What is Bursitis? Its Causes, Symptoms, Treatment, and Prevention

Posted on 11 Feb 2011 18:02

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Bursitis involves inflammation or irritation of the bursa of a joint. The word bursitis comes from the word bursa and "itis" which means inflammation.

A bursa is a small, synovial fluid containing sac surrounded by a membrane. These sacs act as cushions for the joints. Located in areas that are subject to friction, as when a muscle or tendon is pulling around a corner or over a bone, their purpose is to cushion and lubricate the tissues.4,3

This cushioning lessens the effect of the friction to facilitate the motion between bones and tendons, bones and skin, or tendons and ligaments and thus prevent fraying and stress. When bursae become inflamed, redness and swelling within the sac results. This can cause a dull and aching or sharp and intense pain that seems to be coming from the joint itself. The pain tends to increase with movement and may be at its worst during the night while you are trying to sleep. The pain is often mistaken for arthritis. 2,3

What Causes Bursitis?

Bursitis can be irritation to the bursa from overuse or repetitive stress to the joint. Bursitis may occur at the knee or elbow; for example, from kneeling or leaning on the elbows longer than usual on a hard surface. Certain occupations that involve repetitive activities and postures make people more prone to bursitis. Examples are carpenters, house painters, gardeners, musicians and athletes such as tennis players. Bursitis becomes more likely with advancing age.

Bursitis can also be caused by a direct trauma or prolonged injury to the joint, improper body mechanics or lack of conditioning.1,3

An infection, arthritis, gout, thyroid disease, and diabetes can also bring about inflammation of a bursa or tendon.

What Are the Symptoms of Bursitis?

The primary symptom of bursitis, as stated above is pain in a joint area or pain that seems to be coming from the joint itself. This pain can be dull and aching or sharp and intense and tends to be worse at night. The pain may become worse with movement. Swelling of the joint may also occur and the skin in the area may be red and warm to the touch.

How is Bursitis Treated?

The primary first-aid for bursitis is rest and ice application for the first 48 hours after symptoms or injury occur. If swelling and redness are present ice can be applied for a longer period but for chronic bursitis pain heat may be more helpful. Compression wrapping or immobilization of the joint with a splint, brace, or sling may be helpful to speed recovery of the tissues in the initial healing period. Anti-inflammatory medicines such as aspirin, naproxen (Naprosyn1, Aleve), or ibuprofen (Advil, Motrin, or Nuprin) can also be helpful. Activity involving the affected joint is also restricted to encourage healing and prevent further injury during the acute phase of healing.1,3

Using Ice for Bursitis

Bursitis is usually considered a "chronic" condition and as such ice is normally only recommended for the first 48 hours after which heat is used. However, bursitis can be a gray area since swelling, pain, and redness that may occur chronically indicate that ice can still be useful in reducing this irritation thus hastening recovery. When in doubt seek professional advice. See Clearing Up the Ice Versus Heat Mystery for Injuries for a general overview. Also see First Aid For Musculoskeletal Injuries. Follow these ice treatment guidelines:

1. Use a plastic bag filled with melting ice water for best results

2. Use a towel or cloth between the bag and the skin to serve as a buffer to protect the skin from ice damage

3. Apply the ice bag to the area for periods of around ten minutes and remove, allowing the skin to return to normal temperature before re-applying

4. The goal is to reduce the temperature of the underlying soft tissues, and in this case the bursa, and to maintain that reduced temperature over time. The goal is not to freeze the skin. Repeated applications will allow the underlying tissues to reach and maintain the desired temperature while the skin quickly warms back to normal between applications.

5. Repeat application two or three times per treatment session and repeat treatment several times a day for the first 48 hours (or more if/when needed)

Massage of area may be helpful. Massage can be preceded or followed by use of an ice pack.

If symptoms persist beyond a week to ten days or if they are accompanied by a fever or chills, consult a doctor. If the bursitis is caused by an infection, the doctor will prescribe antibiotics.

A doctor or therapist may use ultrasound (gentle sound-wave vibrations) to warm deep tissues and improve blood flow. Iontophoresis may also be used. This involves using an electrical current to push a corticosteroid medication through the skin directly over the inflamed bursa or tendon. Gentle stretching and strengthening exercises are added gradually. The type of exercises recommended may vary depending on the location of the affected bursa or tendon.

If there is no improvement, the doctor may inject a corticosteroid medicine into the area surrounding the inflamed bursa. Corticosteroids can weaken and damage soft tissues if used injudiciously. If there is still no improvement after 6-12 months, the doctor may perform either arthroscopic or open surgery to repair damage and relieve pressure on the bursae.1,3

How to Prevent Bursitis

The steps to preventing bursitis are the same as preventing soft tissue injuries in general. Regular and varied exercise together with a balanced strength and conditioning program can help prevent bursitis just as it can tendonitis.

