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Most folks go through life without knowing much about the anatomy of their bodies until something goes wrong with one of the parts. Bones, joints, muscles—everyone knows what these are. Bursae? Not so much. However, when a bursa starts to swell, it can be a painful introduction to this vital body part. Fortunately, most cases of bursitis resolve in a few days or weeks. Some cases, however, can be quite serious, so pushing through the pain without seeing a doctor is not a good idea.
What is bursitis?
Bursitis is an enlargement or swelling of the bursae, fluid-filled sacs that provide cushioning between bones and surrounding tissues, such as ligaments, tendons, and muscles. Putting pressure on the enlarged bursa or actively moving the affected joint can produce significant pain.The body has almost 160 bursae scattered throughout the body. Some are located right below the skin, but most are located between bones, tendons, muscles, or ligaments. Most bursae are concentrated around joints and are lined with cells that produce synovial fluid, a jelly-like substance with the consistency of pudding. Called synovial bursae, these sacs provide the “cushioning” that keeps joint bones from rubbing against and injuring surrounding tissues.
Bursitis can be classified in several different ways. Acute bursitis is when the disease has a sudden and rapid onset, while chronic bursitis builds slowly over time. It can also be classified based on its location, as either superficial bursitis (bursitis of bursae located below the skin), or deep bursitis (which affects bursae lying between bones and ligaments, tendons, or muscles). Another type of bursae, known as adventitious bursae are not present at birth. Instead, they develop as a result of unusual stress on a joint, such as bunions on the big toe joint.
Bursa themselves are named after the bone or body part they are associated with, such as the elbow bone (olecranon), the heel bone (calcaneus), the kneecap (patella), or the top of the femur (trochanter). The most common types of bursitis are elbow bursitis (olecranon bursitis), knee bursitis (prepatellar bursitis), hip bursitis (trochanteric bursitis), shoulder bursitis (subacromial bursitis), and ankle bursitis (retrocalcaneal bursitis).
The most common causes of bursitis are:
- Overuse injury caused by repetitive joint motions, such as throwing a ball
- Prolonged pressure on a joint, such as resting an elbow on a desk or kneeling on hard floors
- Injury
- Inflammatory conditions such as rheumatoid arthritis, osteoarthritis, lupus, or scleroderma
- Crystalline joint diseases, such as gout or pseudogout
- Infection
Bursitis is a common condition, affecting about 9 million people in the United States each year. Most cases resolve with conservative treatment in a few days to a few weeks. However, flare-ups are common even after the condition has been resolved.
How is bursitis diagnosed?
The diagnosis of bursitis can be made with a medical history and a physical examination. Some cases won’t require additional tests or imaging, but it can be helpful in other situations, especially if the doctor wishes to rule out other conditions with similar symptoms, such as arthritis, gout, or sciatica.In general, however, the symptoms of bursitis are:
- Pain, especially pain resulting from pressure on the area or active movement
- Swelling
- Stiffness
- A decrease in the joint’s range of motion
- When did the pain begin?
- Did the pain come on suddenly or has it been growing over time?
- What kind of activities were you doing (i.e., kneeling, playing tennis, etc.)?
- Did the pain result from a specific incident?
- Has that area been injured or painful before?
An X-ray or MRI may be ordered if the doctor suspects the cause is due to an injury or to rule out other conditions such as fractures. An ultrasound might also be used to rule out other conditions, or if the doctor suspects septic bursitis.
If the physician suspects the swelling is due to infection or crystalline joint disease, 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 may provide evidence of infection.
Bursitis treatment options
Most cases of bursitis will resolve on their own. Activity modification, rest, and pain medications are the only treatments required. More severe or chronic cases may require additional treatment such as prescription medication, physical therapy, assistive devices, or surgery.Treatment, however, will depend on the type of bursitis. Septic bursitis can only be treated with antibiotics. For bursitis caused by inflammatory diseases or joint diseases, treatment will primarily focus on managing the underlying condition.
