Bursitis

What is bursitis?

Bursitis is inflammation of a bursa, a small sac of fluid that cushions and lubricates an area where joint-related tissues—including bone, tendon, ligament, muscle, or skin—rub against one another. Bursae (plural of bursa) are located throughout the body, in and on joints and other places that are at risk of rubbing or pressure. Bursitis can occur anywhere in the body where there is a bursa when inflammation causes the bursa to swell with fluid. The condition is often painful.

Bursitis can affect anyone, but those who perform repetitive tasks in their jobs, sports, or daily activities are at greater risk. It's likely that some of your daily activities, such as tool use, gardening, cooking, cleaning, and keyboarding, require repetitive movement. Also, continuous pressure or stress on a joint or a certain spot increases your risk of developing bursitis. For example, carpet layers, roofers, or gardeners who work on their knees all day can develop bursitis over the kneecap, and people who sit for long periods on hard surfaces can have bursitis over their seat bones.

What are common causes of bursitis?

Bursitis is caused by overuse and repeated movements, a sudden injury (often mild), long periods of pressure on an area, or aging and gradual degeneration of the bursa. Bursitis can also be caused by systemic conditions such as arthritis, infection (septic bursitis), or trauma (traumatic bursitis).

What are the symptoms?

Bursitis typically causes a dull pain, tenderness, and stiffness near the affected bursa. Bursitis inflammation can also make the bursa swell and cause the skin around it to appear red and feel warm to the touch.

The joint areas most commonly affected by bursitis are the shoulder, elbow, hip, and knee. Bursitis may also occur near the Achilles tendon or in the foot.

Symptoms of bursitis may be similar to those of tendinopathy, because both occur in the tissues in and around the joints.

How is bursitis diagnosed?

Your joint-area symptoms probably can be diagnosed with a review of your medical history and recent activities and a physical exam.

If bursitis persists or worsens despite treatment, your health professional may draw fluid from the bursa through a needle (aspiration) and test it for infection or inflammation.

How is it treated?

Bursitis can often be treated at home. Treatment usually includes resting the painful area, applying ice, taking pain relievers (such as acetaminophen or nonsteroidal anti-inflammatory drugs [NSAIDs]), and doing gentle exercises and stretching to prevent stiffness. These steps typically reduce pain and tenderness and allow the bursa to heal. Physical therapy may be recommended to strengthen the muscles around your joints.

Severe or long-lasting bursitis is sometimes treated by removing excess fluid from a swollen bursa with a needle and syringe (aspiration), applying a pressure bandage to the area, or both. If the fluid shows signs of bacterial infection, antibiotic treatment is necessary. Bursitis may also be treated with an injection of corticosteroid medication to reduce inflammation and, occasionally, with surgery to drain or remove the bursa.

Frequently Asked Questions

Symptoms of bursitis can include:

• Pain, tenderness, redness, warmth, and/or swelling near the inflamed bursa. Pain may increase with activity or pressure. Symptoms of bursitis may:
  • Radiate out from the joint area, unlike arthritis pain, which tends to be confined to the joint.
  • Affect the precise area where the inflamed bursa is located.
• Pain and stiffness that may be worse during the night or when getting up in the morning.
• Stiffness in the joint near the affected area. Movement or mild exercise of the joint usually reduces the stiffness. (Too much movement may worsen existing symptoms or bring back the pain and stiffness.)

See illustrations of bursitis of the knee and bursitis of the hip .

Bursitis typically gets worse if the affected bursa is not allowed to rest and heal.

Symptoms of bursitis may be similar to those of tendon injuries. Tendon injuries are also known as tendinopathy. For more information, see the topic Tendon Injuries (Tendinopathy).

To diagnose bursitis, your health professional will review your medical history and daily activities and conduct a physical exam to check your overall health, areas of pain and tenderness, and strength and range of motion. Your exam may also include checking your nerve function (feeling and reflexes) and blood circulation (pulses). If your symptoms are related to use of a tool or sports equipment, your health professional may want you to demonstrate how you use it.

If your medical history and physical exam indicate bursitis, you will probably not need additional testing. If you have a swollen bursa, however, fluid may need to be removed from the bursa (aspiration) to check for infection.

If your symptoms are severe or have not improved with treatment, additional tests may be helpful. These may include:

• Aspiration of the bursa with or without injection of pain-relieving medication. Removing fluid from the bursa can help with diagnosing the cause of symptoms and can also be an effective treatment.
• X-rays, which can show any bone-related problems or calcium deposits in tendons or joint structures.
• MRI (magnetic resonance imaging), which can show small tears and injury to soft tissues such as tendon, ligament, cartilage, and muscle.
• Ultrasound, which can show thickening, swelling, or tears in soft tissues such as the bursae and tendons.

Treatment for bursitis most often includes rest, ice, and taking pain relievers. Acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) can reduce both pain and inflammation.

