Montgomery Medicine No. 729

Let’s Talk About Bursitis

The joy of summer sports and activities has caused many people to complain of sore shoulders, elbows, hips and knees. Most of these folks are suffering from bursitis. Most of you have probably heard the term, but what is it exactly?

Any time a medical term ends in the suffix “-itis” it indicates inflammation of the tissue or organ involved. In this case, bursitis is inflammation of a bursa sac around a joint (pleural bursae or bursas). Bursa is Latin for purse, a very good descriptor of what it looks like – a small sac made of connective tissue.

A bursa is lined by a specialized membrane that secretes fluid into the sac. This turns the bursa in to a little pillow filled with the slippery liquid that helps cushion structures around it while also allowing them to glide more easily over each other. You can demonstrate this by making your own model of a bursa. Put a little water in a small balloon and put an object like a book on top of it and roll it around on the table to get an idea of how bursas work.

Our bodies contain many bursas. The ones that cause the most problems are found around the shoulders, elbows, hips, and knees. These joints are fairly complex and have many bones, tendons, and ligaments that intersect and move against each other. Without the aid of bursas these structures would rub together and cause a lot of pain as well as wear and tear.

All cases of bursitis have a common presentation. There is pain and tenderness around the involved joint, particularly with movement, often with associated swelling. There can be superficial redness and warmth as well. These are the four classic signs of inflammation: redness and swelling with warmth and pain.

The most common cause of bursitis is repetitive motion of a joint, especially in people who overdo things. Shoulder bursitis usually follows too much throwing (common in weekend warriors), pulling or pushing (yard work), or overhead activity such as painting a wall in an up-and-down or side-to-side motion using a roller or brush. The subacromial bursa is the one most commonly involved in the shoulder. It is found just under the outside end of the clavicle (collarbone).

The olecranon bursa in the elbow is also a common location for bursitis. You may have seen someone with swelling over the pointy part of the elbow. The point is formed by a protrusion of the ulna bone called the olecranon that has a bursa over it for the arm tendons to slide over. Bursitis in this location is usually the result of trauma from resting or rubbing the elbow on something or banging the elbow into things. Basketball players posting up in the paint are often afflicted from the constant elbowing they inflict.

Bursitis of the hip is not as common as bursitis of the shoulder or elbow. It is four times more common in women and can occur at any age. It is usually associated with direct trauma such as a fall and is also common in runners. The bursa involved is called the greater trochanteric bursa and is found over the outside of the upper thigh where a protrusion of bone (the greater trochanter) can be felt. Often these patients describe pain up and down the outside of the thigh and increased pain when lying on the affected side.

The bursa most commonly involved in the knee is the pre-patellar bursa that is positioned between the kneecap (patella) and the skin of the knee. Pre-patellar bursitis results in swelling over or above the kneecap and pain with bending the knee. Since the knee is subject to skin abrasions and the bursa lies directly under the skin, it can also become infected.

Pre-patellar bursitis is usually caused by direct trauma and is often seen in those who kneel frequently. It has the nickname “housemaid’s knee,” for it was frequently seen in women who used to crawl on their knees while scrubbing floors. Carpet layers are also at increased risk.

Treatment for all types of bursitis involves resting, icing and anti-inflammatory medication. Occasionally the fluid has to be drained and the bursa may need to be injected with steroid medication to reduce the inflammation. Antibiotics are prescribed if infection is suspected. Occasionally surgery is required to clean out, or even remove the involved bursa.

– Dr. John Roberts is a retired member of the Franciscan Physician Network specializing in Family Medicine.