Bursitis is the

inflammation Inflammation (from la, wikt:en:inflammatio#Latin, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or Irritation, irritants, and is a protective response involving im ...

of one or more bursae (fluid filled sacs) of synovial fluid in the body. They are lined with a

synovial membrane The synovial membrane (also known as the synovial stratum, synovium or stratum synoviale) is a specialized connective tissue that lines the inner surface of capsules of synovial joints and tendon sheath. It makes direct contact with the fibrous ...

that secretes a lubricating synovial fluid. There are more than 150 bursae in the human body. The bursae rest at the points where internal functionaries, such as

muscle Skeletal muscles (commonly referred to as muscles) are organs of the vertebrate muscular system and typically are attached by tendons to bones of a skeleton. The muscle cells of skeletal muscles are much longer than in the other types of muscl ...

s and

tendon A tendon or sinew is a tough, high-tensile-strength band of dense fibrous connective tissue that connects muscle to bone. It is able to transmit the mechanical forces of muscle contraction to the skeletal system without sacrificing its ability ...

s, slide across

bone A bone is a Stiffness, rigid Organ (biology), organ that constitutes part of the skeleton in most vertebrate animals. Bones protect the various other organs of the body, produce red blood cell, red and white blood cells, store minerals, provid ...

. Healthy bursae create a smooth, almost frictionless functional gliding surface making normal movement painless. When bursitis occurs, however, movement relying on the inflamed bursa becomes difficult and painful. Moreover, movement of tendons and muscles over the inflamed bursa aggravates its inflammation, perpetuating the problem. Muscle can also be stiffened.

Signs and symptoms

Bursitis commonly affects superficial bursae. These include the subacromial, prepatellar, retrocalcaneal, and ''pes anserinus'' bursae of the shoulder, knee, heel and shin, etc. (see below). Symptoms vary from localized warmth and

erythema Erythema (from the Greek , meaning red) is redness of the skin or mucous membranes, caused by hyperemia (increased blood flow) in superficial capillaries. It occurs with any skin injury, infection, or inflammation. Examples of erythema not assoc ...

to joint pain and stiffness, to stinging pain that surrounds the joint around the inflamed bursa. In this condition, the pain usually is worse during and after activity, and then the bursa and the surrounding joint becomes stiff the next morning. Bursitis could possibly also cause a snapping, grinding or popping sound – known as

snapping scapula syndrome Snapping scapula syndrome, also known as scapulocostal syndrome or scapulothoracic syndrome, is described by a "grating, grinding, popping or snapping sensation of the scapula onto the back side of the ribs or thoracic area of the spine" (Hauser). ...

– when it occurs in the shoulder joint. This is not necessarily painful.

Cause

There can be several concurrent causes. Trauma,

auto-immune In immunology, autoimmunity is the system of immune responses of an organism against its own healthy cells, tissues and other normal body constituents. Any disease resulting from this type of immune response is termed an "autoimmune disease". P ...

disorders,

infection An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable dise ...

and

iatrogenic Iatrogenesis is the causation of a disease, a harmful complication, or other ill effect by any medical activity, including diagnosis, intervention, error, or negligence. "Iatrogenic", ''Merriam-Webster.com'', Merriam-Webster, Inc., accessed 2 ...

(medicine-related) factors can all cause bursitis. Bursitis is commonly caused by repetitive movement and excessive pressure. Shoulders, elbows and knees are the most commonly affected. Inflammation of the bursae may also be caused by other inflammatory conditions such as

rheumatoid arthritis Rheumatoid arthritis (RA) is a long-term autoimmune disorder that primarily affects joints. It typically results in warm, swollen, and painful joints. Pain and stiffness often worsen following rest. Most commonly, the wrist and hands are involv ...

scleroderma Scleroderma is a group of autoimmune diseases that may result in changes to the skin, blood vessels, muscles, and internal organs. The disease can be either localized to the skin or involve other organs, as well. Symptoms may include areas ...

systemic lupus erythematosus Lupus, technically known as systemic lupus erythematosus (SLE), is an autoimmune disease in which the body's immune system mistakenly attacks healthy tissue in many parts of the body. Symptoms vary among people and may be mild to severe. Comm ...

, and

gout Gout ( ) is a form of inflammatory arthritis characterized by recurrent attacks of a red, tender, hot and swollen joint, caused by deposition of monosodium urate monohydrate crystals. Pain typically comes on rapidly, reaching maximal intensit ...

Immune deficiencies Immunodeficiency, also known as immunocompromisation, is a state in which the immune system's ability to fight infectious diseases and cancer is compromised or entirely absent. Most cases are acquired ("secondary") due to extrinsic factors that a ...

, including

HIV The human immunodeficiency viruses (HIV) are two species of ''Lentivirus'' (a subgroup of retrovirus) that infect humans. Over time, they cause acquired immunodeficiency syndrome (AIDS), a condition in which progressive failure of the immune ...

and

diabetes Diabetes, also known as diabetes mellitus, is a group of metabolic disorders characterized by a high blood sugar level ( hyperglycemia) over a prolonged period of time. Symptoms often include frequent urination, increased thirst and increased ap ...