Rest
The near-universal treatment for bursitis is to rest the joint. This may require immobilizing the joint for one or two days followed by using the joint minimally for several days to a few weeks. Applying ice, using compression devices, elevating the joint, and taking over-the-counter NSAIDs can help manage the pain and swelling.Lifestyle changes
Treating and preventing bursitis may require lifestyle changes such as modifying or eliminating activities that cause bursitis to flare up, such as using knee pads or cushions, reducing weight, and wearing properly fitted footwear.Physical therapy
Physical therapy focuses on strengthening and stretching muscles, improving range of motion, and training patients in managing the condition. Physical therapy might include stretching, yoga, passive movement, strength exercises, and flexibility training.Assistive devices
For hip, knee, or ankle bursitis, assistive devices such as canes or walkers can help rest the joint. Immobilization devices for the shoulder, elbow, knee, or hip can keep the joint stable for a few days while the swelling goes down.Medications
Most bursitis cases will resolve without medications. Over-the-counter pain relievers and NSAIDs are sufficient to manage pain and swelling, but deep bursitis, such as hip bursitis, may require a corticosteroid injection. Septic bursitis, however, can only be managed with antibiotics.Surgery
Surgery is the treatment of last resort for chronic bursitis. An orthopedic surgeon may entirely remove the inflamed bursa, an operation called a bursectomy, or may shave down bone or repair tendons in the joint. A bursectomy is a minimally-invasive procedure carried out with an endoscope, which is a long, thin tube that is inserted into the affected area. The surgeon can use the endoscope to look at the affected joint and can even insert special tools to perform the procedure. Removing the swollen bursa does not damage or debilitate the joint. Most patients will recover their previous range of motion.Bursitis medications
For most cases of bursitis, medications will be used to manage pain and swelling. Septic bursitis, however, must be treated with antibiotics to clear the infection.Non-steroidal anti-inflammatory drugs (NSAIDs)
NSAIDs reduce bursitis swelling and relieve pain. Over-the-counter oral NSAIDs such as ibuprofen or naproxen are successful at treating the vast majority of bursitis cases. Because NSAIDs interfere with blood clotting, they may not be appropriate for some patients. Instead, prescription celecoxib, an NSAID that does not affect blood clotting, may be prescribed. Over-the-counter acetaminophen will effectively relieve pain but does not reduce inflammation of the bursa.Corticosteroids
Deep bursitis may need to be treated with a corticosteroid injection such as methylprednisolone or cortisone to rapidly bring down swelling and provide pain relief. Before injecting the corticosteroid, the physician may remove some of the fluid from the bursa to reduce swelling.Antibiotics
Septic bursitis will be treated with antibiotics, drugs designed to stop the growth of bacteria or kill them outright. Once an infection is confirmed, the doctor will immediately prescribe an antibiotic effective against a broad spectrum of bacteria, usually a first-generation oral cephalosporin, clindamycin, or trimethoprim-sulfamethoxazole. Once the infecting bacteria has been definitively identified, a drug specifically targeting that bacteria will be used. Most patients will be sent home with a prescription. However, oral antibiotics fail to adequately treat septic bursitis in as much as a third to half of all cases, so patients may be hospitalized and put on intravenous antibiotics.What is the best medication for bursitis?
Most bursitis medications relieve pain and swelling, but bursitis has many causes including bacterial infection. Other problems, such as tendonitis or torn muscles, may also be associated with bursitis. There is, then, no best medication for bursitis, only the drug most suitable to the situation.| Best medications for bursitis | ||||
|---|---|---|---|---|
| Drug Name | Drug Class | Administration Route | Standard Dosage | Common Side Effects |
| Motrin (ibuprofen) | NSAID | Oral | Two 200 mg tablets every four hours | Nausea, bleeding, stomach pain |
| Aleve (naproxen) | NSAID | Oral | One 220 mg tablet taken with food or water every 8 to 12 hours | Nausea, bleeding, stomach pain |
| Tylenol (acetaminophen) | Analgesic | Oral | Two 325 mg or 500 mg tablets every four to six hours, with a maximum dose of 3,000 to 4,000 grams per day | Nausea, stomach pain, loss of appetite |
| Celebrex (celecoxib) | Prescription NSAID | Oral | One 200 mg capsule daily | Abdominal pain, diarrhea, stomach upset |
| Depo-Medrol (methylprednisolone acetate) | Corticosteroid | Injection | 4 to 120 mg injection administered by the healthcare provider | Mood changes, edema, increased blood pressure |
| Keflex (cephalexin) | Cephalosporin antibiotic | Oral | One 500 mg capsule every 12 hours, or 250 mg capsule every six hours | Diarrhea, nausea, vomiting |
| Clindamycin | Antibiotic | Oral | 300 mg to 450 mg capsule every six hours | Abdominal pain, nausea, diarrhea |
| Bactrim (trimethoprim-sulfamethoxazole) | Antibiotic | Oral | Dosage depends on weight | Nausea, vomiting, loss of appetite |
| Vancomycin | Antibiotic | Intravenous I | 500 mgevery six hours or 1,000 mg every 12 hours | Nausea, vomiting, changes in urination, headache |
What are the common side effects of bursitis medication?
There are several common side effects of bursitis medications, and different classes of medications have different side effects.
NSAIDs interfere with the body’s ability to form blood clots, so the most common side effects involve bleeding problems. Some gastrointestinal problems often experienced with NSAIDs include stomach problems, abdominal pain, ulcers, and gastrointestinal bleeding. Acetaminophen does not interfere with blood clotting, but it will not help reduce swelling.
Most people given corticosteroid injections for bursitis will experience injection site reactions such as pain and redness. However, treatment typically involves a single, highly-localized, low-dose injection, so commonly-experienced side effects are minimized.
Antibiotics typically cause gastrointestinal problems such as stomach pain, diarrhea, loss of appetite, and stomach upset. The most serious problem with antibiotics, however, is the possibility of potentially severe and even life-threatening allergic reactions.
This is not a complete list, and you should consult with your healthcare professional for possible side effects and drug interactions based on your specific situation.