Some other guidelines are:

  • Warm up or stretch before physical activity. A general mobility warmup should be performed and when engaging in resistance strength training with heavy weight a proper specific exercise warmup and acclimation should be used
  • Strengthen muscles around the joint.
  • Take breaks from repetitive tasks often, especially when pain occurs
  • Cushion the affected joint. Carpenters, painters, plumbers, and carpet layers take note. Use foam for knee pads for kneeling. When having to support your weight on an elbow consider an elbow pad.
  • Avoid staying in one position for prolonged periods of time. Get up, move around, or change positions as often as possible.
  • Asses your posture or have it professionally assessed then take the steps needed to improve any postural deviations. This should include but not be limited to paying attention to your posture during daily life and activities and consciously correcting it
  • Ease into new activities or exercise programs slowly.

Common Types of Bursitis

There are around 160 bursa in the human body but bursitis is more common in in the shoulders, hips, elbows, knees, heels, and wrists.

Elbow (Olecranon) Bursitis

The olecranon bursa of the elbow is particularly susceptible to injury due to the paucity of soft tissue in the elbow joint. The bursa lies over the olecranon process which is a pointy part of the bone at the back of the elbow. The bursa functions to reduce friction between the olecranon and the overlying skin during elbow motion. Normally it is flat but if it becomes inflamed it will swell with fluid causing bursitis. The first symptom is normally swelling of the back of the elbow. As the bursa itself stretches elbow pain starts to occur which will become worse with pressure on the elbow or with elbow movement.

Olecranon bursitis can be caused by a single direct blow to the elbow. Most commonly, however, it is caused by repetitive stress from sporting movements or other habitual movements or from prolonged pressure on the elbow from leaning the body's weight on the elbow. Plumbers or heating and air conditioning specialist are particularly vulnerable to the latter because they must crawl into and work in tight spaces while leaning on their elbows. Elbow pads can help lessen the trauma to the bursa and thus prevent help prevent bursitis.

And infection can in the elbow can also lead to elbow bursitis. Bacteria from any wound to the elbow which breaks the skin could get inside the bursa and cause and infection resulting in fluid, swelling, and pain. Pus may develop in the bursa if the infection is allowed to progress for too long. The bursa may rupture and drain pus, spreading the infection to other parts of the body resulting in serious and even life threatening illness.

Elbow bursitis is commonly associated with rheumatoid arthritis. It may also be associated with conditions such as gout and chondrocalcinosis.5,6

Hip (Trochanteric) Bursitis

Trochanteric or hip bursitis is a common cause of pain in the lateral part (side) of the hip. It is more common between the ages of 40 and 60 and is more frequent in women then in men.

The bony point of the hip is called the greater trochanter (also called the major trochanter, the outer trochanter, and the lateral process of the femur). The muscles that move the hip joint attach to this point including the gluteus medius and minimus, piriformis, obturator internus and externus, and gemelli muscles. There are three main bursa which overlie the greater trochanter, the subgluteal maximus, medius and minimus bursae.

The pain of trochanteric bursitis occurs at at the point of the hip on its lateral aspect, chiefly over the area of the subgluteal bursa. It can spread to the outside of the thigh but rarely beyond the knee.

During the initial stages the pain may be sharp and intense but later gives way to being more achey and diffuse. Pain typcially worsens at night during sleep when lying on the affected hip. It can also be aggravated by getting up from a chair after sitting for a long time. Prolonged walking, stair climbing, or squatting may also worsen it.

Trocanteric bursitis may be caused by:

  • Repetitive stress such as running, stair climbing, bicycling or prolonged standing
  • Direct injury to the hip such as from a fall or bump, or prolonged bed rest on one's side
  • Spine disease such as scoliosis, lumbar arthritis or other
  • Unequal leg length
  • Rheumatoid arthritis.
  • Previous hip surgery
  • Bone spurs or calcium deposits

There is another type of bursitis which is sometimes called hip bursitis. This involves a bursa located on the inside of the groin called the iliopsoas bursa. Bursitis in this bursa causes groin pain and although it may be referred to as hip bursitis it is not as common as trochanteric bursitis. 7,8

Knee Bursitis

The knee region has eleven bursae and knee bursitis can be caused by inflammation in any of these. Three bursa are associated with the knee joint: the quadriceps or suprapatellar, the popliteus, and the medial gastrocnemius. Four are associated with the kneecap (patella): the superficial and deep prepatellar and the superficial and deep infrapatellar. Two bursa associate with the semimembranosus tendons and two more to the collateral ligaments of the knee.

However, the most common type of knee bursitis occurs over the kneecap or on the inner side of the knee below the joint.

