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Bursitis

Bursa is a closed, fluid-filled sac that that surrounds joints or tendons. It functions as a cushion and gliding surface to reduce friction between muscles, tendons and bones as they move back and forth across each other.

The major bursae are located adjacent to the tendons near the large joints, like shoulders, elbows, hips, and knees. Inflammation of a bursa is called bursitis. It is usually a temporary condition that may restrain motion, and it generally does not cause deformity.

It's common among people in sports such as baseball, tennis, racquetball and running. But even everyday household jobs such as yard work, shoveling dirt or snow and house painting can cause bursitis.

Bursitis is often associated with other diseases, such as arthritis, thyroid disease, and diabetes.

Causes & Types

People in poor physical condition and have bad postures are at risk of developing this condition. Injury or overuse is what usually causes bursitis. It may also occur by using an affected limb incorrectly. Although infection could be a probable cause too.

Another way that bursitis occurs is when compression of the bursa happens on a regular basis, such as a side sleeper who places a lot of shoulder or hip pressure when they lay down for long periods. In this case it would not take too much movement of this already compressed area to cause friction of the bursa.

Prepatellar bursitis, which is also called housemaid's knee, results from kneeling on a hard or raised surface for long periods.
Olecranon bursitis, nicknamed student's elbow, results from repeated pressure on the point of the elbow. It often occurs when someone leans on a table or desk for a long time.

The type of bursitis that affects each person varies, as it strikes the areas you overuse or apply pressure the most:

Anterior Achilles tendon bursitis
Also called Albert's disease this type of bursitis is caused by extra strain on the Achilles tendon, such as injury, disease, or shoes with rigid back support. It is characterized by inflammation of the bursa located in front of the attachment of the tendon to the heel.

Posterior Achilles tendon bursitis
Otherwise called Haglund's deformity, it is inflammation of bursa located between the skin of the heel and the Achilles tendon, which attaches the calf muscles to the heel. Aggravated by a type of walking that presses the soft heel tissue to the hard, back support of a shoe, this type of bursitis occurs mostly among young women.

Hip bursitis
Another name for it is trochanteric bursitis. It is often the result of injury, overuse, spinal abnormalities, arthritis, or surgery. This type of bursitis is also more common among women, apart from middle-aged and older people.

Elbow bursitis
Inflammation of the olecranon bursa located between the skin and bones of the elbow is what causes this type of bursitis. Resulting from injury or constant pressure on the elbow doing something as simple as like leaning on a hard surface.

Knee bursitis
Commonly known as goosefoot bursitis or Pes Anserine bursitis, the affected bursa in this case is located between the shin bone and the three tendons of the hamstring muscles, on the inside of the knee. This is usually caused by lack of stretching before exercise, tight hamstring muscles, being overweight, arthritis, or out-turning of the knee or lower leg.

Kneecap bursitis
Medically known as prepatellar bursitis, this type of bursitis is common among skilled laborers like carpet layers and plumbers, who need to sit on their knees a lot.

Signs & Symptoms

The symptoms of this condition can be as varied as the causes and types of bursitis. Varying from an achy pain and stiffness to even a burning sensation on the area surrounding the joint with the inflamed bursa. The pain is usually escalates during and after activity, with the bursa and the surrounding joint area becoming stiffer the following day.

Apart from pain, localized tenderness and limited motion are common among people who have bursitis. Swelling and redness also occurs if the inflamed bursa is close to the surface.

Repeated attacks of pain, swelling, and tenderness, leading to the deterioration of muscles and a limited range-of-motion is a case of chronic bursitis.

Diagnosis

Firstly, an analysis of complete medical history and physical examination is mandatory. As the symptoms of bursitis resemble other medical conditions or problems, an accurate diagnosis is important. So other intensive diagnostic procedures are also employed.

