Bursitis

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What is bursitis?

Bursitis is caused by inflammation of a bursa, a small fluid-filled sac that functions as a gliding surface to reduce friction between tissues of the body.  There are approximately 160 bursae in the body.  The major bursae are located bordering the tendons near large joints such as the shoulders, elbows, hips, knees, and ankles. 

What causes bursitis?

Bursitis is most often caused by repetitive minor impact on the area, or a serious injury.  In addition, incorrect posture at work or home and poor stretching or conditioning before exercise can also lead to bursitis. The following risk factors have been associated with the development of bursitis:

  • Repetitive stress or overuse injury
  • Spine disease
  • Joint-related injury
  • Bone spurs or calcium deposits
  • Rheumatoid arthritis
  • Leg-length inequality

Who usually gets bursitis?

Bursitis is more common in adults, especially women over 40 years of age.

What parts of the body does bursitis affect?

Any part of the body that has a bursa can be irritated and inflamed.  However, the following joints have the highest risk factors for the development of bursitis:

  • Shoulder
  • Elbow
  • Hip
  • Knee
  • Achilles tendon

What are the symptoms of bursitis?

The symptoms of bursitis are directly related to the level of inflammation of the bursa.  The inflamed bursa can cause localized pain and tenderness.  If the bursa is so severely inflamed that swelling occurs, it can cause local redness and warmth.  The pain may increase gradually or sudden.  If calcium deposits are present, the pain can be severe. 

How can I prevent bursitis?

Avoiding behaviors and activities that make the inflammation of the bursa worse is the best way to prevent bursitis.  For example:

  • Avoid repetitive activities that put stress on the bursa.
  • Maintain strength and flexibility of the muscle surrounding the joint/bursa.
  • Maintain a healthy weight.

How is bursitis treated?

The doctor will feel the joint for swelling or tenderness.  An x-ray may be taken or fluid from the bursa may be removed with a small needle to check for infection.

Drug therapies include:

  • Non-steroidal anti-inflammatory drugs (NSAIDs)  reduce pain and swelling.  Over the counter NSAIDs include: ibuprofen (Motrin, Advil) and naproxen (Aleve). Be forewarned that using NSAIDs over a long period of time can increase the risk of stomach bleeding and heart attack.
  • Corticosteroid injections into the bursa can reduce inflammation.  Usually only one shot is needed.  Sometimes oral corticosteroids are used to treat chronic inflammation.

Natural therapies include:

  • A healthy diet including whole grains, fruits, vegetables, and fatty fish and avoiding sugary, fatty and processed foods.
  • Nutraceuticals such as glucosamine sulfate, omega-3 fatty acids, vitamin C with flavonoids and bromelain
  • Herbs such as Boswellia (Boswellia serrata), Turmeric (Curcuma Longa), White Willow (Salic Alba)

The use of nutraceuticals and herbs can decrease the level of inflammation.  However, they can trigger side effects and can interact with other herbs, nutraceuticals, or medications.  They should be taken with care, and under the supervision of a health care provider.

While massage may be tempting to relieve pain, it is not recommended until an infection has been ruled out. Then it may help to reduce the discomfort from a sore joint.

Chiropractic and Movement Therapy

  • Mobilizing the muscles around the joints will help reduce the pressure on the joint and bursa.
  • Graston Therapy may help break down adhesion, increasing flexibility and reducing muscle tension.
  • Other therapies, including chiropractic adjustments and muscle release techniques, may also be helpful to improve muscles and ligaments and reduce the tension caused by repetitive motions.

Research:

Bron C, Wensing M, Franssen JL, Oostendorp RA. Treatment of myofascial trigger points in common shoulder disorders by physical therapy: a randomized controlled trial [ISRCTN75722066]. BMC Musculoskelet Disord. 2007 Nov 5;8:107.

De Silva V, El-Metwally A, Ernst E, Lewith G, Macfarlane GJ; Arthritis Research UK Working Group on Complementary and Alternative Medicines. Evidence for the efficacy of complementary and alternative medicines in the management of osteoarthritis: a systematic review. Rheumatology (Oxford). 2011 May;50(5):911-20. Review.

Huang HH, Qureshi AA, Biundo JJ Jr. Sports and other soft tissue injuries, tendinitis, bursitis, and occupation-related syndromes. Curr Opin Rheumatol. 2000 Mar;12(2):150-4. Review.

Kimmatkar N, Thawani V, Hingorani L, et al. Efficacy and tolerability of Boswellia serrata extract in treatment of osteoarthritis of knee — a randomized double blind placebo controlled trial. Phytomedicine. 2003;10:3-7.

Klein G, Kullich W. Short-term treatment of painful osteoarthritis of the knee with oral enzymes. Clin Drug Invest. 2000;19:15-23.

Lewis JS, Sandford FM. Rotator cuff tendinopathy: is there a role for polyunsaturated fatty acids and antioxidants? J Hand Ther. 2009 Jan-Mar;22(1):49-55. Review.

Paoloni JA, Orchard JW. The use of therapeutic medications for soft-tissue injuries in sports medicine. Med J Aust. 2005 Oct 3;183(7):384-8. Review.

Reginster JY, Deroisy R, Rovati L, et al. Long-term effects of glucosamine sulphate on osteoarthritis progression: a randomised, placebo-controlled clinical trial. Lancet 2001;357:251-256.

Schmid B, Ludtke R, Selbmann HK, et al. Efficacy and tolerability of a standardized willow bark extract in patients with osteoarthritis: randomized, placebo-controlled, double blind clinical trial. Z Rheumatol. 2000;59:314-320.

Vas J, Perea-Milla E, Mendez C, Galante AH, Madrazo F, Medina I, et al. Acupuncture and rehabilitation of the painful shoulder: study protocol of an ongoing multicentre randomised controlled clinical trial [ISRCTN28687220]. BMC Complement Altern Med. 2005 Oct 14;5:19.

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