitis, which is inflammation or irritation in the cord attaching muscle to bone, called a tendon.

Age plays a role in bursitis, and one of the most common places it strikes is in the shoulder, which has the greatest range of motion of all the body's major joints. The pain is generally felt along the outside top of the shoulder. The discomfort of bursitis tends to be most severe after a night's sleep and will typically subside somewhat with normal activity. Other places that are prone to bursitis are the elbows, hips, knees, and the base of the thumb.

Bursitis is associated with strenuous activity, particularly among the following types of people:

Athletes -- They may get bursitis after running, throwing, or jumping, or from making aggressive arm swings in tennis, baseball, gymnastics and even bowling.

Manual workers -- Heavy lifting, repetitive motion or working for extended periods can strain the joints and bring on a bursitis attack.

Otherwise-sedentary people -- If they push their bodies past reasonable limits, they risk bursitis.
Bursitis/tendonitis is a common overuse injury in sports where the arm is used in an overhead motion (i.e., swimming, baseball). The pain is usually felt at the tip of the shoulder and referred down the deltoid muscle into the upper arm. It occurs when the arm is lifted overhead or twisted. Bursitis occurs when the bursa becomes inflamed and painful as surrounding muscles move over it.

How Do I Know If I Have It?

Your doctor will diagnose bursitis based on your symptoms, a physical exam, and the answers you give to questions about your medical history and activities that may have brought on the pain and swelling.

Some diagnostic tests may be performed to rule out other causes of your pain. These include the following:

  • An X-ray of the affected area, to look for bony spurs (abnormal areas) or arthritis;

  • Aspiration, in which fluid is taken from the swollen bursa and evaluated under a microscope, to rule out gout or infection;

  • Blood tests to screen for conditions such as rheumatoid arthritis or diabetes.

A magnetic resonance imaging test (MRI) also may be performed to evaluate your condition.

What Are the Symptoms of Bursitis?

  • Pain, inflammation, and swelling in the shoulders, elbows, hips, knees, or joints of the hands or feet, particularly during stretching or extension when exercising, lifting, or otherwise pushing the joint beyond its normal limits;

  • Restricted range of motion in a joint, with or without immediate pain;

  • Muscle weakness;

  • Loss of motion, especially affecting the shoulder.

How Is It Treated?

Although bursitis generally disappears in a few days or weeks, you must take measures to avoid further strain or injury. A physical therapy program that includes stretching and focused strengthening exercises could be helpful.

Though you may be tempted to tough-out the pain, it's not a good idea. Left untreated, chronic bursitis can lead to the formation of calcium deposits in normally soft tissues, sometimes causing permanent reduction of motion in the affected joint.

Initial treatment typically consists of aspirin or other over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs). These pain relievers also tend to reduce inflammation. An injection of a local anesthetic mixed with one or more cortisone preparations into the bursa may be recommended to decrease inflammation and reduce pain. Heat and ultrasound can help relax the joint and promote tissue repair.

Diathermy (deep-heat therapy), under the direction of a sports physician, licensed physical therapist, or trainer, not only can relieve the discomfort and inflammation of bursitis but also can soothe tense muscles, nerves, and tendons. It may help to apply ice to the affected area for 20 to 30 minutes twice daily for two to three days.

Your doctor may prescribe physical therapy to strengthen the joint and prevent recurrence. Medication may also be prescribed including anti-inflammatory/ analgesic medication to relieve pain.  When you return to your sport, go back slowly. Warm up well and do range-of-motion exercises.

Bursitis may recur, particularly if you engage regularly in strenuous exercise or physical labor. In such cases, your doctor may prescribe corticosteroid treatment, in the form of either oral medication, topical creams, or injections to the affected joints. In severe cases, it may be necessary to draw fluid from inflamed and swollen bursae with a needle to relieve the pressure. In persistent conditions, bursae can be surgically removed.

Red & Infrared Light Therapy (sometimes called Anodyne treatment) have proven to increase the blood flow thus providing more nutrients and oxygen and speed the healing process. This process in quickly gaining converts and has become accepted in most hospitals and PT clinics.

How Can I Prevent It?

