The human body contains over 160 bursae, whose function is to provide a thin cushion between surfaces such as tendons, muscles, ligaments and skin as they glide over a bone when joints move. Healthy bursae are important as they create almost frictionless movement between two surfaces when they move in different directions. Bursae look like small fluid-filled balloons wedged in between bone and soft tissue. People are mostly unaware of their bursae until one becomes irritated or inflamed, causing uncomfortable or painful symptoms such as joint swelling. This condition is called bursitis. “Student’s elbow” and “Housemaid’s knee” are names given to two common types of bursitis.
When a bursa becomes inflamed the membrane thickens and produces excess synovial fluid which causes the bursa to swell. The inflamed bursa can impair movement and cause localised pain and swelling, which are often the first symptoms. Bursitis commonly affects the bursa in the knee, heel, hip, shoulder and elbow. Symptoms can vary in severity and pain is usually worse in the morning and after exercise or strenuous activity. Other symptoms include stiffness and warmth in the affected joint. If bursitis is caused by an infection, high fever, chills and generalised joint and muscle aches may also be present. Bursitis pain can go away within a few weeks but recurrent flare-ups are common.
Bursitis is usually caused by repetitive overuse injury, stress to a joint or prolonged pressure applied directly to a bursa such as kneeling for a long time, or leaning on elbows. Bursitis can be caused by an acute injury and less commonly by infection (through a break or puncture in the skin or a scratch or insect bite). People with inflammatory conditions such as rheumatoid arthritis, gout or lupus are more prone to bursitis. Bad posture when sitting or standing for long periods can irritate the hip and knee bursae.
Bursitis becomes more common as people get older. Certain occupations or hobbies can contribute to the development of the condition. Activities with a repetitive motion or pressure such as carpet laying, kneeling when gardening, or playing a musical instrument can cause bursitis. Being overweight can increase the risk of hip and/or knee bursitis. Chronic bursitis that is left untreated can cause calcium deposits to build up in soft tissue which can result in permanent loss of movement in the affected joint.
Diagnosis of bursitis is usually through medical history and a physical exam. An x-ray may be taken to rule out other causes of discomfort, and sometimes fluid from the inflamed bursa may be tested.
While the condition generally gets better on its own, therapy to strengthen the muscles in the affected area can be of benefit. Early treatment with rest, ice, elevation and pain medications such as the anti-inflammatories ibuprofen or naproxen can give relief. If there is an infection present, this will need to be treated with antibiotics. For persistent bursitis, a corticosteroid injected into the bursa can relieve pain and inflammation quite quickly, and one injection may be all that is needed. Temporary use of a walking cane can relieve pressure on an affected joint. Sometimes surgical drainage of the bursa is needed. Wearing a support such as a sling to support a shoulder or elbow joint can help.
To decrease the risk of developing bursitis or severity of flare-ups it is important to look after your joints. Use kneeling pads when gardening, lift properly by bending the knees (otherwise you will increase the pressure on hip bursae), wheel heavy loads rather than lifting to avoid stress on the shoulder bursa. Take frequent breaks when undertaking a repetitive activity and stop if you experience pain. Warm up and stretch for at least 5 to 10 minutes before strenuous activity or exercise to protect your joints from injury.
See a doctor if the joint pain is so severe that it prevents all movement, or pain lasts longer than two weeks. Sharp, shooting pains, fever, excessive swelling, bruising, rash or redness in the affected area all require medical assessment.
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