by Eve Redstone

Created on: June 01, 2008

Bursitis is an inflammatory condition affecting the bursae. Bursae are fluid filled sacs that acts as cushions between bones and the muscles that pass over them (deep bursae) or between bones and tendons or skin (superficial bursae). The bursae are filled with synovial fluid. Bursitis can affect any bursal sac but some are more prone to the condition than others, particularly the knee, hip and the elbows.

The bursae may become inflamed and sore due to a direct injury such as a fall, chronic injury from overuse, the deposition of uric acid (gout), infection or chronic disease such as arthritis.

The major symptom of bursitis is pain. This is accompanied by inflammation and tenderness, particularly on movement of the affected joint. The range of movement of the affected joint will often be reduced.

The cause of the bursitis usually becomes clear when the history of the condition is taken. Patients may report a recent injury leading to traumatic bursitis, a history of a chronic inflammatory illness such as arthritis or a history of repetitive movement such as kneeling. Bursitis secondary to infection occurs when bacteria are directly introduced to the bursal sac by trauma, following injury or a surgical procedure, or by spread from infection in other tissues (cellulitis).

The initial treatment of bursitis is symptomatic. Heat packs and cold packs can both be effective. Cold treatments are better in the first day to reduce the influx of inflammatory mediators to the joint, after this heat is usually more beneficial. Resting of the joint is important and elevation is helpful where it is practical. Immobilisation of the joint should only be undertaken with care as it can lead to more problems in the long term.

Non-steroidal anti-inflammatory drugs can provide good relief in the acute stages for those patients able to take them. Giving oral steroids, or injecting steroids directly into the joint can also reduce the inflammation if it is not resolving after a week. This should only take place if infection has been eliminated as a possible cause. In chronic overuse injury steroid injections should not be used as an alternative to reducing activity as this can lead to long-term joint damage. Steroid injections can cause a temporary worsening of the condition.

In bursitis caused by infection long courses of antibiotics are often required, and aspiration of fluid from the joint is often necessary.

There are natural remedies that can help with the pain and inflammation in both acute and chronic bursitis. Fish oils work well for some sufferers with chronic bursitis. For acute pain the turmeric sourced curcurmin, rosemary, and bioflavonoids are good choices.

Long-term treatment of bursitis involves identifying the cause, and removing it. This can mean changing jobs for some patients, changing lifestyle for the very active (by finding alternative forms of exercise) or treating an underlying disease such as gout. For example long distance runners, hikers and dancers are prone to bursitis of the hip. Surgery is occasionally offered.

Bursitis may occur some time after the cause. Traumatic bursitis can take three days to become apparent. Having legs of an uneven length can lead to hip bursitis in later life, and using a heel lift in one shoe can reduce this.

Bursitis can be caused by different factors, and treatment has to be directed at the specific cause to be effective.

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