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Bursitis: The pain outside the joint

The sheath covering tendons is often only a few cell layers thick. It contains a tiny amount of lubricating fluid. This permits the tendons to slide easily over the bones. When the tendon or the sheath itself is injured by a fall or an overuse activity such as kneeling while roofing or playing multiple 36 holes of golf, inflammation occurs. By “inflammation,” we mean that the body rushes cells and blood vessels to the site of injury to initiate a repair response. The cells release proteins called cytokines and growth factors, as well as other compounds that switch specialized cells called macrophages to a reactive state. These cells then influence the healing cycle.

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Featured

 Bursitis: A Painful Cousin of Arthritis

Happily, most cases of bursitis respond well to more conservative treatment and many patients start to feel better when we find the anti-inflammatory medication that seems to work best for them and a gentle, overall exercise program for fitness and to prevent the return of the pain.

 Bursitis: Everything You Need To Know

Bursae are small fluid-filled sacs around the joints that cushion the bones, muscles and tendons. Inflammation of these bursae is referred to as bursitis and can be a painful condition that requires attention. Bursitis most commonly affects joints that require frequent movements such as the hip, shoulder, knee and elbow joints.

 Common Superficial Bursitis

Patients with chronic superficial bursitis typically present with swelling over the involved bursa and may report associated occupations or activities, but often have minimal or no pain. Other patients, particularly those with acute traumatic/hemorrhagic bursitis or septic bursitis, can present with significant pain, tenderness, and decreased range of motion.

Articles of Interest

Hip bursitis – my hips don’t lie… or do they?

Although bursitis is commonly blamed for this pain, research has found that many patients with hip pain actually show little or no signs of inflammation (Strauss et al., 2010), which means that inflammation is not always the problem. Sometimes, the pain may be due to sensitivity of other structures nearby such as tendons. As such, we use the term greater trochanteric pain syndrome (GTPS) to describe the pain that people have in this region.

Housemaid’s Knee (Prepatellar Septic Bursitis)

The clinically relevant message pertaining to this case is that when a patient who could be a candidate for housemaid’s knee presents with knee swelling, aspiration and culture are advisable to ascertain the characteristics of the fluid and arrive at the appropriate diagnosis.

Olecranon Bursitis

Olecranon bursitis, also called baker’s or Popeye elbow, can be a painless or an irritating condition involving the bursa located near the proximal end of the ulna in the elbow over the olecranon. Normal bursae sacs generally are filled with a small amount of fluid, which helps the joint remain mobile. The sac can swell under the soft tissue from overuse or when the area sustains an injury from a bump or fall.

Pes anserine bursitis: How do you manage it?

Pes Anserine means ‘goose’s foot’. It is the place where the three tendons on the inside of your knee attach to the lower leg. This three tendon attachment looks like a ‘goose’s foot’. These three tendons are the sartorius, gracilis, and semitendinosus. Bursitis is just another term for paratendonitis. Therefore, we should treat this condition as tendon swelling rather than a true inflammation.

Prepatellar (Kneecap) Bursitis

Prepatellar bursitis is often triggered by repetitive external pressure from kneeling. Manual laborers including plumbers, roofers, carpet layers, coal miners, and agriculture workers are at higher risk for developing the condition.

Septic Bursitis: ED Presentation, Evaluation, and Management

The most common bursae affected are the olecranon, prepatellar, and superficial infrapatellar bursae. Septic bursitis is uncommon and is often difficult to distinguish clinically from aseptic bursitis, cellulitis, and septic arthritis.

Shoulder Bursitis

You have several bursae within your shoulder. Your subacromial bursa is the most commonly inflamed of the shoulder bursa. Subacromial bursitis is a common cause of shoulder pain that is usually related to shoulder impingement of your bursa between your rotator cuff tendons and bone (acromion). Your subdeltoid bursa is a less commonly inflamed shoulder bursa.

Bursitis: “My GP says I have bursitis, what should I do?”

Bursitis is the inflammation of a bursa. This can happen due to a direct blow to the bursa (this will happen if you hit your elbow or the front of your knee and develop an isolated swollen lump). More commonly though, bursitis will be the result of poor posture and inadequate muscle strength and control, leading to an overload of a bursa. Common examples of this are shoulder bursitis, bursitis on the outside of the hip, and iliotibial band bursitis on the outside of the knee.

Causes of Bursitis

Bursae are the small fluid-filled sac-like cavities around joints. Bursa serve as cushions between the joint bones and the muscles and tendons close to the joints. Their purpose is to reduce friction when the joint is moving. Anyone can develop this condition, so understanding its causes is important.

Cortisone injections may be a bad idea for some types of shoulder pain

Luckily there are alternatives to cortisone injections such as Toradol which is a non steroidal anti inflammatory. Two clinical studies showed that Toradol is equivalent to cortisone injection for shoulder problems such as rotator cuff and frozen shoulder. Furthermore, Toradol should not have the same problem as Cortisone in terms of weakening tendons.

Don’t Miss This! Olecranon Bursitis: When to Tap

Most patients with classic olecranon bursitis probably do NOT need their joint aspirated...

Hip Bursitis?

Gluteal tendinopathy, greater trochanteric pain syndrome, and lateral hip pain are more appropriate terms to describe these symptoms since inflammation of the bursa doesn’t seem to be the driving factor here.

What’s the Difference Between Arthritis and Bursitis? Here’s How These Conditions Are Related

Arthritis and bursitis both cause painful inflammation that can be perceived as coming from a joint, like your hip or shoulder. The key difference comes down to the specific structure within your body that has become inflamed, and you need to sort it out to get the right treatment.

Resources

6 Things to Know About Bursitis

There are more than 150 bursae all over the body, and any of them can get inflamed. Bursitis of the shoulder and bursitis of the hip are both common, but the knees, elbow, groin, heel and big toe are also susceptible to bursitis.

EMed

Beware the immunocompromised patient. Primary bursitis may originate from rheumatoid arthritis, gout or infections. Secondary bursitis may arise from inflamed nearby structures (e.g. subacromial bursitis from rotator cuff tendonitis).

Healthily

In most cases, the injury develops over time because joints, muscles and tendons near the bursae are overused. Repetitive movement is a particular risk for this type of injury.

ScienceDirect

Bursitis is defined as inflammation of the bursa and may occur in the superficial bursas of the shoulder, greater trochanter, knee or elbow, or in deeper bursas of the ischial tuberosity, iliopsoas and popliteal areas.

StatPearls

Bursitis is a swelling or inflammation of a bursa, which is a synovium-lined, sac-like structure found throughout the body near bony prominences and between bones, muscles, tendons, and ligaments. There are many causes of bursitis, including overuse injury, infectious disease, trauma, and inflammatory disorders.