Overuse and stress. You may commonly subject your body's joints to these conditions when you're at work and at play. The eventual result of repetitive movements and pressure may be a painful inflammation called bursitis.
You have more than 150 bursae in your body. These often tiny, fluid-containing sacs lubricate and cushion pressure points between your bones and the tendons and muscles near your joints. They help you move without pain. When they become inflamed, movement or pressure is painful.
Most often bursitis affects the shoulder, elbow or hip joint areas. But you can also have bursitis by your knee, heel and even in the base of your big toe. Bursitis pain usually goes away within a week or so with proper treatment, but recurrent flare-ups are common and frustrating.
If you have bursitis, you may notice:
- A dull ache or stiffness in the area of your elbow, hip, knee, shoulder, big toe or other joint.
- The pain is worse with movement or with pressure.
- The affected area feels swollen or is warm or hot to the touch.
- Occasional skin redness in the area of the inflamed bursa.
In bursitis of the hip, there isn't any visible swelling or skin redness because the bursae are located beneath some of your body's bulkiest muscles. In this form of bursitis, pain is primarily over the greater trochanter, a jutting portion of your thighbone (femur) just below where the bone joins the hip.
The common causes of bursitis are overuse, stress or direct trauma to a joint, such as with repeated bumping or prolonged pressure from kneeling. Bursitis may also result from an infection, arthritis or gout. Many times, the cause is unknown.
Other forms of bursitis are caused by the repetitive motion related to certain activities. They may be named after the profession or trade associated with certain motions of the joints.
Miners' elbow results from swinging a pick. You may get a similar inflammation by pushing a vacuum cleaner back and forth. Throwing a baseball and swinging a tennis racket or a golf club are other examples of repeated physical activity that may lead to bursitis or tendinitis of the elbow or shoulder. Simple repeated leaning on your elbows could lead to bursitis over the tip of your elbow.
Weaver's bottom describes an inflamed bursa over the bone in your buttocks. It may result from sitting on a hard surface and swaying back and forth, such as sitting at a loom. The pressure from standing for a prolonged time may lead to bursitis of the hip. Housemaid's knee — a soft, egg-shaped bump on the front of your knee — results from kneeling while installing tiles, scrubbing a floor, gardening or doing other activities that place pressure on your knees.
You may not be able to pinpoint a specific incident or activity that led to your bursitis. In fact, in some cases the inflammation may stem from a staphylococcal infection or, rarely, tuberculosis.
If you work in a profession or have a hobby that requires repetitive motion, you’re at an increased risk of developing bursitis. The occurrence of bursitis also increases with age. In addition, certain diseases and conditions increase your risk of developing bursitis, such as:
- Staphylococcal infection
- Tuberculosis, although rarely
- Arthritis
- Gout
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When to Seek Medical Advice
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Most cases or flare-ups of bursitis respond well to home treatment. However, consult your doctor if:
- Bursitis pain is disabling or doesn't subside after 10 days of home treatment
- You notice excessive swelling, redness, bruising or a rash in the affected area
- Pain is sharp or shooting, especially when you exercise or exert yourself
- You have a fever
- You have other medical conditions that may increase your risk of an infection, such as diabetes,
rheumatoid arthritis or autoimmune diseases such as lupus
- You take medications that increase your risk of infection, such as corticosteroids or
immunosuppressants
Your doctor may do a physical examination and ask about your recent activities. By feeling the painful joint, your doctor may be able to identify a specific area of tenderness.
If it appears that something else may be causing the discomfort, your physician may want an X-ray of the affected area. If bursitis is the cause, however, the X-ray images will not establish the diagnosis, but they help to exclude other causes of your discomfort.
Although you usually can trace bursitis to events of overuse or pressure, there may be no obvious cause. In the latter case, your doctor may want to perform additional screening or tests to rule out other causes of joint inflammation and pain. These may include blood tests or an analysis of fluid from the inflamed bursa.
With simple self-care and home treatment, bursitis usually disappears within a week or two.
Your doctor also may inject a corticosteroid drug into the bursa to relieve inflammation. Often, an anesthetic is included to relieve pain. The treatment generally brings immediate relief and, in many cases, one injection is all that you’ll need. However, your doctor will likely discuss ways in which you may help prevent further recurrences.
Your doctor may prescribe a COX-2 inhibitor such as celecoxib (Celebrex) or rofecoxib (Vioxx) to relieve both pain and inflammation especially if you're having side effects from over-the-counter (OTC) pain relievers or nonsteroidal anti-inflammatory medications. COX-2 inhibitors carry less risk of stomach upset and stomach bleeding. Some reports indicate that COX-2 inhibitors may be associated with an increased risk of heart attack, transient ischemic attack or stroke in people who use them. Further review by the Food and Drug Administration is needed.
Only rarely is it necessary to surgically remove the affected bursa.
To help prevent bursitis or reduce the severity of flare-ups:
- Warm up or stretch before physical activity.
- Strengthen your muscles to help protect the joint. Wait until the pain and inflammation are gone
before starting to exercise a joint that has bursitis.
- Take frequent breaks from repetitive tasks. Alternate repetitive tasks with rest or other
activities.
- Cushion your joint. Use cushioned chairs, foam for kneeling or elbow pads. Avoid resting your elbows
on hard surfaces. Avoid shoes that don't fit properly or that have worn-down heels.
- Don't sit still for long periods. Get up and move about frequently.
If your bursitis is caused by a chronic underlying condition, such as arthritis, it may recur despite these preventive measures.
To take care of your bursitis at home:
- Take nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs such as aspirin, ibuprofen (Advil,
Motrin, others) or naproxen sodium (Aleve, Anaprox) can provide relief. Use as directed. Consult your
doctor if you need NSAIDs for an extended period of time because some should be used for only 3 to 7
days.
- Apply ice packs. Use for 20 minutes several times a day during the first 2 days, or for as
long as the joint area is warm to the touch.
- Apply heat. Use heat after the affected joint is no longer warm or red to help relieve muscle
and joint pain and stiffness. But don’t overdo it. Heat shouldn’t be applied for more than 20 minutes at
a time. Sometimes moist heat seems to penetrate deeper and give you more relief than dry heat.
- Perform stretching exercises. Stretching can help restore full range of motion.
- Elevate the affected joint. Raising a knee or an elbow can help reduce swelling.
- Keep pressure off your joint. Use an elastic bandage, sling or soft foam pad to protect a
joint until the swelling goes down.
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February 1, 2002 —
