Bursae are fluid-filled sacs found about your joints. They surround the areas where tendons, skin, and muscle tissues meet bones. The lubrication they add helps reduce friction during movement of the joint.
Bursitis is an inflammation of your bursae. Inflamed bursae cause pain and discomfort in the affected location. They also limit the ways you can move your joints.
General symptoms of bursitis include:
- joint pain
- joint swelling
- erythema, or “skin redness,” which can appear purple or slightly darker on dark skin tones
- thickening of your bursae
Different types of bursitis also have their own specific symptoms:
- With prepatellar bursitis, it can be hard to bend your leg.
- With olecranon bursitis, it may be hard to bend your arm.
- Trochanteric and retrocalcaneal bursitis can cause difficulty walking.
- Trochanteric bursitis can also make it painful to lie on your hip.
There are over 150 bursae in the human body, and so there are several types of bursitis. Four forms are most common:
- Prepatellar bursitis is inflammation around your kneecap, also known as the patella. It can be acute or chronic.
- Olecranon bursitis is inflammation around your elbow. The affected bursae are located at the tip of your elbow, called the olecranon. In some cases, small nodules can be felt within the bursae. It’s usually chronic.
- Trochanteric bursitis occurs in the bursae of your hips. It can develop slowly. It may appear alongside other medical conditions, such as arthritis.
- Retrocalcaneal bursitis may cause pain and swelling in your heel. It can be acute or chronic.
These conditions may be chronic, meaning they occur on a regular basis. Alternatively, they may be acute, meaning they appear suddenly.
Bursitis can also be classified by what causes the inflammation:
- Septic (infectious) bursitis is caused by an infection. This often occurs when the skin around the bursa is punctured, allowing the infection to enter. Septic bursitis causes the bursa to become red, hot, or swollen. It also results in chills, fever, and other symptoms of infection.
- Aseptic (nonseptic or noninfectious) bursitis is usually caused by repeated minor trauma to the joint area or strain injury.
The most common causes of bursitis are injuries or damage to your bursae. Damage may trigger pain, swelling, and redness in the affected area.
However, causes tend to be different for each type of bursitis.
Tears or damage to your kneecaps or knee bursae may cause swelling. Other causes are:
- sports-related activities
- bending your knees repeatedly
- staying on your knees for long periods of time
- bleeding in your bursae
Repeatedly resting your elbows on hard surfaces or a hard blow to the back of the elbow can cause this type of bursitis. It can also be caused by infection or gout.
Gout occurs when uric acid crystals build up in the body. Gout can result in tophi, or small nodules, that can be felt within the bursa.
Many things can trigger bouts of inflammation and pain in your hips. These include:
- lying on your hips for long periods of time
- improper posture while sitting or standing
- any condition that affects your bones, such as arthritis
Running, jumping, or other repetitive activities can inflame the bursae in your heels. Beginning a strenuous exercise without properly warming up may also be a cause. Shoes that are too tight at the back of the heel can make it worse as it rubs against the bursa.
Septic (infectious) bursitis
Septic, or infectious, bursitis occurs when the bursa becomes inflamed due to an infection from bacteria. This usually happens when bacteria are directly introduced into the bursa through a wound in the surrounding skin.
Skin infections, such as cellulitis, may lead to septic bursitis. Blood or joint infections can also spread to the bursa and cause septic bursitis.
Symptoms of septic bursitis are similar to those of aseptic bursitis. Your healthcare professional may draw a sample of bursal fluid and use a bursal fluid analysis to test for infectious bursitis.
Risk factors for bursitis include:
- having a chronic medical condition
- participating in repetitive sports or activities
- repetitive use of a given joint
- improper posture
- getting an infection that can spread to your bursae, bones, and joints
- injuries to the bursae
Bursitis can often be diagnosed by physical exam. However, tests can also be used to diagnose this condition.
Your healthcare professional can use an X-ray or ultrasound to take images of the affected area. Blood tests and samples from the affected bursae can also be used for diagnosis.
Needle aspiration is always recommended in cases where infectious bursitis appears to be limited to the joint.
In some cases, such as when a person has olecranon bursitis, performing a needle aspiration will increase the risk of a secondary infection moving from the skin into the bursa.
The medical professional may not perform a needle aspiration then. Instead, they may give you antibiotics before observing you clinically. This is known as empiric therapy.
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Rest, pain medication, and icing your joint may relieve your bursitis. However, other treatments may be necessary:
- Antibiotics are necessary in cases in which the bursa is infected.
- Corticosteroids can be used to relieve pain, inflammation, and swelling as long as there’s no evidence of any infection in or around the bursa.
- At-home exercises may help relieve pain and other symptoms. In rare cases, physical therapy is needed.
In chronic or severe cases where treatment does not help, surgery might be necessary to remove the affected bursa.
Bursitis isn’t always preventable. However, making some basic lifestyle changes can reduce your risk of developing bursitis and prevent severe flare-ups, such as by:
- maintaining a healthy weight to avoid putting extra stress on your joints
- exercising to strengthen the muscles supporting your joints
- taking frequent breaks when performing repetitive tasks
- warming up before starting strenuous activities
- practicing good posture when sitting and standing
- stopping an activity if you experience pain
Your condition will likely improve with treatment. However, bursitis can become chronic. This may be more likely if your bursitis is:
- not diagnosed and treated appropriately
- caused by an underlying health problem that can’t be cured
Talk with your doctor if your pain or other symptoms don’t improve with treatment.