Bursitis is a common, painful condition that affects many patients within the population. Our bodies are filled with small fluid-filled sacs called bursae that are located at certain friction points, such as joints or bony prominences. These bursa help cushion and protect the bone from friction as tendons and muscles cross over bone during movement, especially in places like elbows, knees, and hips. Bursitis occurs when these fluid-filled sacs become irritated and inflamed from too much friction or pressure. Bursitis can occur anywhere where we have bursa sacs. The bursa sac on our hip is located on the prominent bone on the upper outside portion of our thigh. This is one of the largest bursa sacs in our body and sees a significant amount of stress and friction as a large number of muscles and tendons rub over it. Stress and friction increase as we walk, run, move from sitting to standing position, and sleep on our sides. Hip bursitis (also known as trochanteric bursitis) may be a sign of a more serious issue. If an individual continues to have bursitis pain at the hip that has not improved despite treatment, he or she may have a tear of a muscle located next to the bursa called the gluteus medius. A tear of this muscle can cause significant pain that extends into the buttocks and down the leg. It can be associated with weakness, an altered gait pattern, and the inability to sleep on one’s side.
Causes & Symptoms
There are many ways a bursa can become inflamed. Normally, inflammation is related to irritation, friction, or trauma to a bursa, as described below:
- Excess irritation – Occurs when pressure is repeatedly put on the bursa. For instance, repeatedly leaning on the elbows could lead to elbow bursitis, and wearing shoes that rub uncomfortably against the back of the foot may lead to heel bursitis.
- Excess friction – This can happen between the bursa and the nearby soft tissues. For example, during hip and knee movements a thick band of tissue called the iliotibial band (IT Band) passes back and forth over the hip’s trochanteric bursa. If the IT Band is too tight, walking or exercising may lead to excess friction and hip bursitis.
- Trauma – Lastly, trauma can cause a bursa to fill with blood temporarily, causing swelling and irritation of the bursars synovial lining. For example, banging the kneecap on a hard surface may lead to knee bursitis.
Bursitis can also be associated with underlying medical conditions, particularly forms of inflammatory arthritis that cause changes to a joint, such as rheumatoid arthritis or gout. In most cases, bursitis is caused by an injury, therefore, the signs and symptoms normally develop gradually, even over several days or weeks. These signs and symptoms typically include the following:
- Swelling – as the bursa fills with fluid.
- Tenderness – that is triggered when pressing the skin over the bursa.
- Stiffness – that limits the joint’s ability to comfortably bend and straighten.
- Pain – from inflammation of the bursa and possible problems in nearby soft tissues.
- Skin redness – which may be signs of skin irritation, bursa inflammation, or an infection.
Who Gets Bursitis?
Anyone can develop bursitis, however, certain factors may increase the risk of bursitis, such as the following:
- Chronic medical problems
- Improper posture
- Receiving an infection that can go widespread to your bursae, bones, and even joints
- Other chronic conditions such as arthritis, diabetes, gout, or thyroid disease
Bursitis can also be caused by patients who are in jobs (or perform hobbies) that involve repetitive tasks, such as sports, manual labor, or music.
How Does It Affect You? How Serious Is It?
Bursitis signs and symptoms can vary depending on several factors, including the severity of inflammation and its underlying cause. Another important factor is the bursa’s location. Visible swelling, skin redness, and skin warmth are more likely when the inflamed bursa is located directly under the skin. Bursae located under the skin are known as subcutaneous bursae. Some examples of these bursae include the prepatellar bursa at the front of the knee, a bursa at the tip of the elbow, and the subcutaneous bursa at the back of the heel. Additionally, little or no visible swelling, skin redness, or skin warmth is more likely when the inflamed bursa is located under many layers of soft tissue. Examples of these types of bursae include the greater trochanteric bursa in the hip, and the subacromial bursa in the shoulder. A patient’s anatomy may also affect whether or not swelling is noticeable. For instance, a person who has excess weight or loose skin may not notice mild or moderate swelling in a knee or elbow.
Whenever a bursa is infected, it is called septic bursitis. This condition requires urgent medical care and treatment, including antibiotics. Whilst septic bursitis can develop in any bursa, it is most likely to occur in the prepatellar bursa at the front of the knee and another bursa called olecranon bursa at the tip of the elbow. Some signs and symptoms linked to septic bursitis include:
- Feeling warm to touch
- Rashes, bumps, or sores (skin infection)
- Frequently becoming sick
Septic bursitis also occurs when an infectious bacteria or other microorganisms may enter through a cut, scrape, puncture, bug bite, or other similar occurrences allowing these microorganisms to enter the body. However, sometimes an infection can occur without an obvious entry point on the skin.
