Bursitis (Swollen Painful Bursa)

What is bursitis?

Bursae are fluid-filled sacs between tendons and bones or tendons and overlying skin. A bursa is filled with a lubricant synovial fluid that ensures smooth, painless movement between the joints. Therefore the correct anatomical term is synovial bursa. Bursitis is the medical term for inflammation of a bursa that causes pain and swelling at the affected site. Bursae of the shoulder, elbow, hip, knee joints are commonly affected. Treatment of bursitis involves rest to the affected joint by immobilizing the joint, painkillers, exercise and rarely surgical drainage of the fluid from the bursae.

Bursitis Symptoms

Most cases of bursitis are acute and the symptoms intense. These symptoms of bursitis include :

  • Swelling, redness and warmth (signs of inflammation) around the joints.
  • Stinging to burning pain during movement of the affected joint.
  • Stiffness of the affected joint especially in the morning.
  • Fever may be associated with above symptoms

Repeated inflammation of bursa may lead to chronic bursitis. Patients with chronic bursitis may experience acute episodes otherwise the only symptoms that are experienced includes chronic stiffness of the joint and restricted movement of the joint due to pain.

Picture from Wikimedia Commons

Causes of Bursitis

The important reasons for bursitis are :

  • Excessive pressure (maintaining same posture for prolonged period) on the joint.
  • Repeated movement (chronic overuse) of the affected joint.
  • Inflammatory condition (rheumatoid arthritis, gout) can predispose a person to bursitis.
  • Infection.
  • Scoliosis (bending of the spine from side to side) may predispose to shoulder bursitis.
  • Trauma.
  • Systemic diseases (chronic).
  • Unknown reasons (idiopathic)

Injury to bursa leads to swelling due to inflammation (acute bursitis) so the bursa cannot fit in the small space between the bone and tendon or tendon and overlying skin. This condition results in further increase in pressure on the bursa during movements of the overlying joint. Thus inflammatory damage to the bursa becomes a vicious cycle leading to chronic bursitis.

Types and Location

Knee bursitis

Housemaid’s knee, carpet layer’s knee, coal miner’s knee (pre-patellar bursitis) is caused by extensive kneeling during scrubbing of floor, laying carpets and so on. Superficial location of the bursa may lead to infection (sepsis) of the bursa (septic bursitis) due to abrasion.

Clergyman’s knee (infra-patellar bursitis) is bursitis occurring just below the knee cap (patella). Usually Clergyman’s are commonly affected with this type of bursitis due to injury (chronic pressure) of the bursa during prolonged prayer on hard surface.

Hip bursitis

Trochanteric bursitis affects the hip joint

Elbow bursitis

Student’s elbow, Baker’s elbow, water on the elbow (olecranon bursitis) occurs due to repetitive injury (even repetitive movement) to the elbow (during playing golf, tennis even excessive pressure due to leaning on the elbow during studying or computer work can cause this type of bursitis.

Shoulder bursitis

Subacromial bursitis due to repetitive movement of the shoulder joint (like throwing of a baseball).

Risk Factors

  • Age: chance of suffering from bursitis increases with aging.
  • Occupation or hobbies: gardening, painting, prolonged work on computer leaning on the elbow, baseball, tennis players, golfers, floor tiles setting.
  • Co-existent medical conditions: gout, rheumatoid arthritis.

Bursitis Treatment

When there is no infection associated with bursitis the patient can be managed with :

  • Ice packs
  • Elevation of the limb
  • Analgesics and anti-inflammatory drugs
  • Physical therapy

When associated with bacterial infection, antibiotic therapy with further investigation for the underlying cause of infection is required. Repeated attacks of bursitis may be managed with surgical drainage of the bursa.

References :

http://www.mayoclinic.com/health/bursitis/DS00032

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001456/

http://orthoinfo.aaos.org/topic.cfm?topic=a00409

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