Bursitis

Page last reviewed: 13/07/2011

Bursitis is inflammation (swelling) of a bursa. A bursa is a small fluid-filled sac which forms under the skin, usually over the joints and between tendons and bones.

A bursa can become inflamed through injury or repetitive movement. For example, runners and joggers have an increased risk of developing bursitis in their ankles. Less commonly, bursitis can occur as a result of an infection or as a complication of certain conditions, such as rheumatoid arthritis (see Bursitis - causes for more information).

Bursitis causes pain and swelling in the affected body part. The symptoms of bursitis usually improve within a few weeks. Resting the affected body part and taking painkillers, such as ibuprofen, can help to relieve symptoms and speed up recovery.

Bursae

There are around 160 bursae in the human body. They can be found in any area where friction occurs.

Bursae act as cushions between two surfaces that rub against each other, such as bones, muscles, joints and tendons, helping to reduce friction. Bursae reduce friction because they're lined with special cells called synovial cells, which produce a liquid that lubricates the moving parts of the body.

Where bursitis occurs

It's possible for any bursa to become inflamed, but the most common places where bursitis occurs are the:

  • shoulder
  • elbow
  • ankle
  • knee
  • hip
  • thigh

The risk of developing bursitis is increased if you regularly do an activity that involves a lot of repetitive movement. For example, darts players who repeatedly bend and straighten their elbow may get bursitis of the elbow. People who do a lot of kneeling, such as carpet fitters and gardeners, have a high risk of developing bursitis in their knee (known as 'housemaid's knee').

Taking precautions, such as wearing knee pads or warming up before exercise, may help to reduce your risk of getting bursitis. See Bursitis - prevention for more information.

When to see your GP

You should visit your GP if there's no improvement in your symptoms after two weeks.

Joints
Joints are the connection point between two bones that allow movement.
Pain
Pain is an unpleasant physical or emotional feeling that your body produces as a warning sign that it has been damaged.

Page last reviewed: 13/07/2011

The symptoms of bursitis include:

  • pain - usually a dull ache in the affected body part that's made worse by movement or pressure
  • tenderness in the affected body part
  • swelling of the affected body part
  • loss of movement in the affected body part

Septic bursitis

Septic bursitis is bursitis that's caused by infection. Additional symptoms of septic bursitis include:

  • a high temperature (fever) of 38ºC (100.4ºF) or above
  • feeling shivery
  • the affected body part feeling warm to the touch
  • redness of the affected body part
  • having cellulitis (an infection of the deeper layers of the skin)
  • having some broken skin over the bursitis

When to seek medical advice

Always visit your GP if you have the symptoms of a fever because a fever is usually an indication that you have an infection. Otherwise, you should visit your GP if your symptoms don't improve after two weeks.

Page last reviewed: 13/07/2011

Bursitis can develop in three main ways:

  • injury
  • infection
  • when you have a pre-existing health condition that causes inflammation of the bursa

Injury

If a bursa is injured, the tissue inside it can become irritated, resulting in inflammation (swelling).

In most cases, the injury develops over a prolonged period of time as a result of overuse of the joints, muscles and tendons that are near the bursae. Repetitive movement is a particular risk for this type of injury.

Some of the ways that specific parts of the body can become injured and cause bursitis are listed below.

  • The shoulder can become injured by overhead lifting or reaching.
  • The elbow can become injured by repeatedly bending and straightening it, or by falling on it. This may affect certain athletes, such as gymnasts or hockey players.
  • The knee can become injured by repeated movement or repeated kneeling (bursitis of the knee is known as 'housemaid's knee'). This may affect people with certain jobs, such as carpet layers, or certain sports players, such as footballers. 
  • The ankle can become injured by excessive walking (particularly if you're not wearing suitable walking shoes), or by activities such as ice skating or athletics.
  • The hips can become injured by running.

A bursa may also be injured if subjected to a sudden impact, such as banging your elbow on a piece of heavy furniture or by falling with heavy pressure on to your knees.

Infection

Bursae that are near the surface of your skin, such as those near your elbow, can become infected. Infection can occur if bacteria on the surface of your skin find their way into cuts and grazes and then move into a bursa. Bursitis caused by an infection is known as septic bursitis.

The immune system (the body's natural defence against injury and illness) is usually very effective at preventing this sort of infection, so septic bursitis tends to only occur in people who have a weakened immune system. Factors that are known to weaken the immune system include:

Health conditions

A number of health conditions can sometimes cause inflammation of a bursa. 

These conditions include:

  • gout - a condition that's caused by a build-up of uric acid in the blood
  • rheumatoid arthritis- a condition where the immune system attacks the linings of the joints
  • scleroderma - a condition that causes hardening of the skin
  • ankylosing spondylitis - a type of long-term arthritis that affects parts of the spine
  • systemic lupus erythematosus- a poorly understood condition that affects many of the body's tissues and organs

Page last reviewed: 13/07/2011

Your GP will usually be able to diagnose bursitis by carrying out a physical examination of the affected body part and asking you some questions. For example, your GP may ask if you have recently fallen on the joint, or if you have a job or hobby that involves repetitive use of the joint.

Fluid sample

If you have the symptoms of a fever - a temperature of 38ºC (100.4ºF) or above - your GP may remove a small sample of fluid from the affected bursa. This will be done using a needle in a procedure known as an aspiration. Afterwards, a dressing will be placed over the area and you'll need to avoid strenuous activity for around two days.

If there's blood in the fluid, it may suggest that you have injured your joint.

The fluid sample will be sent to a laboratory to check for the presence of bacteria, which will indicate that you have a bacterial infection (septic bursitis). The sample may also be checked for crystals, which can develop as a result of conditions such as gout.

