Bursitis Health Article

Definition

Bursitis is the painful inflammation of the bursa, a padlike sac of fluid found in areas of the musculoskeletal system that are subject to friction, such as joints. Bursae cushion the movement between the bones, tendons, and muscles near the joints. Bursitis is most often caused by repetitive movement performed by individuals in the course of their occupations, activities of daily living, or recreational activities.

Description

There are more than 150 bursae in the human body. Usually bursae are present from birth, but they may form in response to repeated excessive pressure. Each sac contains a small amount of synovial fluid, a clear liquid that acts as a lubricant. Inflammation causes pain on movement. The most common site for bursitis is the subdeltoid (shoulder), but it also is seen in the olecranon (elbows), trochanteric (hips), knees, heels (Achilles), and toes. The affected area may be referred to as "frozen," because movement is so limited. In the knee there are four bursae, and all can become inflamed with overuse.

Causes and symptoms

The most common cause of bursitis is repeated physical activity using excessive force, but it may also flare up for no known reason. Bursitis may be caused by trauma, proximity to inflammatory disease such as rheumatoid arthritis and gout, and it is also associated with acute or chronic infection.

Pain and tenderness are common symptoms. If the affected joint is close to the skin, as with the shoulder, knee, elbow, or Achilles tendon, swelling and redness are seen and the area over the joint may feel warm to the touch. The bursae around the hip joint are deeper, and swelling is not obvious. Movement may be limited and is painful. In the shoulder, it may be difficult for the patient

to raise the arm away from the side of the body. When the shoulder is affected, patients report difficulty with activities such as putting on clothes or combing their hair.

In acute bursitis, symptoms appear suddenly. With chronic bursitis, pain, tenderness, and limited movement flare up after exercise or strain.

Diagnosis

When a patient has pain in a joint, a careful physical examination is performed to determine which type of movement is affected and if there is any swelling. Bursitis will not show up on x rays, although sometimes calcium deposits in the joint are seen. If infection is suspected, aspiration of the bursa should be performed and the fluid sent to the laboratory for cell count, gram stain and culture. In most cases, the fluid will not be clear. It can be tested for the presence of bacteria, which indicate an infection, and crystals, which could indicate gout. In instances where the diagnosis is difficult, a local anesthetic is injected into the painful spot. If the discomfort stops temporarily, then bursitis is suspected.

Treatment

Conservative treatment of bursitis is usually effective. The application of heat, rest, and immobilization of the affected joint area is the first step. A sling may be used for a shoulder injury, and a cane is helpful for patients with hip problems. Nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen, and naproxen, obtained without a prescription, may relieve pain and inflammation. Once the pain decreases, mild to moderate exercise of the affected area may begin. If muscles proximal (near) to the affected joint have become weak or stiff because of the disease or prolonged immobility, exercises to build strength and improve movement are prescribed. A physician or physical therapist prescribes an effective exercise regimen.

If the bursitis is related to an inflammatory condition such as arthritis or gout, then management of the under- lying disease is necessary to control the bursitis.

When bursitis does not respond to conservative treatment, an injection into the joint of a long-acting corticosteroid preparation, such as prednisone, may offer the patient immediate and lasting relief. The corticosteroid, which acts to reduce inflammation, is mixed with a local anesthetic and works on the joint within minutes. Usually one injection is all that is needed. It is important that the patient does not overuse the joint too soon because the pain has gone. A gradual build up to normal use is necessary.

Surgery to remove the damaged bursa may be performed in extreme cases.

If bursitis is caused by an infection, then additional treatment is needed. Septic bursitis may be caused by the presence of Staphylococcus aureus. This is confirmed by examining a sample of the fluid in the bursa and sending it for culture. Septic bursitis requires treatment with antibiotics specifically for the infection, and these antibiotics may be taken by mouth, injected into a muscle, or administered intravenously. The bursa must be drained by needle aspiration two or three times during the first week of treatment. When a patient has such a serious infection, there may be underlying causes such as previously undetected diabetes, or compromised immune system defense function, a byproduct of several diseases and some medications, e.g. chemotherapy.

Alternative treatments take into consideration the role of diet in bursitis. Dietary changes and vitamin supplements may be helpful. The use of herbs, homeopathy, aromatherapy, and hydrotherapy may help to relieve symptoms. Ginger has been used to reduce inflammation. Acupuncture has been shown to be effective treatment for hip and shoulder pain caused by bursitis and other conditions. Other therapies that deal effectively with musculoskeletal problems may also be helpful, such as osteopathy, massage, chiropractic, and applied kinesiology.