Knee Bursitis Symptoms

Since there are so many possible bursa affected in knee bursitis symptoms can vary depending on the location of the inflamed bursa and what is causing that inflammation. However just like all bursitis the area affected may be painful or tender with movement or pressure, feel warm to the touch, and appear swollen. Although direct trauma, such as from a blow or fall, can cause these symptoms to come on quite rapidly most knee bursitis is from repetitive trauma over time, rather from movement or pressure, so symptom come on slowly and get worse over time.

If a fever occurs in addition to swelling and pain in the knee, see a doctor immediately. This could indicate an infection.

General Causes of Knee Bursitis

  • Repeated and prolonged pressure on the knee as from kneeling
  • A direct blow to the knee or a fall on the knee (or repeated falls)
  • Bacterial infection of the bursa
  • Complications from osteoarthritis, rheumatoid arthritis or gout in the knee

The following are the most common forms:

Prepatellar Bursitis: Housemaid's Knee

This type of knee bursitis involves inflammation of the prepatellar bursa, located directly over the kneecap. It is caused by direct trauma to the knee such as falling onto the been knee or frequent kneeling on a hard surface. For those who must spend long periods kneeling on their knees, like carpet layers, plumbers and gardeners, carpenters, heating and air conditioning specialists, etc., knee pads are or a foam pad are recommended.

Infrapatellar Bursitis: Vicar's Knee or Preacher's Knee

This type of knee bursitis, involving the infrapatellar bursa, is usually caused by repetitive knee flexion with weight bearing such as squatting, jumping or deep knee bends. It may be associated with patellar-quadriceps tendinitis.

Anserine Bursitis

This type of knee bursitis is common in overweight women who also have osteoarthritis of the knees. It is also common in those who play sports requiring running and frequent side-to-side splitting and cutting such as soccer.

Medial Collateral Ligament Bursitis

This type of knee bursitis is caused by inflammation of a bursa between the deep and superficial parts of the medial collateral ligament and has been associated with degenerative disease of the medial joint compartment. It also may be common in horse or motorcycle riders because of the friction to the inner side of the knee.

Semimbranosus Bursitis

This type of knee bursitis is usually seen in runners. It may be associated with hamstring tendinitis.10,9


"Questions and Answers About Bursitis and Tendinitis." Arthritis, Musculoskeletal and Skin Diseases Home Page. Web. 11 Feb. 2011. <http://www.niams.nih.gov/Health_Info/Bursitis/default.asp>.

1. "Questions and Answers About Bursitis and Tendinitis." Arthritis, Musculoskeletal and Skin Diseases Home Page. Web. 11 Feb. 2011. <http://www.niams.nih.gov/Health_Info/Bursitis/default.asp>.
2. Frontera, Walter R., J. K. Silver, and Thomas D. Rizzo. "Musculoskeletal Disorders: Foot and Ankle." Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation. Philadelphia, PA: Saunders/Elsevier, 2008. 415. Print.
3. "Bursitis." The Johns Hopkins White Pages, Arthritis. Vol. 2007. Baltimore: Medletter Associates, LLC. 69. Print.
4. "Patient Education - Tendonitis." American College of Rheumatology. Web. 11 Feb. 2011. <http://www.rheumatology.org/practice/clinical/patients/diseases_and_conditions/tendonitis.asp>.
5. Frontera, Walter R., J. K. Silver, and Thomas D. Rizzo. "Musculoskeletal Disorders: Elbow and Forearm." Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation. Philadelphia, PA: Saunders/Elsevier, 2008. 115-119. Print.
6. "Elbow (Olecranon) Bursitis - Your Orthopaedic Connection - AAOS." AAOS - Your Orthopaedic Connection. Web. 11 Feb. 2011. <http://orthoinfo.aaos.org/topic.cfm?topic=A0002
7. Frontera, Walter R., J. K. Silver, and Thomas D. Rizzo. "Musculoskeletal Disorders: Hip and Thigh." Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation. Philadelphia, PA: Saunders/Elsevier, 2008. 303-305. Print.
8. "Hip Bursitis - Your Orthopaedic Connection - AAOS." AAOS - Your Orthopaedic Connection. Web. 11 Feb. 2011. <http://orthoinfo.aaos.org/topic.cfm?topic=A00409>.
9. Mayo Clinic Staff. "Knee Bursitis." Mayo Clinic.com. Mayo Foundation for Medical Education and Research (MFMER). Web. 12 Feb. 2011. <http://www.mayoclinic.com/health/knee-bursitis/DS00954/METHOD=print>.
10. Frontera, Walter R., J. K. Silver, and Thomas D. Rizzo. "Musculoskeletal Disorders: Knee and Lower Leg." Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation. Philadelphia, PA: Saunders/Elsevier, 2008. 355. Print.

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This page created 11 Feb 2011 18:02
Last updated 11 Jan 2018 20:45

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