Bursitis is inflammation or irritation of the bursa. Bursa are fluid-filled sacs around joints and tendons that reduce friction from movement and provide a cushion between bones, tendons, muscles, and skin. In this article, we consider the types of bursitis (types) and their treatment.
Bursitis can quickly occur (acute) or slowly increase over time (chronic). Acute bursitis is often the result of trauma, infection, or inflammatory disease. Chronic bursitis often follows a prolonged period of reuse or movement. Bursitis can affect almost any joint in the body, although in some places more often than in others.
Types of bursitis
Bursitis can affect various areas of the body. The exact symptoms and preferred procedures depend on the location as well as the cause.
Shoulder (subacromial bursitis). Shoulder bursitis causes pain in the shoulder and often spreads up the arms. The pain is often present at rest, but increases with the movement of the arm, especially when raising the arms above the head; he also often interrupts sleep. It is difficult to distinguish between humeral bursitis from other problems, such as the rupture of the cuff or tendonitis.
Upper back (scapular bursitis). Upper back bursitis affects the space between the shoulder blade and ribs and can cause pain or a feeling of popping up. Reaching the arm above the head or pushing up can aggravate the pain.
Elbow joint (ulnar bursitis) – Elbow bursitis usually causes a visible swelling at the tip of the elbow, like a golf ball. This may be the result of trauma (bleeding in a bursa), infection, crystals (gout), or rheumatoid arthritis. This usually causes pain when the elbow is bent but not extended. The elbow usually expands without discomfort.
Pelvic (Sciatic Bursitis) – Pelvic bursitis is often caused by prolonged sitting on hard surfaces. This causes pain in the lower buttocks, which are aggravated by sitting; the pain may disappear when a person is standing.
Big trochanteric pain syndrome (formerly called trochanteric bursitis). A large trochanteric bursa is located in the upper outer thigh. Bursitis in this area is usually associated with inflammation of nearby tendons and can cause pain while lying or sleeping on the affected side of the body. People with major trochanteric syndrome also have pain when stretching their legs, walking, but not standing still. Symptoms may be exacerbated by an abnormal gait due to uneven stress on the hips. There are many factors, including chronic back pain, contralateral knee pain (knee pain on the opposite side of the body from bursitis), different leg lengths and overweight.
Ilio-lumbar bursitis – The lumbar muscle extends from the spine to the femur and is used to flex the thigh. The iliac-lumbar bursa abuts the lumbar muscle deep in the front of the thigh. This type of bursitis causes pain in the groin area, especially when the thigh is bent against resistance or when climbing stairs. This can lead to arthritis in the area, excessive use (such as excessive running) or injury. Because the symptoms are similar to the symptoms of other problems in the hip area (for example, problems with bone or cartilage), imaging tests are often required to confirm the diagnosis. Infection in the lumbar muscle (lumbar abscess) may have similar symptoms.
Patella and popliteal bursitis – the patella bursa is located in front of the patella, and the popliteal bursa is oppositely lower. Bursitis in these areas can occur due to a recurring knee injury and is often observed in people who often kneel. Patellar bursitis is referred to as the “maid’s knee” or “nun’s knee.” It can also occur as a result of infection, gout, or rheumatoid arthritis. The tumor occurs in the bursa, and not in the knee joint itself. People with popliteal and popliteal bursitis usually feel more comfortable lying with an extended knee, while people with edema in the knee joint tend to feel better lying with a partially bent knee.
Goosefoot pain syndrome. The bursa is located approximately 5 cm below the upper part of the tibia on the inside of the knee. Goosefoot pain syndrome causes pain on the inside of the knee, which usually occurs suddenly, often during the night. This is more common in people with osteoarthritis of the knee, obesity, or when the knees point inward, also called knee deformity.
Heel (inflammation of the mucous membrane of the heel tendon bag). The bursa is located between the calcaneus and the Achilles tendon, which connects the heels to the calf muscle. It usually serves as a pillow to absorb shock when walking. Calcaneal tendon bursitis can cause pain and swelling in the area. It can be easily confused with Achilles tendonitis (inflammation of the Achilles tendon).
Types of bursitis treatment focuses on alleviating inflammation and pain, treating infection (if present), and preventing complications and future relapses.
Medication. In most cases, NSAIDs can help relieve pain and inflammation. These include ibuprofen and naproxen and others. External NSAIDs (e.g., diclofenac gel) may be a suitable option for patients who cannot tolerate oral NSAIDs.
Glucocorticoid (steroid) injection can also help with pain and inflammation from bursitis. For some, the types of bursitis indicated are steroid injections, but not in others. This, as a rule, is not useful (and may even be harmful) for more superficial types of bursitis, for example, in the bursa of the elbow joint, bursa of the knee or bursa of the heel.
Septic bursitis requires drainage of contaminated fluid and antibiotics to treat the underlying infection. Rarely, surgery is indicated in cases where drainage and antibiotics cannot cure the infection.
Joint protection – it is important to protect the affected joints, rest in the affected area and help the bursa recover. Bursa protection can also prevent the worsening or recurrence of bursitis. Examples of joint protection:
- Avoid or alter actions that cause pain.
- The use of pillows for people who often have to kneel or sit.
- Modification of shoes to reduce pressure on the back of the heel (for example, cutting a “V” -shaped groove on the back of the shoe using a pad inside the shoe to raise the heel).
- Customizable devices worn over elbows to protect them and prevent fluid buildup.
Other measures – Ice can help relieve pain, especially for bursitis, which affects surface areas such as the elbow, patella, and heel. Heat (such as a heating pad) may be more effective for deeper forms of the disease, such as the thigh, shoulder, or inside of the knee.
In many cases, physical therapy can help treat symptoms and prevent a recurrence in the future. Optimal exercise depends on the type and severity of bursitis but may include stretching, strengthening, or working to improve (and maintain) the range of motion.
Surgical intervention is rarely required to remove all or part of the damaged bursa.
Treatment of infection – Septic bursitis is treated with antibiotics. The choice of which antibiotic to use and for how long depends on the type and severity of the infection. For mild cases, several weeks of oral antibiotics may be sufficient; for more severe infections, intravenous antibiotics may be required (hospital data).
It is also often necessary to drain the infected liquid with a needle. This is done in the doctor’s office, usually several times, until the infection resolves.