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Bursitis – Causes, Symptoms and Treatment

Bursitis is an inflammation of the bursa, causing pain and swelling near joints. It commonly affects the shoulder, elbow, or hip.

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Things worth knowing about "Bursitis"

Bursitis is an inflammation of the bursa, causing pain and swelling near joints. It commonly affects the shoulder, elbow, or hip.

What is Bursitis?

Bursitis refers to the inflammation of a bursa (plural: bursae). Bursae are small, fluid-filled sacs located near joints throughout the body. They act as cushions between bones, tendons, and muscles, reducing friction and protecting surrounding tissue during movement. When a bursa becomes irritated or inflamed, the condition is called bursitis.

Causes

Bursitis can develop due to several different causes:

Overuse and repetitive motions: Frequent, repetitive movements or prolonged pressure on a joint – such as kneeling for extended periods or intensive athletic activity – are among the most common triggers.
Injury or trauma: A direct blow or fall onto a joint can cause the bursa to become inflamed.
Infection: Bacteria can enter the bursa and cause septic bursitis, a more serious form requiring prompt treatment.
Rheumatic conditions: Diseases such as rheumatoid arthritis or gout can predispose individuals to developing bursitis.
Poor posture: Chronic poor posture can place added strain on joints and bursae over time.

Symptoms

The hallmark symptoms of bursitis include:

Pain around the affected joint, often worsening with movement or pressure
Swelling and visible puffiness over the joint area
Redness and a sensation of warmth in the affected region
Limited range of motion in the affected joint
In cases of infectious bursitis: fever and general feelings of illness

Commonly Affected Areas

Bursitis can occur near any joint in the body, but most frequently affects:

Shoulder (subacromial bursitis)
Elbow (olecranon bursitis)
Hip (trochanteric bursitis)
Knee (prepatellar bursitis, also known as “housemaid's knee”)
Heel (retrocalcaneal bursitis)

Diagnosis

Bursitis is typically diagnosed through a combination of:

Physical examination: The doctor assesses tenderness, swelling, and range of motion in the affected area.
Imaging: Ultrasound is the primary imaging tool for visualizing inflamed bursae. MRI (magnetic resonance imaging) or X-ray may also be used to rule out other conditions.
Laboratory tests: Blood markers such as CRP and white blood cell count help identify infection or systemic disease.
Bursal aspiration: A sample of fluid may be drawn from the bursa for analysis to detect bacteria or crystals (as seen in gout-related bursitis).

Treatment

Conservative Management

Most cases of bursitis respond well to non-surgical treatment:

Rest and activity modification to reduce strain on the affected joint
Ice application to decrease swelling and relieve pain
Anti-inflammatory medications (NSAIDs such as ibuprofen or diclofenac)
Physical therapy to restore mobility and strengthen surrounding muscles
Corticosteroid injections directly into the bursa for persistent or severe cases

Treatment of Septic Bursitis

Infectious bursitis requires antibiotic therapy. In severe cases, surgical drainage or complete removal of the bursa may be necessary.

Surgical Treatment

When conservative measures fail, the inflamed bursa may be surgically removed in a procedure called a bursectomy. This is often performed minimally invasively using an arthroscopic approach.

Prevention

In many cases, bursitis can be prevented by taking the following precautions:

Avoiding overuse and repetitive strain on joints
Taking regular breaks during physically demanding tasks
Warming up properly before exercise or sport
Using protective padding when kneeling for extended periods
Ensuring an ergonomically suitable work environment

References

Aaron D.L. et al.: Four common types of bursitis: diagnosis and management. In: Journal of the American Academy of Orthopaedic Surgeons, 2011; 19(6): 359-367.
Abzug J.M., Kozin S.H.: Septic Arthritis and Bursitis. In: Rockwood and Green's Fractures in Adults. 8th ed. Lippincott Williams & Wilkins, 2015.
Reilly D., Kamineni S.: Olecranon bursitis. In: Journal of Shoulder and Elbow Surgery, 2016; 25(1): 158-167.

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