, can also cause bursitis. Infrequently,

scoliosis Scoliosis is a condition in which a person's spine has a sideways curve. The curve is usually "S"- or "C"-shaped over three dimensions. In some, the degree of curve is stable, while in others, it increases over time. Mild scoliosis does not t ...

can cause bursitis of the shoulders; however, shoulder bursitis is more commonly caused by overuse of the shoulder joint and related muscles.

Traumatic injury An injury is any physiological damage to living tissue caused by immediate physical stress. An injury can occur intentionally or unintentionally and may be caused by blunt trauma, penetrating trauma, burning, toxic exposure, asphyxiation, or o ...

is another cause of bursitis. The inflammation irritates because the bursa no longer fits in the original small area between the bone and the functionary muscle or tendon. When the bone increases pressure upon the bursa, bursitis results. Sometimes the cause is unknown. It can also be associated with various other chronic systemic diseases.

Diagnosis

Types

The most common examples of this condition: *

Prepatellar bursitis Prepatellar bursitis is an inflammation of the prepatellar bursa at the front of the knee. It is marked by swelling at the knee, which can be tender to the touch and which generally does not restrict the knee's range of motion. It can be extreme ...

, "housemaid's knee" *

Infrapatellar bursitis Infrapatellar bursitis is inflammation of the superficial or deep infrapatellar bursa. Symptoms may include knee pain, swelling, and redness just below the kneecap. It may be complicated by patellar tendonitis. Risk factors include kneeling or ...

, "clergyman's knee" * Trochanteric bursitis, giving pain over

lateral Lateral is a geometric term of location which may refer to: Healthcare *Lateral (anatomy), an anatomical direction *Lateral cricoarytenoid muscle *Lateral release (surgery), a surgical procedure on the side of a kneecap Phonetics *Lateral cons ...

aspect of hip *

Olecranon bursitis Olecranon bursitis is a condition characterized by swelling, redness, and pain at the tip of the elbow. If the underlying cause is due to an infection, fever may be present. The condition is relatively common and is one of the most frequent typ ...

, "student's elbow", characterised by pain and swelling in the elbow *

Subacromial bursitis Subacromial bursitis is a condition caused by inflammation of the Synovial bursa, bursa that separates the superior surface of the supraspinatus muscle, supraspinatus tendon (one of the four tendons of the rotator cuff) from the overlying coraco-ac ...

, giving shoulder pain, is the most common form of bursitis. * Achilles bursitis * Retrocalcaneal bursitis *

Ischial bursitis Ischial bursitis (also known as weaver's bottom) is inflammation of the synovial bursa located between gluteus maximus muscle and ischial tuberosity. Signs and symptoms Ischial bursitis causes pain down the posterior aspect of the upper thigh. ...

, "weaver's bottom" *

Iliopsoas bursitis Iliopsoas bursitis is inflammation of a bursa (synovial sac) lying between iliopsoas muscle and hip joint, lateral to femoral vessels. Pain is experienced over the same area and made worse by extension Extension, extend or extended may refer to: ...

* Anserine bursitis

Treatment

It is important to differentiate between infected and non-infected bursitis. People may have surrounding cellulitis and systemic symptoms include a fever. The bursa should be aspirated to rule out an infectious process. Bursae that are not infected can be treated symptomatically with rest, ice, elevation,

physiotherapy Physical therapy (PT), also known as physiotherapy, is one of the allied health professions. It is provided by physical therapists who promote, maintain, or restore health through physical examination, diagnosis, management, prognosis, patient ...

anti-inflammatory drug Anti-inflammatory is the property of a substance or treatment that reduces inflammation or swelling. Anti-inflammatory drugs, also called anti-inflammatories, make up about half of analgesics. These drugs remedy pain by reducing inflammation as o ...

s and pain medication. Since bursitis is caused by increased friction from the adjacent structures, a compression bandage is not suggested because compression would create more friction around the joint. Chronic bursitis can be amenable to

bursectomy A bursectomy is the removal of a bursa, which is a small sac filled with synovial fluid that cushions adjacent bone structures and reduces friction in joint movement. This procedure is usually carried out to relieve chronic inflammation (bursitis) ...

and aspiration. Bursae that are infected require further investigation and

antibiotic An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting bacterial infections, and antibiotic medications are widely used in the treatment and prevention of ...

therapy. Steroid therapy may also be considered. In cases when all conservative treatment fails, surgical therapy may be necessary. In a bursectomy the bursa is cut out either

endoscopically An endoscopy is a procedure used in medicine to look inside the body. The endoscopy procedure uses an endoscope to examine the interior of a hollow organ or cavity of the body. Unlike many other medical imaging techniques, endoscopes are insert ...

or with open surgery. The bursa grows back in place after a couple of weeks but without any inflammatory component.

References

External links

Bursitis treatment
from

NHS Direct NHS Direct was the health advice and information service provided by the National Health Service (NHS), established in March 1998. The nurse-led telephone information service provided residents and visitors in England with healthcare advice 24 ho ...

Questions and Answers about Bursitis and Tendinitis
nbsp;– US National Institute of Arthritis and Musculoskeletal and Skin Diseases {{Soft tissue disorders Synovial bursae Inflammations Soft tissue disorders