Bursitis describes inflammation of one or more ‘bursae’, which in turn are small sacs of fluid lined by synovial membrane. The role of bursae (or a ‘bursa’ in the singular) is to provide a ‘cushion’ between bones, tendons and muscles around joints and thereby to reduce friction and impact. It achieves this by secreting lubricating synovial fluid, which is a viscous fluid that has a ‘yolk-like’ consistency – the word ‘synovial’ actually comes from the word ‘ovum’ – egg in Latin, and by using it to absorb impact.
In bursitis, the bursae become inflamed which makes movement of the afflicted area painful and difficult. Muscles and tendons can also further aggravate inflammation, thereby worsening the problem. In some cases this will reduce movement to the point where muscles become stiffened.
Signs and Symptoms
There are over 150 bursae in the human body, but the condition will mostly affect the ‘superficial bursae’. These are the prepatellar, retrocalcaneal and pes anserinus bursae – or the knees, shoulders and elbows. Common symptoms include:
• Joint pain
• Localized warmth
• Reddening of the skin
• Stinging pain around the joint that gets worse after activity
Often there are multiple causes that contribute to the development of bursitis. These include direct trauma to the area, autoimmune conditions, infection, iatrogenic causes (caused by physicians), repetitive movements, excessive pressure, arthritis, diabetes and sometimes scoliosis (in which the spine is curved from side to side). Most often, shoulder bursitis is the result of simple overuse.
Treatment for bursitis will vary depending on the cause. Where the cause is infection, there may be visible signs of cellulitis around the area alongside flu-like symptoms such as fever, lethargy and sweating. In such cases, treatment can be achieved through the use of antibiotics and in some cases steroids. If this does not work, then surgery might be used (bursectomy) in order to remove the affected bursa. Bursectomy can be achieved either endoscopically or through open surgery. Following a bursectomy, the bursa will grow back in place but without the inflammation.
When there is no infection, bursitis will be treated symptomatically through a combination of rest, ice, elevation, physiotherapy, analgesics and anti-inflammatory medication. Compression bandages are not used as they may actually create more tension and friction around the joint. Again, in chronic cases, bursectomy may be a valid option.