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23 November, 2009

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Bursitis

Bursitis is inflammation of a bursa. Bursae are small sacs located between two adjoining structures, usually muscles, tendons and bones. Bursae decrease friction and assist movement of the tendon over the bony surface. Bursitis does not cause joint deformity but can cause significant pain and restrict movement.

Bursae are located outside the joint itself. Since both tendons and bursae are located near joints, inflammation in these soft tissues may be mistaken as arthritis. However, arthritis involves inflammation within joints, whereas bursitis involves inflammation outside the joint.

Bursitis is most common in the shoulder, elbow, hip and knee
The body contains many bursae but the shoulder, elbow, hip, knee and heel are the most common sites of bursitis. Common causes include injury, repeated pressure and overuse. Certain disorders (such as rheumatoid arthritis, gout and diabetes) can also contribute to the development of bursitis.

The inflammation and swelling strike suddenly over a few hours or days. If caused by injury, bursitis will resolve after a few days or weeks. However, if bursitis is caused by overuse, the inflammation will continue unless the particular activity or movement is stopped.

Symptoms
The symptoms of bursitis may include:

Localised pain
Swelling
A warm feeling in or around the affected area
Increased pain at night
Pain worsened by movement
Stiffness
Reddening of the skin.

Overuse injury
A common cause of bursitis is overuse of the particular body part, especially if that activity is performed awkwardly or with considerable pressure. Examples of work-related activities that may trigger bursitis include production line packing and typing. Sports that can cause bursitis include jogging, tennis and squash.

Other soft tissue injuries that can be classified as overuse injuries include:

Carpal tunnel syndrome – a painful disorder of the hand leading to increased pressure on the main nerve that runs through the wrist.
Ganglion – a cyst on a tendon or joint capsule.
Tennis elbow – inflammation of tendons surrounding the elbow joint.
Tenosynovitis – inflammation of the tendons (the tough connective tissue that anchors muscle to bone).

Diagnosis
Bursitis is generally detected as a tender, warm swelling at the site of a bursa. A diagnosis may also include investigating and ruling out any other possible causes. Tests may include:

Physical examination
Medical history
X-rays, to rule out the possibility of any other condition
Ultrasound
Drawing off fluid from the bursa to rule out the possibility of infection.

Treatment
Treatment will depend on the cause of the bursitis. Treatment aims to alleviate the symptoms as much as possible while the healing process takes place. Options may include pain-killing drugs, cold packs, gentle mobilising exercises and rest. Anti-inflammatory medications or injections of corticosteroids may be used in cases of severe pain.

If infection is present, there is usually warmth, redness, pain and swelling in the affected areas. Treatment with an appropriate antibiotic is necessary. If the bursitis was triggered by overuse, it is important to avoid the particular activity.

Correct posture and joint protection are useful and braces or splints can decrease the stress on the areas and support good alignment. After an acute attack, it is important to consider how recurrences can be prevented.

Long-term management
Your doctor or physiotherapist can offer suggestions and strategies to reduce your risk of developing bursitis again. General suggestions include:

Work-related bursitis – use ergonomically designed furniture and equipment, take frequent breaks, do simple stretching exercises for 10 minutes every hour and keep benches at waist height so that the shoulders can relax.
Sport-related bursitis – warm up thoroughly by stretching and gently going through the motions of your chosen sport. Make sure you use good form and regularly practice strengthening and conditioning exercises that compliment your particular sport. Cool down thoroughly with gentle, sustained stretches. Make sure footwear and equipment are appropriate for you.

Where to get help

Your doctor
Physiotherapist
Arthritis Victoria Tel. (03) 8531 8000
Australian Physiotherapy Association Tel. (03) 9092 0888

Things to remember

Bursitis is inflammation of a bursa.
Bursae are small sacs that contain fluid to lubricate moving parts, such as joints, muscles and tendons.
Common causes of bursitis include injury and overuse.
Treatment includes rest, ice packs, gentle mobilisation exercises and avoiding the particular activity that prompted the condition.

You might also be interested in:
Arthritis.
Gout.
Knee injuries.
Neck and shoulder pain.
Rheumatoid arthritis.
Workplace safety - overuse injuries.

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