Brief overview
- Treatment: immobilization of the affected joint, analgesics, sometimes cortisone, shock wave therapy, puncture to aspirate excess fluid, physio-therapy; bacterial or chronic bursitis: often surgical removal, antibiotics (against bacteria); in case of underlying disease: specific treatment of this disease
- Causes: Often overuse resulting from unaccustomed, force-intensive, repetitive movements; other possible causes: Underlying diseases such as rheumatism or gout, bacterial infection; Risk factors: Age, obesity, certain occupations (such as tile setters, musicians, and athletes).
- Prognosis: Usually rapid improvement with effective treatment and immobilization of the affected joint; further overuse brings risk of chronification with persistent, recurrent symptoms (over months or years)
What is bursitis?
However, bursae are also located where skin, muscles, tendons or ligaments lie directly over a bony prominence – for example, in the area of the large rolling mound (bony prominence at the top of the outer side of the thigh bone).
In general, inflammation is possible in all bursae. In practice, however, the bursae of the following body parts are most frequently affected:
Shoulder
Bursitis of the shoulder is one of the most common forms of bursitis. There are a total of four bursae in the shoulder area:
- The bursa subdeltoidea is located between the delta muscle of the shoulder and the shoulder joint. Inflammation of this bursa is called bursitis subdeltoidea.
- The bursa bursa subcoracoidea is connected to the articular cavity of the shoulder joint and to another bursa, the bursa subtendinea musculi subscapularis.
Heel
Two bursae are located in the area of the calcaneus and the Achilles tendon insertion. One bursa is located right in between and is called the bursa subachillea. The second bursa, the bursa postachillea, is located between the Achilles tendon and the skin.
Elbow
The bursitis of the elbow is called bursitis olecrani by medical experts. Most often, the inflammation is located at the bony tip of the elbow (olecranon).
Knee
Bursitis of the knee is one of the most common forms of bursitis. Several bursae can be found inflamed in the knee area. In most cases, either the bursa in front of the kneecap or the one below the kneecap is inflamed.
You can read everything important about the causes, symptoms and treatment of this form of bursitis in the article Bursitis – Knee.
Hip
You can learn more about the causes, symptoms and treatment of bursitis in the hip area in the article Bursitis – Hip.
What is the treatment?
The home remedy of cold may also alleviate the discomfort: It is recommended, for example, to cool the affected area with a cooling pad. Some sufferers also apply cooling compresses.
If the symptoms do not subside despite immobilization and anti-inflammatory painkillers and there is no bacterial infection, the doctor may inject cortisone into the inflamed bursa. It has a stronger anti-inflammatory effect than NSAIDs.
Excess fluid can be aspirated by puncturing the bursa. At best, this accelerates healing.
Physiotherapeutic measures are also recommended. They help to make the affected joint mobile again.
Chronic bursitis is also imminent if the inflammation is prolonged without treatment or the cause is not eliminated.
If another underlying disease is behind the bursitis, it must be treated accordingly.
The concept of homeopathy and its specific effectiveness are controversial in science and not clearly proven by studies.
What to do in case of bursitis of the shoulder?
In the case of wear-related as well as chronic bursitis, pain therapy is often not sufficient. Then the inflamed bursa must be surgically removed.
What to do in case of bursitis of the heel?
Orthoses are special support bandages that relieve the heel without restricting mobility. Shoe adjustments are corrections that are applied to suitable footwear, such as raising the heel or softening the heel cap.
If the complaints do not subside after this therapy or if a heel spur (bone outgrowth on the heel bone) is partly responsible, surgical intervention is advisable. This is done endoscopically or openly.
What are the symptoms?
Bursitis caused by bacteria is often accompanied by fever and general malaise. Sometimes the lymph vessels in the vicinity of the bursitis are inflamed, which is externally visible by red streaks along the lymphatic path and swollen lymph nodes. In most cases, inflammation-related pain in the shoulder, for example, occurs insidiously. Those affected then gradually adopt a protective posture, which in the medium term leads to further complaints in the shoulder.
What are the causes and risk factors?
Bursitis usually results from overloading of the structures involved (joint, muscles, tendons, ligaments). Unaccustomed, repetitive movements, for example, are the trigger. Sometimes bursitis also results from age-related wear and tear. Rarely, a bacterial infection is the cause of bursitis. Men are affected slightly more often than women.
Bursitis due to overload
When the function of the bursa as a buffer is overstressed by unaccustomed, force-intensive and repetitive movements, the bursa sometimes reacts with inflammation.
Overuse also often leads to bursitis in the arms, especially the upper arms.
The two bursae of the shoulder also often become inflamed from heavy use. People who do a lot of work with their arms above their heads, such as painters and forestry workers, are particularly susceptible. Sports such as badminton or climbing also favor inflammation of these two bursae.
Bursitis due to an underlying disease
Infectious bursitis (septic bursitis)
Sometimes bursitis is caused by infection (septic bursitis). Bacteria such as “Staphylococcus aureus” enter the body, for example, after injuries to the skin or bone fractures and trigger bursitis.
Risk factors for bursitis
Stress from recurrent pressure also increases the risk. Poorly fitting, pressing or rubbing shoes sometimes inflame the bursa postachilleae, which is located between the Achilles tendon and the skin, and thus lead to heel pain. Tight and pointed shoes promote a so-called hallux valgus (malposition of the big toe) and irritation of the bursa at the metatarsophalangeal joint of the big toe.
It may be possible to have occupational chronic bursitis recognized as an occupational disease.
What are the examinations and diagnoses?
If bursitis is suspected, the doctor will first ask you about your medical history: He or she will ask you to describe your symptoms in detail, and will ask about recent physical stress and any underlying diseases.
In unclear cases, further examinations are necessary. For example, the inflamed structures are imaged using ultrasound or magnetic resonance imaging (MRI) to assess them more precisely. An X-ray shows whether calcium has already been deposited in the bursa (bursitis calcarea) or interstitial walls of connective tissue (bursal hygroma) have formed.
What is the course and prognosis?
How long bursitis lasts and how severe the symptoms are depends in particular on the cause of the inflammation. If the bursitis is treated effectively and the joint is immobilized, the symptoms usually improve after a few days.
Therefore: Bursitis should be taken seriously at an early stage.
