An inflammation of the bursa – also known as bursitis – usually develops in joints that are subject to particularly heavy strain, such as the shoulders, elbows or knees. While the inflammation is often initially only noticeable by a slight feeling of friction, over time symptoms such as severe pain and redness and overheating of the affected area can occur. Conservative therapy is usually chosen to treat bursitis – but in some cases, surgical removal of the bursa may be necessary.
What are bursae?
Bursae are flat tissue structures that serve to provide cushioning between hard surfaces and soft structures in the body. They contain synovial fluid (synovium) to allow smooth movement. Bursae are usually located near joints, for example on the knees, shoulders or elbows. In addition, they occur in areas of the body where skin or muscle rests directly on a bone. Certain occupational groups, such as tilers or cleaners, but also wrestlers, ice hockey and tennis players, as well as handball and volleyball players, have an increased risk of bursitis. This is because prolonged stress – such as constant kneeling while working – is the main cause of bursitis.
Causes of bursitis
Various causes can underlie bursitis. Most often, it is triggered by infections, injuries or constant irritation. In addition, osteoarthritis and arthritis, metabolic diseases such as gout, and infectious diseases such as tuberculosis or gonorrhea increase the risk of bursitis. Bursitis is particularly often triggered by pressure overload. The cause is sustained or repetitive motion, such as occurs during long-distance running, but also when laying tiles. The continuous stress causes minute injuries that can lead to inflammation of the bursa. If an external injury is the cause of bursitis, a distinction is made between two different forms:
- An external force, such as a blow to the knee, can cause the bursa to fill with blood and become inflamed.
- An open injury near the bursa can allow bacteria to enter the wound and cause bacterial bursitis.
Typical symptoms of bursitis
In the case of bursitis, there are initially hardly noticeable symptoms – you often notice a burning or slightly rubbing sensation. If the joint continues to be stressed, the symptoms usually intensify: there may be severe pain (especially when pressure is applied), overheating and redness of the affected area, and significant swelling. This is due to additional fluid accumulating in the bursae. Bursitis is particularly common in joints that are subjected to a lot of stress. These include the shoulder, elbow, hip, knee and ankle. If a bursa is affected near a joint, the increase in volume can result in restricted movement of the joint in question. Often, sufferers adopt a protective posture and do not place full weight on the affected joint. In some cases, bursitis can spread to the surrounding tissue and lead to redness of the extremities and general symptoms of illness – for example, swelling of the lymph nodes, fever, fatigue and exhaustion. If the bursa lies deep under the skin, usually only the pain indicates inflammation. Other symptoms are usually absent.
Treating a bursitis
Normally, bursitis heals on its own within a few weeks. Until then, acute pain can be treated well with cooling ointments or gels. Cooling packs also help to relieve the pain. However, these should not come into direct contact with the skin, otherwise frostbite can occur. Heat treatments, on the other hand, should be avoided at all costs. To allow the bursitis to heal, it is recommended that the affected joint be immobilized for some time with a bandage or splint. However, rest should only be given for a short time, because if the joint is not moved for too long, it may possibly lead to persistent movement restrictions.Therefore, it is advisable to move the joint again slowly and without strain after a short period of rest. Doctors often prescribe physiotherapy for bursitis, so that the joint is first moved under guidance.
Medication helps to relieve pain
To relieve the pain associated with bursitis, pain relievers such as ibuprofen or diclofenac may be considered. These medications not only reduce pain, but also inhibit the inflammatory response. This has a positive effect on the healing process. If the pain is severe, local anesthetics can be injected directly into the respective joint. If the bursitis was caused by a bacterial infection, an antibiotic can also be taken – if necessary.
Surgical removal of the bursa
If the inflammation has subsided but the bursa is still palpable like a pillow, the accumulated fluid must be removed by puncture. In contrast, surgical removal of the entire bursa is relatively rarely necessary. Surgery is performed, for example, if the symptoms of chronic bursitis do not subside or recur. The hip and elbow are particularly often affected by chronic bursitis. Intermediate walls of connective tissue can grow in the bursa and calcium deposits can occur.