A sample of fluid from the bursa is obtained to rule out infections and to find the cause of the bursitis. And apart from x-rays and blood tests, other tests may also be required:
Computed tomography scan ( CT or CAT scan)
Magnetic resonance imaging (MRI)
Arthrogram to provide evidence of a tear, opening, or blockage.
Aspiration to rule out infection or gout as causes.

Prevention

Bursitis can be prevented by doing stretching exercises regularly, especially before and after heavy workouts. Stretching muscles lengthens tendon connections around the bursa, allowing less friction to the tendon/bursa/bone connections.

Relaxation techniques also help to reduce pressure on the bursa and to keep it from losing its natural lubrication. Wearing a protective pad can also help avoid pressure and injury to the joint. When bursitis does occur, it is important to treat it immediately, and thereby prevent it from reaching a stage that is more severe.

In bursitis, the bursa is inflamed but not infected. If the swelling spreads despite treatment or if you develop fever, chills, or increased warmth, these are signs of possible infection.

Treatment

Treatment for this condition is determined by several factors:
Age, overall health and medical history
Extent of the condition
Patient's tolerance for specific medications, procedures, or therapies
Expectations for the course of the condition

Personal preferences and the possibility of an infection also play a role in treatment. The treatment for bursitis also depends on whether or not it involves infection.

In the case of aseptic bursitis - a non-infectious condition, treatment may include:

Rest
Do not put any pressure on the sore and swollen area until the swelling subsides. Rest the affected area such as the shoulder, elbow, knee, or hip. And wait 3 to 6 weeks before returning to the sport or task that originally caused your condition.

Ice
Put an ice pack on the area for 20 to 30 minutes 3 or 4 times a day to help relieve pain. But it important not to do this more often, as it can constrict the blood vessels and further stiffen the joint area.

Compression
Wear a compression wrap around the affected area such as the elbow or knee. It is important to support and protect the bursa by bracing any areas of the tendon that are being pulled on during use, as this will help stop bursa friction from occurring.

The pressure on the bursa can also be reduced while sleeping by using a softer bed topper like a memory foam mattress pad or even getting a new mattress that is composed with memory foam or latex foam. Memory foam and latex foam reduce compression because they are the only substances that conform with the bumps and curves of the body and can thereby reduce the pressure spot by more evenly disbursing the weight of the body.

Elevation
While resting, keep the affected area at an elevation.

Pain relief
Reducing bursa inflammation and soothing the pain of bursitis can be done topically with pain relievers containing anti-inflammatory agents. A topical formula with natural menthol will not only relieve pain, but also dilate the blood vessels. This allows for relief of the bursitis, without causing any stiffening of the tissue.

Anti-inflammatory and pain medications such as ibuprofen or aspirin are usually prescribed. Cortisone injections can also reduce inflammation, but they are very caustic and can cause a weakening of the tissue structure and sometimes create more scar tissue.

Physical therapy
This may involve stretching and strengthening exercises. Also maintain your range of motion by moving the joint to help keep the joint from getting stiff.

Soft tissue manipulation
Methods such as ultrasound and massage are also used to help break down the scar tissue in the tendon tissue and let the tendon and muscle regain normal flexibility. This can lessen the chance of further injury.

Ultrasound uses sound waves to increase circulation to the tissue and soften the scar tissue, allow it to break down further. Ultrasound can also be used as phonophoresis to help topical pain and nutrient solutions reach further down into the tissues by transporting them with the sound waves.


In the case of septic bursitis - bursa that becomes infected with bacteria, treatment may also include:

Antibiotic medications
Repeated aspiration of the inflamed fluid
Surgical drainage and removal of the infected bursa sac (bursectomy)

With treatment, the pain and swelling of bursitis usually clear up within 2 to 3 weeks. But the healing of the area continues and doesn't even peak until at least six weeks following the initial injury.

This is due to scar tissue formation, which initially acts like the glue to bond the tissue back together. Scar tissue continues to form past six weeks in some cases and as long as a year in severe cases. After 6 months, if this condition persists, it is considered chronic.

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