That dull misery in the shoulder, knee or elbow known as bursitis can strike anybody, from the couch potato to the highly trained athlete. Though bursitis may hurt as much as arthritis, it isn’t a joint disease. Rather, it's an acute or chronic painful inflammation of a bursa.
Bursae (from the Greek word for wine-skin and related to the English word purse) are small, closed, fluid-filled sacs that protect muscles and tendons from irritation produced by contact with bones. If friction becomes too great—from overexercising, hard work, or injury, for instance—the bursae themselves may get inflamed.
Though the shoulder is a common locale for bursitis, any of the bursae in the human body—there are approximately 150—can become irritated. Occupational bursitis is not uncommon and is known by old, familiar names such as "housemaid's knee," and "policeman's heel." One of the most common foot ailments, the bunion, is a form of bursitis.
Symptoms of Bursitis
- Nagging ache and swelling in or around a joint
- Painful and restricted movement in the affected joint
- Pain radiating into the neck or arms when bursitis strikes the shoulder (the most common site)
- Fever, when associated with an infection.
What Causes Bursitis?
Repetitive, vigorous movement, strenuous and unaccustomed activities that put pressure on a joint, or a blow or other injury can bring on bursitis. The cause can vary depending on where the bursitis occurs. In the shoulder, for example, it can be brought on by excessive strain, such as from serving in tennis. Kneeling on a hard floor can cause bursitis of the knee, and similarly, repeatedly resting the elbow on a hard surface (such as a desk) can cause bursitis in that joint. Arthritis, gout, and certain infections can also contribute to the problem. Bursitis, in fact, may signal the onset of arthritis.
While getting older isn't a cause of bursitis, older people, especially older athletes, are more likely to develop the condition.
What If You Do Nothing?
Bursitis is not in itself a serious ailment. It often clears up on its own in a week or so, especially if you are careful to protect the injured area from further aggravation. However, bursitis sometimes recurs and becomes chronic, in which case you should seek medical attention.
Home Remedies for Bursitis
If you follow these steps, most attacks of bursitis should subside in four or five days and all symptoms should be gone within two weeks.
- Rest the body part that hurts. If you suspect that one activity has caused the pain, stop it until the pain is entirely gone. A sling, splint, or padding may be needed to protect the area from possible bumps or irritation.
- Try over-the-counter pain relievers. Nonprescription NSAIDs (aspirin, ibuprofen, and naproxen) will help reduce pain and swelling, though they won’t accelerate healing. Acetaminophen will help with pain but it doesn’t reduce inflammation.
- Ice it, then heat it. Apply ice packs during the first two days to bring down swelling. Then use heat—warm baths or a heating pad (on a medium or low setting)—to ease pain and stimulate blood flow.
- Don’t push it. Resume exercising only after you feel better. Start with gentle activity.
- Skip the liniments. Liniments and balms are no help for bursitis. Liniments don’t penetrate deeply enough to treat bursitis; they mainly warm the skin and make it tingle, thus distracting attention from the pain beneath. Massage is likely to make matters worse.
- Undergo physical therapy. Physical therapy strengthens joint muscles that have been affected by bursitis and may help prevent the bursitis from getting worse.
It isn't always possible to avoid the sudden blow, bump, or fall that may produce bursitis. But you can protect your body with measures similar to those that protect you from other kinds of overuse injuries, such as tendinitis.
- Keep yourself in good shape. Strengthening and flexibility exercises tone muscles that support joints and help increase joint mobility.
- Don’t push yourself too hard (or too long). If you’re engaged in physical labor, pace yourself and take frequent breaks. If you’re beginning a new exercise program or a new sport, work up gradually to higher levels of fitness. And anytime you’re in pain, stop.
- Work on technique. Make sure your technique is correct if you play tennis, golf, or any sport that may strain your shoulder.
- Watch out for “elbow-itis.” If you habitually lean on your elbow at your work desk, this may be a sign that your chair is uncomfortable or the wrong height. Try to arrange your work space so that you don’t have to lean on your elbow to read, write, or view your computer screen.
- Take knee precautions. If you have a task that calls for lots of kneeling (for example, refinishing or waxing a floor), cushion your knees, change position frequently, and take breaks.
- Wear the right shoes. High-heeled or ill-fitting shoes cause bunions, and tight shoes can also cause bursitis in the heel. Problems in the feet can also affect the hips. In particular, the tendons and bursae in the hips can be put under excessive strain by worn-down heels. Buy shoes that fit and keep them in good repair. Never wear a shoe that’s too short or narrow. Women should save their high heels for special occasions only.
- Avoid staying in only one position for too long. Get up and walk around for a while or change positions frequently.
Beyond Home Remedies: When To Call Your Doctor
Contact your physician if bursitis pain is disabling (when movement of the joint is largely or entirely restricted), if the pain doesn’t subside after a week of self-care, or if the joint is red and swollen. Also call your doctor if you develop a fever, which could signal infectious bursitis—a condition that especially can afflict the elbow. Except for the fever, symptoms resemble other forms of bursitis, but infectious bursitis requires immediate medical attention.
What Your Doctor Will Do
After taking a history and performing a physical examination, your physician may order x-rays to rule out other disorders. Your doctor may administer injections of corticosteroids and a local anesthetic to reduce swelling and ease pain. Also, to reduce swelling, your physician may draw excess fluid from the bursa with a syringe and then tightly wrap and compress the joint with an elastic bandage. In severe, persistent cases surgery to remove the bursa may be necessary. For infectious bursitis, antibiotics will be prescribed.
The Complete Home Wellness Handbook
John Edward Swartzberg, M.D., F.A.C.P., Sheldon Margen, M.D., and the editors of the UC Berkeley Wellness Letter
Updated by Remedy Health Media