Bursitis

What Is Bursitis?

Bursitis is inflammation of the synovial sac that lines a joint. This sac is often referred to as a "bursa." The bursa overlies our joints where other structures of mobility and stability such as tendons, ligaments, and muscles come together.

The synovial sac is filled with a fluid called synovial fluid. This fluid helps to improve joint mobility and contains nutrients that keep the joint healthy.

Bursitis can either be superficial or deep, depending on which bursa is affected. Examples of superficial bursitis are pre patellar (in front of the patella/ kneecap), olecranon (elbow) and calcaneus (heel).

What Is Bursitis?

The synovial sac is filled with a fluid called synovial fluid. This fluid helps to improve joint mobility and contains nutrients that keep the joint healthy.

What Are The Symptoms Of Bursitis?

Bursitis presents with an acutely inflamed and painful joint. The joint may be red or swollen. Movement of the joint may be difficult because of swelling or due to pain. A burning pain may be felt on movement, and if the joint is used quite strenuously, there may be stiffness of the joint after exercise. Usually, the pain due to bursitis will progress and worsen over time, but sometimes the onset might be acute.

Bursitis can occur at any joint site. Subacromial bursitis, which is inflammation of the bursa surrounding the shoulder, is the commonest form of bursitis. It is often caused by muscle imbalances around the shoulder girdle and repetitive movements.

Diagnosis is usually made by history and physical examination findings. If uncertain, the doctor may aspirate the joint (remove some fluid from the bursa) and send the fluid for analysis. It may also be needed to do a workup for autoimmune disorders such as rheumatoid arthritis or gout, especially if you suffer from recurrent episodes of bursitis.

X-rays or sonars of the joint may be done if there are suspected underlying bony abnormalities or tendon/ligament or muscle injuries.

What Are The Causes Of Bursitis?

There are many causes or predisposing factors for bursitis to develop.

Overuse injuries of a joint are the commonest cause of non-traumatic bursitis. Repetitive movements can cause of micro trauma of the soft tissues in the joint. These include actions such as throwing a ball recurrently or washing floors on your knees. Work conditions or hobbies that may have repetitive movements such as playing tennis or golf, grilling, swimming, or running can predispose to bursitis.

Inflammatory conditions and connective tissue disorders may also cause bursitis. These conditions are for example rheumatoid arthritis, gout, osteoarthritis, autoimmune and connective tissue disorders.

Injury to a joint can cause bursitis. This will be either hemorrhagic or trauma bursitis, depending on if there is blood in the bursa or just inflammatory fluid.

Underlying conditions can predispose you to develop bursitis (although anyone can be affected). These factors include age, connective tissue disorders or SLE, diabetes. Anyone may be affected by bursitis regardless of underlying health.

Bursitis can also be caused by infection. This is called septic arthritis. It is very important to distinguish inflammatory arthritis from an infected bursa as infection can spread into the joint and cause severe long-term damage. A sceptic bursa is red, swollen, and very tender and may show signs of an abscess or pus forming. Fever is also a common symptom. If the doctor is not sure whether it is infective bursitis, they may do an aspiration and send some of the fluid to the laboratory. They may also add on blood tests to look for infective markers.

What Are The Things One Should Do To Manage Bursitis?

Rest the affected joint as much as possible.
Intermittent heat and cold application help to improve circulation. Heat increases blood flow, while ice lessens the inflammatory response and also helps with pain.
Take frequent breaks.
Lose weight if overweight, as being overweight increases the load on your joints.

What Are The Things One Should Avoid To Manage Bursitis?

Don't exercise without warming up or doing proper stretches afterwards.
If you had bursitis once in a joint, don't repeat the same movements that caused bursitis. Try using different techniques.

What Are The Best Foods For Bursitis?

As bursitis is an inflammatory condition, you want to have a diet that is low in inflammation.
A diet that is high in omega-3 fatty acids- present in fresh seafood, nuts, avocados, coconut oil, virgin olive oil.
Anti-inflammatory teas such as rooibos and green tea may be helpful.
Green fruits and vegetables, especially fresh and raw, will also help reduce inflammation.
Drink at least 2 litres of water a day.

What Are The Worst Foods For Bursitis?

Avoid processed and refined foods as this is toxic to your body and will worsen inflammation. This includes refined starches and sugar.
Alcohol, caffeine and acidic foods increase inflammation in the body.
Processed foods junk foods should be avoided at all costs.
High GI foods causing spikes in your blood sugar should be avoided.

What Are The Medicines For Bursitis?

Ice, rest, and elevation are the cornerstones of treatment of bursitis. For analgesia, anti-inflammatory medications are used as the mainstay.

Treatment of the underlying cause may be necessary. If a bursitis is caused by chronic conditions such as gout or rheumatoid arthritis treatment focuses on the underlying disease. If the bursitis is occupation related, see if you can change to a different area of work. If it's sports injury related, correct the underlying muscle imbalances to relieve the pressure off the specific joint.

Bursa aspiration depends on the cause of bursitis. In traumatic bursitis, the bursa can be drained, as it will help with recovery. If the bursitis is due to chronic repetitive movements, aspiration is usually not recommended.

If infective bursitis is suspected the treatment will be antibiotics, covering Staphylococcus aureus infection. If you are very ill, the doctor may decide to admit you to give antibiotics intravenously. If antibiotics are not reducing the infection, the bursa may be surgically drained.

Intralesional injections of corticosteroids into the bursa can be done in chronic conditions causing bursitis but is usually not recommended and acute trauma.

Physiotherapy may also be beneficial in strengthening the muscles and tendons surrounding the bursa to prevent further progression of bursitis.

What Are The Tips To Manage Bursitis?

Magnesium, as well as Omega 3 high dose supplementation, lowers inflammation.

Products such as MSM and glucosamine help in joint support.