What Is Bursitis?

What Exactly Is A Bursa?

A bursa is a small fluid-filled sac that functions to operate as a gliding surface to reduce rubbing, friction and irritation between tissues in the body. They are found throughout the body and there are well over a hundred bursae in the human body, the major bursae are located near the large joints of the body such as the hips, knees, shoulders and elbows. Bursitis is the inflammation of a bursa and this can occur commonly in many number of the bursa around the body for a variety of reasons.

What Causes Bursitis?

Bursitis is normally caused through overuse and repetitive movements or minor impact on the area the bursa is situated. This can occur through over training in exercise, or with work postures and movements, it can be straight repetition overload or result from incorrect work, exercise or activity posture/technique. Bursitis is also common as a result of single incident, falls are a common cause of irritation to the bursa that I would see in my physio practice. This could include falls onto the outside of hip area, directly onto the knee, or the shoulder. As a painful condition inflammation of the bursa in general is relatively common, more so in adults and specifically individuals over 40, as age does appear to play a role in your soft tissues being less tolerant to stress, less elastic, being easier to tear, or injure.

Other potential causes of bursa inflammation can include:

• Infection: Examples of bursitis as the result of infection include the bursa at front of the knee, this may occur from scraping your knee on asphalt coming of your bike or falling (specifically this would be labeled as a septic prepatellar bursitis).
• Gout: Inflammation of the elbow bursa from gout crystals can cause what is referred to as an olecranon bursitis and can visually be seen as quite marked swelling around the point of the elbow.
• Rheumatic conditions: Rheumatoid arthritis and psoriatic arthritis can make people more susceptible to suffering inflammation of their bursae.

Where In The Body Does Bursitis Occur?

Bursitis can be experienced in a number of locations throughout the body, most commonly in my physiotherapy practice I see the condition in:

• Shoulder
• Hip
• Knee
• Heel
• Elbow

What Are the Symptoms?

Without a doubt the most common symptom is associated with in inflamed bursa is pain. This pain may build up gradually, or have a sudden onset. In a situation of overuse, the pain will typically be of gradual onset, whereas in the case of trauma, or injury the pain may come on immediately or shortly after the incident. The pain experienced may be mild and annoying, or significant and feel severe and debilitating. When pain is more severe, it is often accompanied with a subsequent loss of motion at the joint, sometimes this associated limitation in motion can be significant as with a shoulder bursitis where significant pain can limit the individual getting their arm above and sometimes even near shoulder height.

How Is It Diagnosed?

Bursitis is typically identified from the history of the problem. And physical examination carried out by a physiotherapist or doctor is frequently enough to confirm suspicions. On assessment the practitioner will be looking for common signs and symptoms including localized pain, swelling, tenderness at the site of the bursa, coupled with painful and/or limited motion of the tissues in the affected area.  Your physiotherapist will be able to perform some special tests to further help with diagnosis and exclude other potential causes of similar pains and presentations, in some situations diagnostic tests can be beneficial to confirm diagnosis or rule out any of these other potential causes of similar symptoms.

• The use of X-ray’s can detect calcification’s in the bursa when the condition has been chronic or recurrent, as well as look for bony abnormalities that could predispose an individual to bursitis. An example of this would be a type II – III acromiom, often referred to as a curved / hooked acromion in the shoulder, such anatomical variation can lead to more compression to the bursa when performing activities at, or above shoulder height.
• Ultrasound Scanning, or MRI (magnetic resonance imaging) are typically the go to investigations when examining soft tissues like the bursa and can be very useful in helping diagnose, or exclude the condition.
• Laboratory evaluation may be required for diagnosis when an infectious bursitis is suspected.

What Is The Treatment For A Bursal Issue?

Bursitis can be treated in a number of ways, for a bursitis that is NOT infected treatment typically includes:

• Avoiding activities that aggravate the problem this is a must in most circumstances, unless the triggering activities are minimized the bursa will continue to be aggravated and it will be slow, or unlikely to settle.
• Resting the injured area. In some situations simply avoiding any aggravating activities isn’t enough and more significant rest of the joint is required. However total rest of the area as a rule is ideally avoided and certainly wouldn’t normally be prolonged beyond days.
• Ice can help manage pain and potentially swelling/inflammation.
• Anti-inflammatory medicine, topical, or oral.
• Physiotherapy
• Corticosteroids injections (cortisone injection) can be beneficial where previous conservative measures have failed and are also beneficial used early on in traumatic bursitis more so than overload bursal issues.
• Surgery, although rarely needed, may be an option when it does not respond to the more conservative treatment options listed above.

Infectious (septic) bursitis is uncommon but requires further evaluation and aggressive treatment. The bursal fluid can be examined in a lab to identify the microbes causing the infection. Treatment of septic bursitis requires antibiotic therapy, sometimes provided intravenously. Repeated aspiration of the inflamed fluid may also be required, including sometimes surgical drainage and removal of the infected bursa (called a bursectomy).

Can Bursitis Be Prevented?

If you are planning to start exercising, or begin any new activity, you will generally be less likely to develop bursitis if you gradually build up the load giving your tissues time to adapt. Meaning over time increasing repetitions/duration and frequency of training/activity. Always listen to your body and stop what you are doing if unusual, localized or persistent pain occurs and seek medical attention from your doctor, or physiotherapist.

Disclaimer: Sydney Physio Clinic does not endorse any treatments, procedures, products mentioned. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific advice or assistance regarding What Is Bursitis? should consult his or her orthopaedic surgeon, general practitioner, sports medicine specialist or physiotherapist.