Inflammation of the bursa (bursitis)

Inflammation of the bursa

Bursitis – also known as bursitis – usually occurs in joints that are particularly heavily used, such as the shoulders, elbows or knees. While the  inflammation is  initially only noticeable through a slight feeling of friction, symptoms such as severe pain and reddening and overheating of the affected area can occur over time. Conservative therapy is usually chosen to treat bursitis – but in some cases surgical removal of the bursa may be necessary.

What is bursitis?

In bursitis, the bursa in a joint becomes inflamed. Bursae are flat structures of tissue that serve as cushioning between hard surfaces and soft structures in the body. They contain  joint lubricant  (synovia) and thus enable smooth movements. Bursae are usually located near joints, such as the knees, shoulders, or elbows. They also occur in parts of the body where skin or muscles lie directly on a bone.

Certain professional groups such as tilers or cleaning ladies, but also wrestlers, ice hockey and tennis players as well as handball and volleyball players have an increased risk of bursitis. Because persistent stress – such as constant kneeling while working – is the main cause of bursitis.

Causes of bursitis

Bursitis can have a variety of causes. It is usually triggered by infections, injuries or permanent irritation. In addition,  osteoarthritis  and  arthritis , metabolic diseases such as  gout  and infectious diseases such as  tuberculosis  or  gonorrhea  increase the risk of bursitis.

Inflammation of the bursa is particularly often triggered by  pressure overload  . The cause is persistent or recurring movement sequences, such as those that occur when running long distances, but also when laying tiles. The constant stress causes the smallest injuries that can lead to inflammation of the bursa.

If an external injury is the cause of bursitis, a distinction is made between two different forms:

  • An external force such as a blow to the knee can cause the bursa to fill with blood and become inflamed.
  • An open injury near the bursa can allow bacteria to enter the wound and cause bacterial bursitis.

Symptoms of bursitis

In the case of bursitis,  the symptoms are hardly noticeable  at first – you often notice a burning or slightly rubbing sensation. If the joint continues to be put under strain, the symptoms usually worsen: severe pain (especially when pressure is applied), overheating and reddening of the affected area, and significant swelling can occur. This is due to extra fluid accumulating in the bursae.

Bursitis is particularly common in joints that are subject to heavy loads. This includes the shoulder, elbow, hip and knee. If a bursa near a joint is affected, the increase in volume can lead to restricted  movement  of the respective joint. Those affected often adopt a relieving posture and do not put full strain on the affected joint.

In some cases, bursitis can spread to surrounding tissue, causing redness in the extremities and general symptoms of the disease, such as swelling of the  lymph nodesfevertiredness  and lethargy. If the bursa lies deep under the skin, usually only the pain indicates an inflammation. Other symptoms are usually absent.

Bursitis: Which Joints Are Affected?

Bursitis often occurs in joints that are subjected to particularly heavy loads, such as shoulders, elbows, hips or knees. However, other joints such as the ankle or heel can also be affected by the inflammation. Find out more about the specific causes and treatment options for bursitis in the respective joints below.

Bursitis in the shoulder

Occupational groups that often work overhead, such as caretakers or painters, suffer from bursitis in the shoulder. However, activities in the household where the arm is repeatedly raised beyond the horizontal, such as cleaning windows, can also cause bursitis in the shoulder.

The bursa below the shoulder level is usually affected by the inflammation – this form of bursitis is also known as  subacromial bursitis  . It is characterized by severe shoulder pain that occurs mainly at night. To relieve the pain, not only painkillers, but also anti-inflammatory injections are often used.

Bursitis in the elbow

The bursa of the elbow lies directly under the skin and is therefore particularly susceptible to inflammation. In most cases, an inflammation of the bursa in the elbow – also known as  bursitis olecrani  – is caused by constant irritation, for example because the elbows are constantly supported when reading or working. This form of chronic bursitis is also known as student’s elbow.

However, the bursa on the elbow is also sensitive to inflammation caused by injuries: falling on the elbow or an open wound through which bacteria can penetrate can quickly lead to inflammation.

Hip bursitis

There are numerous bursae around the hip joint. In  trochanteric bursitis  , for example, the bursa on the outside of the hip is inflamed. If inflammation occurs, it is usually noticeable in the upper area of ​​the thigh bone at the connection to the hip. The pain caused by the inflammation can radiate to the buttocks.

Bursitis in the knee

The three main bursae of the knee, like the bursae of the elbow, are particularly susceptible to bursitis due to their location just under the skin. Depending on which bursa is inflamed, a distinction is made between three different types of inflammation in the knee:

  • Prepatellar bursitis:  In this form, the bursa that lies on the kneecap and serves as a buffer between the skin and the kneecap is affected.
  • Infrapatellar bursitis:  In this form, the bursa that lies below the kneecap is affected.
  • Pes anserinus bursitis:  In this form, the bursa located below the so-called pes anserinus (goose foot) is affected.

Bursitis in the knee is usually caused by frequent kneeling.

Treat bursitis

Normally, bursitis heals on its own within a few weeks. Until then, acute pain can be treated well with cooling ointments or gels. Cold packs also help to relieve the pain. However, these should not come into direct contact with the skin, otherwise frostbite may occur. Heat treatments, on the other hand, should be avoided at all costs.

So that the bursitis can heal, it is advisable to immobilize the affected joint for a while with a  bandage  or  splint  . However, the rest should only be short-term, because if the joint is not moved for too long, it can lead to permanent mobility restrictions.

It is therefore advisable to slowly and carefully move the joint again after a short period of rest. Doctors often prescribe physical therapy for bursitis so that the joint is first moved under supervision.

Medicines help with pain

Painkillers  such as  ibuprofen  or  diclofenac can be used to relieve the pain  associated with bursitis  . These  drugs  not only reduce pain, but also inhibit the inflammatory response. This has a positive effect on the healing process. If the pain is severe, local anesthetics can be injected directly into the respective joint.

If the bursitis was caused by a bacterial infection, an  antibiotic can also  be taken if necessary.

Surgery to remove the bursa

If the inflammation has subsided, but the bursa can still be felt like a pillow, the accumulated fluid must be removed by means of a puncture. Surgical removal of the entire bursa, on the other hand, is only rarely necessary.

An  operation  is performed, for example, if the symptoms of chronic bursitis do not subside or keep coming back. The hips and elbows are particularly often affected by chronic bursitis. Intermediate walls of connective tissue can grow in the bursa and calcium deposits can occur.

Prevent bursitis

To prevent bursitis, repeated pressure on certain joints should be avoided. Otherwise, the constant stress can cause inflammation.

Certain professional groups that are particularly at risk due to activities that put a strain on the joints – such as tilers – should protect themselves with aids such as knee or elbow pads. For people with office jobs, padded chairs and forearm pads are recommended. If, on the other hand, bursitis occurs as a result of physical exertion, special attention should be paid to running shoes that are easy on the joints and proper movement.

If the first complaints appear in the shoulder, elbow or knee, the strenuous movement should be avoided and the joint should be cooled and immobilized for a while. In this way, a full-fledged bursitis can often be prevented.

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