Bursitis

Answer 1

Definition

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.

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

• Joint pain and tenderness
• Swelling
• Warmth 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 resolves. 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

Biundo JJ. Bursitis, tendinitis, and other periarticular disorders, and sports medicine. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 284.

Answer 2

Definition

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.

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.

SymptomsYou 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.

Reviewed By

Review Date: 08/03/2010

Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.