Bursitis is likely to improve in a few days or weeks if you immediately rest and treat the affected area. Take the following steps to treat bursitis:

• Rest the affected area and avoid any activity or direct pressure that may cause pain. Get enough sleep.
• Apply ice or cold packs as soon as you notice pain and tenderness in your muscles or near a joint. Apply ice 10 to 15 minutes at a time, as often as twice an hour, for 72 hours. Continue applying ice (15 to 20 minutes at a time, 3 times a day) as long as it relieves pain. Although heating pads may feel good, ice will relieve inflammation and speed healing.
• Take pain relievers. Use acetaminophen, or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, or aspirin, as directed for pain relief and to reduce bursitis inflammation. (Do not give aspirin to anyone younger than age 20 because of the risk of Reye's syndrome, a central nervous system complication in children.) Do not rely on medication to relieve pain in order to continue overusing a joint.
• Do range-of-motion exercises each day. If your bursitis is in or near a joint, gently move your joint through its full range of motion, even during the time that you are resting the joint area. This will prevent stiffness in your joint. As the pain goes away, continue range-of-motion exercises and add other exercises to strengthen the muscles around your joint.
• Gradually resume your activity at a lower intensity than you maintained before your symptoms began. Warm up before and stretch after the activity. Increase your activity slowly, and stop if it hurts. After the activity, apply ice to prevent pain and swelling. To avoid reoccurrence, try changing the way you do the activity that caused the pain and tenderness.
• Avoid tobacco smoke. Smoking impairs collagen production, which is necessary for wound and tissue healing.¹

Check with your health professional if bursitis is severe or does not respond to several days of home treatment, if the sore area becomes very hot or red, or if you have a fever. You may also want to call your health professional if you are more likely to get an infection because you have other health conditions such as diabetes, rheumatoid arthritis, lupus, or HIV/AIDS, or you take medications such as corticosteroids or immunosuppressants.

Severe or long-lasting bursitis is sometimes treated by removing excess fluid from a swollen bursa with a needle and syringe (aspiration), applying a pressure bandage to the area, or both. If the fluid shows signs of bacterial infection (septic bursitis), antibiotic treatment is necessary, possibly including a hospital stay for intravenous (IV) antibiotic therapy. Bursitis may also be treated with an injection of corticosteroid medication to reduce inflammation. Occasionally a bursa is surgically removed if it has not responded to treatment and is causing significant pain and disability.

Bursitis may return if you do not stretch and strengthen the muscles around the joint and change the way you do some activities. Your health professional may recommend physical therapy.

You can prevent bursitis from developing or recurring by taking steps at home, work, and during activities to promote healing and protect your bursae.

Home treatment for bursitis includes the following strategies:

• Rest the affected area and avoid any activity or direct pressure that may cause pain. Get enough sleep. To maintain your overall health and fitness, continue exercising but only in ways that do not stress the affected area. Do not resume an aggravating activity as soon as the pain stops. When you resume normal activities, change the way you do the activity that caused the pain and tenderness.
• Apply ice or cold packs as soon as you notice pain and tenderness in your muscles or near a joint. Apply ice 10 to 15 minutes at a time, as often as twice an hour, for 72 hours. Continue applying ice (15 to 20 minutes at a time, 3 times a day) as long as it relieves pain. Although heating pads may feel good, ice will relieve inflammation and speed healing.
• Take pain relievers. Use acetaminophen, or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, or aspirin, as directed for pain relief and to reduce bursitis inflammation. (Do not give aspirin to anyone younger than age 20 because of the risk of Reye's syndrome, a central nervous system complication in children.) Do not rely on medication to relieve pain in order to continue overusing a joint.
• Do range-of-motion exercises each day. If your bursitis is in or near a joint, gently move your joint through its full range of motion, even during the time that you are resting the joint area. This will prevent stiffness in your joint. As the pain goes away, continue range-of-motion exercises and add other exercises to strengthen the muscles around your joint. A physical therapist, an athletic trainer, or your health professional can teach you specific exercises for strengthening the shoulder, elbow, wrist, hip, knee, or ankle.
• Gradually resume your activity at a lower intensity than you maintained before your symptoms began. Warm up before and stretch after the activity. Increase your activity slowly, and stop if it hurts. After the activity, apply ice to prevent pain and swelling.
• Avoid tobacco smoke. Smoking impairs collagen production, which is necessary for wound and tissue healing.¹

To prevent bursitis from developing or happening again:

• Evaluate and change daily activities that tend to aggravate your symptoms. Change activities involving repeated movements that may strain your muscles or joints. For example, start alternating hands or change the grip size of your tool. Sitting in one position for long periods may also cause bursitis. If you sit at a desk for long periods, get up and walk around every hour.
  • If you suspect that certain activities at your workplace are causing bursitis, talk to your human resources department for information on alternative ways of doing your job, equipment modifications, or other job assignments.
  • If a certain sport is causing bursitis, consider taking lessons to learn proper techniques. Have an athletic trainer or person who is familiar with sports equipment check your equipment to ensure that it is well suited to your size, strength, and ability. Demonstrate how you use your equipment, and ask for feedback about any mistakes you might be making.
• Protect your joints and pressure areas. Bursitis that is caused by pressure may be prevented by sitting or kneeling on a cushion, not resting your elbows on hard surfaces such as desks, and wearing supportive shoes that fit you well.

Specific tips

See the following for more ideas on how to ease problems in specific areas:

• Shoulder pain
• Elbow pain
• Hip pain
• Knee pain
• Heel pain

Organizations

• Achilles Tendon Problems
• Anterior Cruciate Ligament (ACL) Injuries
• Carpal Tunnel Syndrome
• Knee Problems and Injuries
• Plantar Fasciitis
• Rotator Cuff Disorders
• Tennis Elbow

Citations

1. Jorgensen LN, et al. (1998). Less collagen production in smokers. Surgery, 123(4): 450–455.

Author:	Shannon Erstad, MBA/MPH	Last Updated February 1, 2005
Medical Review:	William M. Green, MD - Emergency Medicine Nicola Maffulli, MD, PhD - Orthopedics
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