Signs and Symptoms of Bursitis
Symptoms of bursitis can develop suddenly (acute bursitis) or over time (chronic bursitis). Common symptoms include pain, tenderness, and mild swelling.
Pain can range from dull to severe, may spread (radiate), and may worsen at night or with activity. In some cases, stiffness develops in the affected joint and range of motion is decreased.
Complications of bursitis include infection and damage to surrounding tissues and structures (e.g., muscles, tendons). Signs of infection include fever, redness, warmth, and increased swelling.
Diagnosis of bursitis involves taking a medical history and performing a physical examination. Information about the onset of symptoms and about activities (e.g., work-related, recreational) that worsen the condition is important to accurately diagnose bursitis.
Imaging tests (e.g., x-rays, magnetic resonance imaging [MRI], ultrasound) and blood tests may be used to rule out other conditions, such as diabetes and rheumatoid arthritis. In some cases, fluid may be withdrawn (aspirated) from the bursa and examined in a laboratory for signs of infection.
Treatment for bursitis depends on the underlying cause. Proper treatment can help prevent the condition from becoming chronic. It is important to protect (e.g., using knee or elbow pads) and rest the affected joint. Over-the-counter or custom-made orthotics, splints, braces, or a cane may be helpful.
In some cases, applying a compression bandage (e.g., ACE bandage) and elevating the affected joint (above heart level) may help reduce symptoms. Ice can be applied to the area for about 10–20 minutes at a time to reduce pain and inflammation. Ice massage for 3–5 minutes, several times per day, also may help.
Medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs; e.g., ibuprofen, aspirin) also may be used to relieve pain and reduce inflammation. Side effects of these medications may be severe and include stomach pain, ulcers, and kidney problems. NSAIDs should only be taken as directed.
Cortisone injections may be used to treat bursitis that persists or worsens in spite of conservative treatment. This therapy involves injecting cortisone (a steroid and anti-inflammatory) directly into the affected area. Over time, cortisone injections can weaken or damage other tissues and structures within the joint (e.g., tendons).
Physical therapy (e.g., ultrasound, electric stimulation, cryotherapy, manual therapy, stretching) may be used to reduce pain and inflammation and to strengthen the muscles and reduce friction within the joint. It also can be helpful to teach the patient proper body mechanics, which may reduce the risk for recurrence.
Antibiotics are used to treat septic bursitis (i.e., bursitis caused by infection). If oral antibiotics are not effective, they may be administered through an IV (intravenously). In severe cases, fluid must be drained from the bursa, or a procedure called surgical debridement (removal of material) must be performed.
To prevent bursitis, it is important to stretch and warm up properly before exercising, and to cool down afterward. Using proper body mechanics when performing any repetitive motion (e.g., typing, running, throwing) also can be helpful. Wearing protective gear, such as knee and elbow pads, can help prevent injuries that can cause bursitis. To help prevent acute bursitis from becoming a chronic condition, follow the advice of a qualified health care provider regarding treatment.