Further testing

Further testing is usually only required if your symptoms don't respond to treatment. If this is the case, it will be necessary to rule out other conditions that may be responsible for your symptoms.

Further tests that you may have include:

  • an X-ray - to rule out fractures or broken bones
  • blood tests - to rule out conditions such as rheumatoid arthritis
  • a magnetic image resonance (MRI) scan - to rule out tissue damage, such as a torn tendon (tendons are the cords that join bones to muscles)

An MRI scan uses a strong magnetic field and radio waves to produce a detailed image of the inside of your body.

Page last reviewed: 13/07/2011

In most cases, bursitis can be successfully treated using a combination of self care techniques and painkillers that are available over the counter from a pharmacist. The pain will usually improve within a few weeks, although the swelling may take longer to completely disappear. The exact length of time it will take to fully recover may depend on:

  • where the bursitis is
  • whether the bursitis is caused by an infection (septic bursitis)

If treated with aspiration (see below), bursitis in the elbow will usually get better in around two weeks, or in five weeks if it's infected. Septic bursitis of the knee usually gets better in three weeks if it's treated with aspiration.  

Self care

Healthcare professionals usually recommend a self care management approach known as PRICE, which stands for:

  • Protection
  • Rest
  • Ice
  • Compression
  • Elevation

You should follow these measures until your symptoms improve.

Protection

You may wish to wear padding to protect the joint from any further injuries. For example, you can wear knee pads if you have bursitis in your knee joints.

Rest

Rest the affected body part until your symptoms improve. Avoid any activity that causes additional pain.

Ice

Ice packs can be a very effective method of reducing the symptoms of inflammation (swelling) and pain. Wrap an ice pack in a towel and apply the towel to the affected area for 10 to 20 minutes. Repeat this every few hours. If you don't have an ice pack, you can use ice cubes or a bag of frozen vegetables wrapped in a towel.  

Compression

Using an elastic bandage or dressing to compress affected joints can often help to relieve pain.

Elevation

If it's physically possible, elevating the affected body part above the level of your heart may help to reduce inflammation. For example, you can prop your foot up on a pillow to raise your ankle. 

Painkillers

Painkillers, such as paracetamol or ibuprofen, are effective ways of treating pain. Ibuprofen, or other non-steroidal anti-inflammatory drugs (NSAIDs), such as naproxen or diclofenac, will also help to reduce inflammation.

Always check the patient information leaflet that comes with the medicine to make sure it's suitable for you and that you're taking the correct dose.

Additional treatment

Aspiration

If the swelling that's caused by bursitis is particularly severe, you may want to consider having the fluid drained out in a procedure that's known as an aspiration. This can improve the range of movement in your joint and relieve pain.

During aspiration, your GP will use a needle to draw out the fluid before covering the area with a dressing. You'll need to avoid strenuous activity for around two days afterwards.

Corticosteroids

If your symptoms of bursitis are particularly severe or they fail to respond to treatment, corticosteroid injections are another possible treatment option. Corticosteroids contain steroids, a type of hormone, and can reduce inflammation.

Your GP can inject corticosteroids directly into the affected body part. Possible side effects of corticosteroid injections include:

  • the surrounding tissue wasting away
  • the skin around the injection changing colour

Corticosteroid injections can't be used if your bursitis is caused by an infection, or if your GP is unsure whether it's caused by an infection. You also can't have another corticosteroid injection if you've already had three or more in the same area within a year.

Antibiotics

If testing confirms that your bursitis is caused by infection, your GP will prescribe antibiotics. Possible antibiotics that you may take include:

  • flucloxacillin
  • erythromycin
  • clarithromycin

These will usually be taken orally (as tablets or capsules) that you take two or four times a day for seven days. After seven days, you should return to your GP so that they can check how well you're responding to the antibiotics. If you still have signs of infection you may need to take antibiotics for another seven days.

If you're prescribed antibiotics, it's very important that you finish the entire course that you're given, even if your symptoms improve. This will help to prevent the infection from returning.

Referral

If your symptoms don't improve after two months of trying these treatments, your GP may refer you to a specialist. This may be:

  • a rheumatologist - a specialist in conditions that affect the bones, muscles and joints
  • an orthopaedic surgeon - a specialist in the surgical treatment of conditions that affect the bones, muscles and joints

You may also be referred if you have infected bursitis that doesn't get better after taking antibiotics, or if your infected bursitis reoccurs.

Surgery

In some cases, surgery to remove the affected bursa may be a possible treatment option. For example, if you keep getting septic bursitis or if other treatments don't work. 

Incision and drainage is a surgical technique that may be recommended if your infection doesn't respond to antibiotics. This involves making an incision in your skin and through to the bursa so that the fluid can be drained out.

Page last reviewed: 13/07/2011

There are some common sense precautions that can take to help prevent getting bursitis. These are briefly outlined below.

Protect exposed joints

If your job involves a lot of kneeling, you should buy a pair of knee pads.

If you run or walk regularly, make sure that you wear a good quality pair of running or walking shoes.

Regular breaks from repetitive tasks

Try to vary your patterns of physical activity by carrying out different tasks that don't all involve using the same part of the body.

Warm up before exercising

Make sure that you warm up for around 10 minutes by doing some light aerobic exercise, such as steady jogging or walking before you start to exercise more vigorously.

Strengthen your muscles

If a joint has previously been affected by bursitis, strengthening the muscles around the joint will help to provide additional protection from further injury. However, you should only try to strengthen the muscles once your symptoms of bursitis have cleared up.

Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.

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