Topic Overview

What is bursitis?

Bursitis is a painful swelling of a small sac of fluid called a bursa. Bursae (plural of bursa) cushion and lubricate areas where tendons, ligaments, skin, muscles, or bones rub against each other. People who repeat the same movement over and over or who put continued pressure on a joint in their jobs, sports, or daily activities have a greater chance of getting it.

What causes bursitis?

Bursitis is commonly caused by:

• Overuse and repeated movements. These can include daily activities such as using tools, gardening, cooking, cleaning, and typing at a keyboard.
• Long periods of pressure on an area. For example, carpet layers, roofers, or gardeners who work on their knees all day can develop bursitis over the kneecap.
• Aging, which can cause the bursa to break down over time.
• Sudden injury, such as a blow to the elbow.

Bursitis can also be caused by other problems, such as arthritis or infection (septic bursitis).

What are the symptoms?

Bursitis usually causes a dull pain, tenderness, and stiffness near the affected bursa. The bursa may swell and make the skin around it red and warm to the touch.

Bursitis is most common in the shoulder, elbow, hip, and knee. Bursitis may also occur near the Achilles tendon or in the foot.

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

How is bursitis diagnosed?

Your doctor will check for bursitis by asking questions about your past health and recent activities and by examining the sore area.

If bursitis continues or gets worse even after treatment, your doctor may drain fluid from the bursa through a needle (aspiration) and test it for infection.

How is it treated?

Home treatment is often enough to reduce pain and let the bursa heal. It usually includes resting the joint, applying ice, and taking pain medicine. Gentle exercises and stretching can help prevent stiffness. Your doctor may suggest physical therapy to strengthen the muscles around your joints.

If you have severe bursitis, your doctor may use a needle to remove extra fluid from the bursa. Or you might wear a pressure bandage on the area. Both treatments are sometimes used together. Your doctor may also give you a shot of medicine to reduce swelling. Some people need surgery to drain or remove the bursa.

Sometimes the fluid in the bursa can get infected. If this happens, you may need antibiotics .

How can you prevent bursitis?

You may be able to prevent bursitis from happening or coming back.

• Rest the area, and avoid any activity or direct pressure that may cause pain.
• Apply ice or cold packs as soon as you notice pain and tenderness.
• Take pain relievers you can buy without a prescription such as aspirin, ibuprofen, or naproxen.
• Change the way you do activities with repeated movements that may strain your muscles or joints.
• Protect your joints from pressure. Cushion knees or elbows on hard surfaces, and wear shoes with good support that fit you well.

Frequently Asked Questions

Learning about bursitis and tendinopathy:	What is bursitis? What causes bursitis? What are the symptoms of bursitis? How can I prevent bursitis?
Being diagnosed:	How can my health professional tell whether I have bursitis?
Getting treatment:	What can I do to treat bursitis? What does a health professional do to treat bursitis?
Ongoing concerns:	What can I do to prevent bursitis from recurring?

Symptoms

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 pictures 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).

Exams and Tests

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. But if you have a swollen bursa, 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 medicine. 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 Overview

Treatment for bursitis most often includes rest, ice, and taking pain relievers. Acetaminophen can reduce pain. 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 pain and inflammation.
• Take pain relievers. Use acetaminophen, or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, or aspirin, as directed for pain relief. NSAIDs may also reduce bursitis inflammation. (Do not give aspirin to anyone younger than age 20 because of the risk of Reye syndrome, a central nervous system complication in children.) Do not rely on medicine 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 delays wound and tissue healing.

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 medicines 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.

Home Treatment

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 pain and inflammation.
• Take pain relievers. Use acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen, or aspirin, as directed for pain relief. NSAIDs may also reduce bursitis inflammation. (Do not give aspirin to anyone younger than age 20 because of the risk of Reye syndrome, a central nervous system complication in children.) Do not rely on medicine 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 delays wound and tissue healing.

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

Other Places To Get Help

Organizations

American Academy of Orthopaedic Surgeons (AAOS)
6300 North River Road
Rosemont, IL  60018-4262
Phone:	1-800-346-AAOS (1-800-346-2267) (847) 823-7186
Fax:	(847) 823-8125
E-mail:	pemr@aaos.org
Web Address:	www.aaos.org
The American Academy of Orthopaedic Surgeons (AAOS) provides information and education to raise the public's awareness of musculoskeletal conditions, with an emphasis on preventive measures. The AAOS Web site contains information on orthopedic conditions and treatments, injury prevention, and wellness and exercise.
American College of Rheumatology
1800 Century Place
Suite 250
Atlanta, GA  30345
Phone:	(404) 633-3777
Fax:	(404) 633-1870
Web Address:	www.rheumatology.org
The American College of Rheumatology (ACR) and the Association of Rheumatology Health Professionals (ARHP, a division of ACR) are professional organizations of rheumatologists and associated health professionals who are dedicated to healing, preventing disability from, and curing the many types of arthritis and related disabling and sometimes fatal disorders of the joints, muscles, and bones. Members of the ACR are physicians; members of the ARHP include research scientists, nurses, physical and occupational therapists, psychologists, and social workers. Both the ACR and the ARHP provide professional education for their members. The ACR Web site offers patient information fact sheets about rheumatic diseases, about medicines used to treat rheumatic diseases, and about care professionals.
American Physical Therapy Association
1111 North Fairfax Street
Alexandria, VA  22314-1488
Phone:	1-800-999-APTA (1-800-999-2782) (703) 684-2782
Fax:	(703) 684-7343
TDD:	(703) 683-6748
Web Address:	www.apta.org
The American Physical Therapy Association is a national organization representing nearly 70,000 physical therapists, physical therapist assistants, and students. Its goal is to foster advancements in physical therapist education, practice, and research. The APTA also provides information and education to the public about physical therapy and how it is used to treat certain conditions.
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), National Institutes of Health
1 AMS Circle
Bethesda, MD  20892-3675
Phone:	1-877-22-NIAMS (1-877-226-4267) toll-free (301) 495-4484
Fax:	(301) 718-6366
TDD:	(301) 565-2966
E-mail:	niamsinfo@mail.nih.gov
Web Address:	www.niams.nih.gov
The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) is a governmental institute that serves the public and health professionals by providing information, locating other information sources, and participating in a national federal database of health information. NIAMS supports research into the causes, treatment, and prevention of arthritis and musculoskeletal and skin diseases and supports the training of scientists to carry out this research. The NIAMS Web site provides health information referrals to the NIAMS Clearinghouse, which has information packages about diseases.

Related Information

• Achilles Tendon Problems
• Knee Problems and Injuries
• Plantar Fasciitis
• Rotator Cuff Disorders
• Tendon Injury (Tendinopathy)
• Tennis Elbow

References

Other Works Consulted

• Colburn KK (2007). Bursitis, tendonitis, myofascial pain, and fibromyalgia section of The locomotor system. In RE Rakel, ET Bope, eds., Conn's Current Therapy 2007, pp. 1148–1151. Philadelphia: Saunders Elsevier.
• McMahon PJ, Kaplan LD (2006). Sports medicine. In HB Skinner, ed., Current Diagnosis and Treatment in Orthopedics, 4th ed., pp. 163–220. New York: McGraw-Hill.

Credits

Author	Shannon Erstad, MBA/MPH
Editor	Kathleen M. Ariss, MS
Associate Editor	Michele Cronen
Primary Medical Reviewer	Adam Husney, MD - Family Medicine
Primary Medical Reviewer	William M. Green, MD - Emergency Medicine
Specialist Medical Reviewer	Nicola Maffulli, MD, PhD - Orthopedics
Last Updated	December 17, 2008