Warming up before strenuous exercise and cooling down afterward is the most effective way to avoid bursitis and other strains affecting the bones, muscles and ligaments. Avoid activities that aggravate the problem. Rest the affected area after activity.

Call Your Doctor If:

  • Pain in a joint persists more than a few days; you may be experiencing tendonitis, a strained ligament or tendon, or the onset of arthritis;

  • You are unable to move the affected area;

  • Swelling persists after taking a painkiller or anti-inflammatory agent as prescribed. You may need to have a doctor drain fluid from the affected joint, or you may need steroid injections into the joint to decrease inflammation.

  • You have a fever with your bursitis symptoms.

Some Common Types of Bursitis

Subacromial bursitis

The subacromial bursa lies just above the rotator cuff. Bursitis often develops due to injury, impingement (pinching), overuse of the shoulder, or calcium deposits. Symptoms include pain in the upper shoulder or upper third of the arm, and severe pain upon moving the shoulder.

Trochanteric bursitis

The trochanteric bursa is located over the prominent bone on the side of the hip. Women and middle-aged to older people are more often affected by this type of bursitis. It may occur spontaneously without specific injury. Also, it can be caused by walking abnormally due to arthritis in the hip, knee, ankle, foot, or back. Symptoms include pain gradually occurring over the side of the hip (and sometimes traveling down the thigh); pain when sleeping on the side affected by bursitis, rising from a deep chair, sitting in a car, or climbing stairs; and occasionally, pain when walking.

Ischial bursitis

The ischial bursa is located below the bone in your buttock called the ischium. Inflammation may occur as a result of injury or prolonged sitting on hard surfaces. Symptoms include pain when sitting or lying down on the buttocks and pain that travels to the back of the thigh. Ischial bursitis is also called "weaver's bottom" or "tailor's seat" because traditionally, it was an occupational injury of weaving where there was pressure on the buttocks at the same time as frequent extension of the hip.

Olecranon bursitis (Elbow)

Elbow bursitis is caused by the inflammation of the olecranon bursa located between the skin and bones of the elbow. Elbow bursitis can be caused by injury or constant pressure on the elbow (for example, when leaning on a hard surface). Swelling of this small sac may be also be caused by injury, gout, rheumatoid arthritis, or infection.

Prepatellar bursitis (Knee)

The prepatellar bursa is located beneath the skin and in front of the kneecap. It becomes inflamed as a result of infection, injury, gout, or repeated irritation from kneeling. Symptoms include swelling in the front of the knee that may be painful. Redness and/or warmth may occur with infection or gout. Infrapatellar bursitis (clergyman's knee), a similar condition, affects the infrapatellar bursa, located just below the kneecap.

Pes anserinus bursitis

Bursitis in the knee is also called goosefoot bursitis or Pes Anserine bursitis. The Pes Anserine bursa is located between the shin bone and the three tendons of the hamstring muscles, on the inside of the knee. This type of bursitis may be caused by lack of stretching before exercise, tight hamstring muscles, being overweight, arthritis, or out-turning of the knee or lower leg.

Retrocalcaneal bursitis

This bursa is located at the back of the heel. Bursitis in this area is often associated with conditions such as ankylosing spondylitis or rheumatoid arthritis. It can occur in healthy individuals who wear improperly fitted shoes. Symptoms include painful swelling that develops at the back of the heel.

Calcaneal bursitis

This bursa is located at the sole or bottom of the heel. Inflammation usually produces pain in the heel when standing. Causes include heel spurs, excess weight, injury, and wearing improperly fitted shoes.

Anterior Achilles tendon bursitis

This type of bursitis is also called Albert's disease. Extra strain on the Achilles tendon, such as injury, disease, or shoes with rigid back support, causes this condition, which is characterized by inflammation of the bursa located in front of the attachment of the tendon to the heel.

Posterior Achilles Tendon Bursitis

This type of bursitis, also called Haglund's deformity, is located between the skin of the heel and the Achilles tendon (which attaches the calf muscles to the heel). Aggravated by a type of walking that presses the soft heel tissue to the hard back support of a shoe, this type of bursitis occurs mostly in young women.

See: Achilles Tendon - Bursitis

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