WHAT’S UP DOC? Bursitis

Q: I was diagnosed with bursitis in my elbow, and my friend’s doctor told her she had bursitis in her shoulder. Is this the same disease?

A: A bursa is a fluid filled sac-like structure that acts like a cushion between the bones, muscles, skin/soft tissue and tendons around our joints. There are about 160 of them in our bodies. Some bursa are deeper in the joint structures, and some are more superficial (between the skin and the joint).

If a bursa becomes irritated/inflamed, the condition is called bursitis. When this occurs the amount of fluid in the bursa will increase, and there will be an increase in production of fibrous tissue as well as other inflammatory responses causing irritation. This may occur acutely (most commonly from trauma such as prolonged kneeling, pressure from prolonged leaning on the elbows, or from some other direct joint trauma) or chronic (most often from repetitive motions, whether from work, sports, hobbies, etc.). Bursitis is fairly common, accounting for about 1 in 200 visits to primary care clinicians.

Although in theory any bursae may develop bursitis, the most common locations for this condition are the shoulder, elbow, knees and hip, joints that often experience repetitive motions and/or trauma. The big toe, ankle and heel are also fairly commonly affected.

The symptoms of bursitis differ a bit depending on what joint is affected, but typically include pain with movement (or when the area is pushed on), redness, swelling, stiffness and achiness, all symptoms one would expect from an irritated/inflamed joint.

Bursitis is typically diagnosed based on the symptoms and the physical exam. No blood tests are usually needed (unless the diagnosis is uncertain and another condition, such as gout or an autoimmune condition, is being considered). Imaging tests are also not usually required, although in select cases an MRI or CT may be ordered to rule out some other cause (such as in cases where bone, muscle or other body tissues are thought to be involved).

Bursitis may be caused (or worsened) by repetitive activity (such as a sports activity or a repetitive motion done at work or for some hobby), or by repeated trauma (such as leaning on the elbows or knees for long periods of time and/or frequently). Other inflammatory conditions, such as arthritis, gout or others, may also increase the risk of someone developing bursitis, as can certain autoimmune diseases (such as rheumatoid arthritis). Overall, developing bursitis becomes more common as we age.

Any time someone has bursitis, the possibility of whether the bursa is infected, called septic bursitis, is also considered. Things that increase the suspicion of septic bursitis include fever, disabling joint pain (including the inability to even move the joint), excessive redness/swelling (especially if it is extremely tender to the touch), other severe symptoms. The reason septic bursitis must always be considered is that this condition requires treatment with antibiotics and can cause other complications including a spread of the infection. The diagnosis of septic bursitis may be confirmed by using a needle to obtain a sample of the fluid in the bursa (removal of some of the bursa fluid can also help relieve symptoms, whether from bursitis or septic bursitis), and then obtaining cultures of the fluid (which can take a few days to get final results). Other tests may be indicated as well.

The treatment for bursitis is usually ‘conservative’, including rest, avoidance of any predisposing factors (for example, in someone who kneels on their knees for work develops bursitis they may benefit from using knee pads), cold/heat treatments, NSAIDs (non-steroidal anti-inflammatory drugs), and in some cases drainage of some of the fluid and even injection of steroids into the bursa. Surgery is not usually needed to treat bursitis, although in certain refractory cases it may be considered.

Most cases of bursitis are readily diagnosed based on the history and physical exam, so if you think this may be a condition that is causing you problems you should see your primary care clinician for evaluation. Overall, most cases of bursitis get better with conservative treatments and by avoiding any contributing factors (such as repetitive motions or trauma) to prevent recurrences.

Jeff Hersh, Ph.D., M.D., can be reached at DrHersh@juno.com