Between the bones and surrounding soft tissues (tendons and muscles) are the bursae. Each bursa is a thin fluid-filled sac which is there to cushion and lubricate the soft tissues, helping the bones and soft tissues to glide over each other without friction.
Sometimes the bursae can become inflamed – a condition known as bursitis. At the same time you may also develop tendinitis, which is inflammation in the tendons. Bursitis and tendinitis can affect any part of the body but are most common near the large joints, including the knee and hip.
Causes of bursitis
Inflammation of the bursae and tendons are normally overuse injuries that result from making repetitive movements which strain the muscles and tendons. People at risk include those whose job involves making the same movement over and over again, such as a painter and decorator, carpenter or other types of manual worker. Certain sports also carry a risk of bursitis and tendinitis, including those that involve repetitive throwing or hitting a ball. Bursitis may also be caused by an infection or certain types of disease including diabetes, thyroid disease and gout.
Symptoms of bursitis
Both bursitis and tendinitis are painful conditions with similar symptoms, including pain, swelling, redness, heat and tenderness around the affected area. You may find it difficult to move the affected areas as normal. The symptoms tend to worsen if the condition is left untreated, leading to muscle deterioration and further loss of movement in the joint, and symptoms may be more intense after physical activity. It is important to get an early diagnosis because inflammation in the bursa may lead to chronic pain while tendinitis can worsen to the point that the tendon may tear or separate from the bone.
Diagnosing bursitis
Your doctor will carry out a physical examination of the affected area and ask about the symptoms and how they first developed. They may ask about your employment and any sporting or leisure activities to determine why the bursae may have become inflamed. An MRI scan provides a detailed picture of the soft tissues and may be used to confirm the diagnosis and show the extent of the injury. In some cases, you may be given an X-ray to rule out other possible causes of pain, such as a fracture. Aspiration is a procedure that uses a fine needle to take fluid from the swollen bursae. This fluid is then analysed for signs of infection. In some cases, you may also be given a blood test to check for other conditions which may be causing your symptoms.
Some of the most common forms of bursitis are:
- Hip bursitis – which is most common in women, particularly in middle-age or older women.
- Knee bursitis – which is typically caused by arthritis, being overweight, failing to stretch properly before exercising or tight hamstring muscles.
- Kneecap bursitis – which is common among people who are required to kneel for extended periods of time, such as plumbers or carpet fitters.
Treating bursitis
The recommended treatment will depend whether your bursitis is caused by an infection (septic bursitis) or is due to some kind of injury or repetitive strain (aseptic bursitis). Normal treatments for aseptic bursitis include the RICE method to relieve pain (rest, ice, compression and elevation); anti-inflammatory medication and pain killers; injections of steroids into the affected area to relieve swelling; and wearing a splint to restrict movement of the affected joint.
Treating septic bursitis may involve antibiotics, surgery to drain or remove the infected bursa (bursectomy) or using a fine needle to remove the infected fluid.
Preventing bursitis
While it is not always possible to prevent bursitis, it is a good idea to take regular breaks when making repetitive movements to avoid straining the soft tissues. Try cushioning knees and elbows to avoid putting too much pressure on these joints. During exercise always warm up and cool down properly and build up your fitness gradually to avoid straining joints. Make sure you stop if you experience pain.
Joseph Queally provides specialist diagnosis and treatment of all types of sports-related injuries and repetitive strain injuries, including bursitis. Contact us for more information.