Recommended Treatment & Rehabilitation
The diagnosis of bursitis can be performed with a medical history and a physical examination. Some cases will not require additional tests or imaging, although, it can be very helpful in other types of situations, especially if the doctor wishes to rule out other conditions with similar symptoms, such as arthritis, gout, or sciatica. Within a physical examination, a healthcare provider will test for pain, look for swelling, and test range of motion. An X-ray or MRI may be used if the doctor suspects the cause is from an injury or to rule out other conditions such as fractures. An ultrasound can also be used to rule out other conditions, or if the doctor suspects septic bursitis. If a physician suspects the swelling is due to an infection, fluid from the bursa will be drawn out through a syringe (a procedure called aspiration) and then tested for bacteria or crystals. Blood tests are rarely necessary, but they can help provide evidence of infection.
Bursitis treatment involves different strategies to decrease inflammation in the bursa. Medical treatment is necessary when septic bursitis is suspected because the infection can spread to other points in the body, including the bloodstream, so whilst it is not common, this condition is life-threatening. Generally, once bursitis has occurred in a bursa, there is a risk of it returning. Fortunately, there are steps that can be taken to prevent bursitis from recurring. When home treatments have not eased the symptoms, then medical treatment is advised. Here are some treatments you can do once bursitis has taken effect in a bursa:
- Physiotherapy – to help strengthen and stretch the tissues around the bursa that was affected.
- Cortisone injection – to reduce inflammation rapidly.
- Antibiotics – for cases of septic bursitis.
- Orthotics – to help improve body mechanics and take the stress of the bursa.
Not all the treatments are appropriate for all types of bursitis. For example, physiotherapy may be appropriate if the inflamed bursa is located under a tight tendon or muscle, however, it may not be helpful if the bursa is located below the skin.
If a bursitis is chronic and difficult to treat, a doctor may recommend a surgery called a bursectomy. During this surgery, the inflamed bursa is removed. A bursectomy can be performed along with other surgical procedures. For instance, a surgeon can remove an inflamed bursa from the back of the heel as well as the bone spurs that contributed to the bursa’s irritation. After surgery, a bursa may grow back; the hope is that the new bursa will be less prone to a repeated inflammation.
Bursitis can take effect in different locations throughout the body; however, the hip and shoulder are the most common. These types of exercises will help for those who have been experiencing either shoulder or hip bursitis:
Hold the elbow of your injured arm with your other hand. Then use your hand to pull your injured arm gently up and across your body. You will feel a gentle stretch across the back of your injured shoulder. Finally, hold this position for at least 15-30 seconds, then slowly lower your arm. Repeat this method 2-4 times.
Standing about an arm’s length away, grasp onto a solid surface. You could use a countertop or the back of a sturdy chair. Afterwards, with your knees slightly bent, bend forward with your arms straight. Lower your upper body, and let your shoulders stretch. As your shoulders are able to stretch further, you may need to take a step or two backwards. Hold this position for at least 15-30 seconds, then stand up and relax. If you had stepped back during your stretch, step forwards so you can keep your hands on the solid surface. Repeat this exercise 2-4 times.
Shoulder blade squeeze
First you stand with your arms at your sides, then secondly, you squeeze your shoulder blades together. Do not raise your shoulders up as you squeeze. Hold this position for 6 seconds, then repeat the entire procedure 8-12 times.
Hip rotator stretch
Lie on your back with both knees bent and your feet flat on the floor. Afterwards, put the ankle of your affected leg on your opposite thigh near your knee. Use your hand to gently push your knee away from your body until you feel a gentle stretch around your hip. Hold the stretch for 15-30 seconds, then repeat the method 2-4 more times.
Straight leg raises
Lie on your side, with your affected hip on top. Next, tighten the front thigh muscles of your top leg to keep your knee straight. Keep your hip and your leg straight in line with the rest of your body, and keep your knee pointing forwards. Do not drop your hip back. Lift your top leg straight up towards the ceiling at about 30cm off the floor. Finally, hold this stretch for 6 seconds before slowly lowering your leg. It is recommended to repeat this exercise 8-12 more times.
Lie on your side, with your affected hip on top and your head propped on a pillow. Keep your feet and knees together and your knees bent.
Afterwards, raise your top knee, but keep your feet together. Do not let your hips roll back as your legs should open up like a clamshell. Lastly, hold this position for 6 seconds, then finally slowly lower your knee back down. Rest for 10 seconds, then repeat the procedure 8-12 times.