What Is Bursitis? by Dr Nathan Wei
As baby boomers age, they become susceptible to many types of aches and
pains. One of the most common afflictions is bursitis...inflammation of a
bursa.
A bursa is a small sack filled with fluid. These bursae (plural of “bursa”)
are located wherever tendons or ligaments move across joints, to protect the
bones, tendons and muscles that surround joints. Protection by bursae comes from
the ability of these sacks to cushion shock or to reduce the effects of friction
during movement of a joint.
Repetitive trauma, pressure, or overuse can lead to inflammation of a bursa.
Also, aging is another cause of bursal inflammation. Inflammation is the body’s
response to any type of injury. When a bursa becomes inflamed, it becomes
swollen due to two factors. First, the lining of the bursa thickens; then this
thickened lining starts to produce more fluid. A person who develops bursitis
will experience the common symptoms of inflammation which include pain,
swelling, heat and possibly redness.
There are more than 150 bursae located throughout the body. The most common
sites for bursitis to develop are the hips, shoulders, knees, elbows, and feet.
A discussion of the various types of bursitis is in another article.
The location of the various bursae makes a diagnosis difficult when a joint
becomes painful. It could be bursitis, arthritis, tendonitis, or perhaps a
mixture of all three!
The diagnosis is important because the treatment is different for the three
conditions… and because the diagnosis has different implications. For example,
if a patient develops a painful hip, a diagnosis of arthritis possibly requiring
surgery is very different from the treatment that would be administered if the
diagnosis were bursitis.
A skilled rheumatologist or orthopedist can provide meaningful and expert
advice when it comes to figuring out what the problem is and what to do about
it.
Prevention is possibly the most important thing a patient can do. Regular low
impact exercise is valuable but a person should avoid too much exercise as it
can lead to overuse. Overuse then leads to bursitis. Stretching exercises are
also useful for helping to avoid bursitis. Once a person has had bursitis, they
are prone to developing it again so it’s important to cushion high risk areas.
This involves the use of pads to protect joints or simply changing the way
certain activities are done.
So what about treatment? The most important part of treatment is getting an
accurate diagnosis. Most bursitis responds to simple measures such as rest, ice,
and over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs). Patients
occasionally require a prescription-strength NSAID. Physical therapy is often
useful. In cases where the bursitis fails to improve or gets worse, withdrawing
fluid from the inflamed bursa and injecting steroid is warranted. Steroid
injection should be administered using ultrasound guidance whenever
possible. www.Isnare.com
Nathan Wei, MD FACP FACR is a rheumatologist and Director of the Arthritis and
Osteoporosis Center of Maryland. He is a Clinical Assistant Professor of
Medicine at the University of Maryland School of Medicine.
