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Bursitis

Bursitis is a painful swelling, usually around your joints. Bursitis is common in the upper extremities namely the shoulders, and elbows. Bursae (the plural of bursa) cushion spaces around bones and other tissue. You’re more likely to get it if you have a job or hobby that puts a lot of stress on your joints.
Shoulder Bursitis

Causes of Bursitis 

The most common causes of bursitis are repetitive motions or positions that put pressure on the bursae around a joint. Examples include:

  • Throwing a baseball or lifting something over your head repeatedly 
  • Leaning on your elbows for long periods
  • Extensive kneeling for tasks such as laying carpet or scrubbing floors
  • Other causes include injury or trauma to the affected area, inflammatory arthritis such as rheumatoid arthritis, gout and infection.

Symptoms of Bursitis 

Bursitis causes pain, swelling and tenderness around the affected bone or tendon. The bursae sacs may swell, often making movement difficult. Symptoms can vary depending on the location of the bursae sac. Other signs and symptoms of bursitis include:

Shoulder: 

Pain when raising arms above head

Discomfort worsens at night

Decreased range of motion

Elbow:

Increased pain if the elbow is bent

Infection is common in this bursa

If you have an infection that’s causing bursitis, you might have other symptoms, including:

  • Discoloration or redness on your skin.
  • A feeling of warmth or heat.
  • Fever.
  • Chills.

Prognosis of Bursitis 

Bursitis is usually short-lived. Most people heal within a few weeks. However, it may return if you don’t stretch and strengthen the muscles around the joint and change the way you do some activities.

Risk Factors of Bursitis

Anyone can experience bursitis. People who are more likely to develop it include:

  • Athletes.
  • People who do physical work or manual labor.
  • Musicians.

People with certain health conditions have a higher risk of bursitis, including:

  • Arthritis (especially inflammatory arthritis like gout and psoriatic arthritis).
  • Diabetes.
  • Thyroid disease. 

Impact of Bursitis

Shoulder and Elbow Bursitis can lead to several conditions:

  • Adhesive Capsulitis (Frozen Shoulder): Adhesive capsulitis, or frozen shoulder, is a condition marked by progressive pain and stiffness in the shoulder joint. 
  • Degenerative Joint Changes: Degenerative joint changes, often referred to as osteoarthritis (OA), are characterized by the breakdown and eventual loss of cartilage in the joints.
  • Tendon Damage: Refers to the injury or degeneration of tendons, the fibrous connective tissues that attach muscles to bones. 
  • Chronic Pain: Chronic bursitis may involve repeated attacks of pain, swelling, and tenderness. These may lead to the deterioration of muscles and a limited range of motion in the affected joint.

Diagnosis of Bursitis 

In addition to a complete medical history and physical exam, diagnostic tests for bursitis may include:

X-ray: A diagnostic test that uses invisible electromagnetic energy beams to make pictures of internal tissues, bones, and organs on film.

Magnetic resonance imaging (MRI): An imaging test that uses a combination of large magnets, radio frequencies, and a computer to make detailed pictures of organs and structures within the body.

Ultrasound: An imaging test that uses high-frequency sound waves to look at the internal organs and tissues.

Lab Tests

Your doctor might order blood tests or an analysis of fluid from the inflamed bursa to pinpoint the cause of your joint inflammation and pain. This procedure involves using a thin needle to remove fluid from the swollen bursa to check for infection or gout as causes of bursitis.

Pain Medicine Interventions 

Pain management, intervention and treatment include:

  • R.I.C.E. This stands for rest, ice, compression, and elevation
  • Anti-inflammatory and pain medicines, such as ibuprofen or aspirin
  • Injection of a steroid into the affected area to help decrease pain and swelling
  • Splints or braces to limit movement of the affected joint 

Treatment of Bursitis 

Beyond pain medicine intervention, treatment options include: 

Septic bursitis results when the bursa becomes infected with bacteria. This causes pain and swelling. Treatment may include:

  • Antibiotics
  • Repeated aspiration of the infected fluid (a needle is used to take out the fluid)

Surgical Intervention: When conservative measures are ineffective or symptoms worsen, surgery
    may be considered:

Bursectomy: Surgical drainage and removal of the infected bursa. This is called a bursectomy.

Procedure Videos

Steroid injection

Prevention 

Elbow and Shoulder bursitis can be prevented. To prevent bursitis, avoid activities that put repetitive stress on the elbow and shoulder joint. 

  • Warm up before exercising or before sports or other repetitive movements.
  • Start new exercises or sports slowly. Gradually increase the demands you put on your body.
  • Take breaks often when doing repetitive tasks.
  • Cushion “at risk” joints by using elbow or knee pads.
  • Stop activities that cause pain.
  • Practice good posture. Position your body properly when doing daily activities.

References

  1. Bursitis. Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/bursitis. Accessed June 27, 2024.
  2. Bursitis. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/bursitis/symptoms-causes/syc-20353242. Published August 31, 2022. Accessed June 27, 2024.
  3. Bursitis. Penn Medicine. https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/bursitis. Accessed June 27, 2024.
  4. Cleveland Clinic. “Bursitis.” Cleveland Clinic, https://my.clevelandclinic.org/health/diseases/10918-bursitis#outlook-prognosis. Accessed 27 June 2024.
  5. Radiopaedia. “Subacromial-Subdeltoid Bursitis.” Radiopaedia, https://radiopaedia.org/articles/subacromial-subdeltoid-bursitis. Accessed 27 June 2024.