Bursitis

Bursitis is inflammation of the fluid-filled sac (bursa) that lies between a tendon and skin, or between a tendon and bone. The condition may be acute or chronic.

      

   

Examples

The most common examples of this condition:

 
 

  


Causes, incidence, and risk factors

Bursae are fluid-filled cavities near joints where tendons or muscles pass over bony projections. They assist movement and reduce friction between moving parts.

Bursitis can be caused by chronic overuse, trauma, rheumatoid arthritis, gout, or infection. Sometimes the cause cannot be determined. Bursitis commonly occurs in the shoulder, knee, elbow, and hip. Other areas that may be affected include the Achilles tendon and the foot.

Chronic inflammation can occur with repeated injuries or attacks of bursitis.

Symptoms

You may notice:

  • Joint pain and tenderness when you press around the joint

  • Stiffness and achiness when you move the affected joint

  • Swelling, warmth or redness over the joint

Treatment

Your health care provider may recommend temporary rest or immobilization of the affected joint.

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen may relieve pain and inflammation. Formal physical therapy may be helpful as well.

If the inflammation does not respond to the initial treatment, it may be necessary to draw out fluid from the bursa and inject corticosteroids. Surgery is rarely required.

Exercises for the affected area should be started as the pain goes away. If muscle atrophy (weakness or decrease in size) has occurred, your health care provider may suggest exercises to build strength and increase mobility.

Bursitis caused by infection is treated with antibiotics. Sometimes the infected bursa must be drained surgically.

Expectations (prognosis)

The condition may respond well to treatment, or it may develop into a chronic condition if the underlying cause cannot be corrected.

Complications

  • Chronic bursitis may occur.

  • Too many steroid injections over a short period of time can cause injury to the surrounding tendons.

Calling your health care provider

Call your health care provider if symptoms recur or do not improve after 2 weeks of treatment.

Prevention

Avoid activities that include repetitive movements of any body parts whenever possible.

References
Regan WD, Grondin PP, Morrey BF. Elbow and forearm. In: DeLee JC, Drez D Jr, Miller MD, eds. DeLee and Drez’s Orthopaedic Sports Medicine. 3rd ed. Philadelphia, Pa: Saunders Elsevier; 2009:chap 19.
Shah A, Busconi B. Hip, pelvis, and thigh. In: DeLee JC, Drez D Jr, Miller MD, eds.DeLee and Drez’s Orthopaedic Sports Medicine. 3rd ed. Philadelphia, Pa: Saunders Elsevier; 2009:chap 21.
Wapner KL, Parekh SG. Foot and ankle. In: DeLee JC, Drez D Jr, Miller MD, eds.DeLee and Drez’s Orthopaedic Sports Medicine. 3rd ed. Philadelphia, Pa: Saunders Elsevier; 2009:chap 25.

Schmidt MJ, Adams SL. Tendinopathy and bursitis. In: Marx JA, ed. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier; 2009:chap 115.

Prepatellar bursitis (housemaid's knee)

Inflammation causes the knee to become tender and swollen, making it difficult and painful to move the joint.

The knee has 15 bursae, fluid-filled sacs that act as shock absorbers and protect the bones, joints and tendons from the harm friction can cause.

The prepatellar bursa, is located in front of the kneecap (patella). When this becomes inflamed, as the result of repeated friction between the skin and patella, it's known as prepatellar bursitis.

Symptoms

Along with the bursa becoming tender and swollen, complications can arise when fluid within the bursa becomes infected, causing the area to become red, hot and painful.

Causes and risk factors

Friction between the skin and the patella can be caused by someone spending a lot of time on their knees, doing repetitive movements. Inflammation can also occur as the result of injury, infection or an underlying inflammatory condition.

However, often it's not clear why someone has developed a prepatellar bursitis.

Treatment and recovery

Rest is one of the most important treatments. Cold and heat therapy can also be used to relieve inflammation:

  • A bag of frozen vegetables wrapped in a tea towel is a simple means of providing cold therapy.
  • A hot water bottle wrapped in a towel is an effective form of heat therapy.
  • Alternating hot and cold water from a showerhead is another idea.

Painkillers and anti-inflammatory medication such as ibuprofen are also usually recommended.

Persistent fluid accumulation in the bursa increases the risk of further episodes of inflammation. Under these circumstances, the fluid may need to be aspirated, and hydrocortisone may be injected to relieve any inflammation and prevent further fluid accumulation.

If the problem persists despite these measures, surgical excision of the bursa may be necessary.

The best way to avoid inflammation of the bursa is to steer clear of any action that causes repeated friction between the skin and patella.

In some occupations, such as carpet-fitting, this may not be possible, although it's not unheard of for people to change profession because of recurring knee problems.

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