What Is Bursitis? What Causes Bursitis?

Bursitis happens when the bursa is inflamed. The burse acts as a cushion between bones, tendons, joints and muscles - bursae are fluid-filled sacs (the plural of bursa is bursae). People with bursitis will feel pain at the site of inflammation. The medical word "bursa" comes from the Latin bursa, meaning a purse, which is what a bursa resembles. According to Medilexicon's medical dictionary, bursitis is "inflammation of the bursa".

About the bursae

There are about 160 bursae in the human body. These little, fluid-filled sacs cushion pressure and lubricate points between our bones, tendons, and muscles near our joints. The bursae are lined with synovial cells. Synovial cells produce a lubricant that reduces friction. This cushioning and lubrication allows our joints to move easily. When a person has bursitis - inflammation of the bursa - movement or pressure is painful.

Overuse, injury and sometimes an infection from gout or rheumatoid arthritis may cause bursitis.

What parts of the body may become affected by bursitis?

Any bursa can become affected; however, the following are the most common places:

• Shoulder
• Elbow
• Ankle
• Knee
• Buttocks
• Hip
• Thigh

How prevalent is bursitis?

As many cases of bursitis are mild, lots of people with bursitis will sit it out or self treat and never see a doctor about it. It is therefore hard to know how common it is. GPs (general practitioners, primary care physicians) in the UK say that about 1 in every 200 patient visits are because of bursitis.

What are the symptoms of bursitis?

A person with bursitis can have one or more of the symptoms below:

• Pain - the pain increases with movement or pressure
• Tenderness is felt even without movement
• Swelling
• Loss of movement

If the bursitis is caused by an infection it is called Septic Bursitis. The patient with septic bursitis may have the following additional symptoms:

• Fever
• The affected area is red
• The affected area feels hot when touched

What causes bursitis?

Bursitis can be caused by an injury, an infection, or a pre-existing condition in which crystals can form in the bursa.

Injury

An injury can irritate the tissue inside the bursa and cause inflammation. Doctors say that bursitis caused by an injury usually takes time to develop. The joints, tendons, or muscles that are near the bursae may have been overused. Most commonly, injury is caused by repetitive movements.

Below are some examples of causes of bursitis:

• Tennis elbow - bursitis of the elbow is often termed tennis elbow. It is a common problem among tennis players and golfers. Repetitive bending of the elbow can eventually lead to injury and inflammation.


• Clergyman's knee - repeated kneeling can cause injury and eventual swelling to the bursae in the knee area.


• Shoulder - caused by repeated overhead lifting or reaching upwards.


• Ankle - injury to the ankle can be caused by walking too much and with the wrong shoes. Bursitis of the ankle is also common among ice skaters and athletes.


• Buttocks - the bursae in that area can become inflamed after sitting on a hard surface for a long time, such as on a bicycle.


• Hips - some long-distance runners, and also middle distance runners and sprinters if they train a lot can develop hip bursitis.


• Thigh - this can be caused by stretching.

Bursitis can also be caused by a hard blow to the area.

Infection

Infection that causes bursitis tends to be in bursae that are nearer the surface of the skin, such as those near the elbow. A cut on the skin is an opportunity for the bacteria to get in. Most healthy people would not be affected by opportunistic bacteria trying to get in through the skin. However, people with weakened immune systems, such as those with diabetes, HIV/AIDS, Cancer (receiving chemotherapy or radiotherapy), as well as people taking steroids, and heavy consumers of alcohol.

Health conditions

People with certain health conditions are more prone to the formation of crystals inside the bursa. The crystals irritate the bursa and make it swell. The conditions that may cause this include gout, rheumatoid arthritis, and scleroderma.

How is bursitis diagnosed?

Carrying out a diagnosis for bursitis is fairly straightforward. The doctor will examine the affected area and ask the patient some questions about his/her recent activities. If the patient has a high temperature the physician may take a small sample of fluid from a bursa near the affected body part. The sample will be tested for bacteria, and perhaps also crystals.

If the patient does not get better after treatment the doctor may carry out further tests so that he/she can eliminate the possibility that the symptoms might not be due to something else. These may include:

• An x-ray, to make sure no bones are broken or fractured
• Blood tests, to check for rheumatoid arthritis
• A CT scan or MRI scan to see if there is a torn tendon

What is the treatment for bursitis?

Self-treatment

Most bursitis cases can be treated by the patient without having to see a doctor. A trip to a pharmacy, a conversation with the pharmacist, and some self-care techniques are usually enough. The NHS (National Health Service, UK) recommends PRICEM - a self-care management approach. PRICEM stands for:

Protection
Rest
Ice
Compression
Elevation
Medication


• Protect the affected area - Some people place padding to protect the affected bursae from any blow.


• Rest - Do not exercise or use the joints in the affected area unless you really have to. Let it rest. Bursitis is a condition that responds well to rest.


• Ice packs - Ice packs can help reduce pain and inflammation. Make sure you do not place the ice directly on the skin, use a pack or towel. A small pack of frozen vegetables are ideal.


• Raise the affected area - If you can, lift the affected area, raise it; less blood will gather there. This may help reduce the inflammation.


• Painkillers - Ibuprofen is an effective painkiller for treating pain, it also reduces inflammation.


• Steroids - For more severe symptoms the doctor may inject steroids into the affected area. Steroids block a body chemical called prostaglandin. Prostaglandin causes inflammation. Steroids may raise the patient's blood pressure if used for too long, as well as increasing his/her risk of getting an infection. UK doctors are advised not to give more than three steroid injections in one year.


• Antibiotics - If the fluid test confirms that there is a bacterial infection, the doctor will probably prescribe antibiotics. These will be administered orally (via mouth).


• Surgery - Very rarely, the bursa may have to be surgically drained.

Prevention

• Protect that part of the body that may be most vulnerable - If you have to kneel a lot, get some knee pads. Elbow braces can protect tennis and golf players. If you are an athlete or avid walker, invest in some good walking or running shoes.


• When doing repetitive tasks have breaks - Apart from taking regular breaks, try varying your movements so that you are using different parts of your body.


• Warm up before exercise - Before any type of vigorous exercise you should warm up for at least 5 to 10 minutes. The warm up could include walking at a good speed, slow jogging, or a cycling machine.


• Strong muscles add extra protection to the area - If you strengthen the muscles in the area where you had bursitis (after you are better), especially the area around the joint, you will have extra protection from injury. Make sure you do this well after your bursitis has gone completely.