Bursa inflammation (Bursitis)

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What is Bursitis?

Bursitis is described as an inflammation of the fluid-filled sac (bursa) which are natural shock absorbers located inside our joints. Bursae are filled with fluid that help reduce rubbing and friction between tissues such as bones, muscles, tendons, and skin. Bursitis can affect any joint, but is most common in major joints such as the shoulders, hips, elbows, knees and heels.

You might have bursitis if one of your joints is:

  • painful (often a dull-ache feeling)
  • tender or warm
  • swollen or red
  • more painful when you move it or press on it
  • difficulty to move your join

What are the common causes of bursitis?

Bursitis is most common in adults, around the age of 40. They are usually caused by muscle injuries or repetitive stressful movements which cause inflammation of the bursa. High-risk activities include; gardening, carpentry, painting, tennis, golf, skiing, baseball and any other activities that cause friction and pressure onto your joints.

Bursitis can also be caused by:

  • reactions to medications
  • stress
  • inflammation due to an underlying medical condition such as rheumatoid arthritis, gout, psoriatic arthritis
  • infection

How is bursitis diagnosed?

Your GP will ask about your symptoms and do a physical assessment to check if the joint is swollen. Your GP might also ask you to have examinations:
Imaging tests such as X-rays, MRI and ultrasounds.

  • These exams can exclude other issues that might causing the pain and also they can give your GP a clear image of your joints
  • Lab tests: to check for any signs of infection

What are the treatment options for bursitis?

  • Rest and Ice: Apply ice (or a bag of frozen peas) wrapped in a towel onto the affected area for 10 minutes to reduce swelling for the first 48 hours after symptoms occur. Repeat this process every few hours throughout the day.
  • Physical Therapy: such as physiotherapy, osteopathy, chiropractic therapy can help you strengthen muscles and give you more range of motion in the joint.
  • Medication: your GP may prescribe medications such as ibuprofen which work quickly to lower inflammation and reduce pain. If the inflammation in the bursa is caused by infection your GP may also prescribe you with antibiotics to help fight the infection.
  • Corticosteroid Injection: occasionally your GP may suggest a corticosteroid injection to help relieve the pain and inflammation caused by the bursa.
  • Aspiration: if the bursa is significantly large and swollen then your GP may suggest draining the bursa with a needle.
  • Surgery: very rarely for some types of bursitis, such as chronic hip bursitis, surgery may be warranted to help relieve a patient’s pain.

How long does bursitis last for?

Bursitis may last for weeks or months depending on which area is affected. The pain usually improves within a few weeks, but the swelling may take longer to completely disappear.

Can bursitis be prevented?

Not all causes of bursitis can be prevented, however there are a few things that can be done to help lower your risk of bursitis:

  • Use cushions when you’re resting a joint on a hard surface (kneeling or sitting).
  • Maintain a healthy weight. Being overweight places more stress on the joints which can increase the risk of bursitis. This is especially the case for the knee joints.
  • Take regular breaks when doing repetitive movements and exercises. This will help reduce the stress on your joints.
  • Be sure to maintain a correct lifting posture, failure to do so can increase pressure on the bursa of the knees and hips.

What are the best exercises for bursitis?

The nature of exercises may change according to the area affected. There are different types of exercises: muscle strengthening, joints mobility, stretching etc. that may help you to reduce the inflammation and improve the mechanics of your joints.

Here are some examples of typical exercises for bursitis, start each exercise slowly and stop doing them if you start feeling pain.

Posterior stretching exercise (shoulder)

  1. Hold the elbow of your affected arm with your opposite hand.
  2. Use your hand to pull your affected arm up and across your body. You will feel a mild stretch across the back of your affected shoulder.
  3. Hold for 10 up to 25 seconds. Then slowly lower and release your arm.
  4. According to your symptoms you may repeat this exercise from 3 to 5 times.
  5. If you can’t do this exercise daily, try to do it between 2-3 times a week.

Up the back stretch

To perform this exercise you may have to wait until a reduction of your pain and an improvement of your range of motion.

  1. Light stretch: Put your hand at the back of your low back. Let it rest to stretch your shoulder.
  2. Medium stretch: With your other hand, hold your injured arm behind your back by the wrist. Move your arm up the spine to gently stretch your shoulder.

Heel slide (Knee)

  1. Lie on your back with the painful leg straight and the opposite knee bent.
  2. Gently bend your affected knee by sliding your heel across the floor in the direction of your buttock until you feel a gentle stretch in your knee.
  3. Hold for about 4-5 seconds, and then slowly straighten your knee.
  4. Repeat up to 15 times.
  5. If you can’t do this exercise daily, try to do it between 2-3 times a week.

Quad sets

  1. Sit with your affected leg straight and supported on the floor. Place a small, rolled-up towel under your affected knee.
  2. Activate the thigh muscles of your affected leg by pushing the back of your knee down into the towel.
  3. Hold for about 4-5 seconds, then rest for up to 10 seconds.
  4. Repeat up to 15 times.
  5. If you can’t do this exercise daily, try to do it between 2-3 times a week.

Straight leg raise to the front (Hip)

  1. Lie on your back, bend your good knee so that your foot remains flat on the floor. Keep your affected leg straight. Make sure that your low back is supported and has a normal position and a good curve (not too much gap between your back and the floor). With the palm of your hand you should be able to touch the floor and with the back of your hand your lower back.
  2. Activate the thigh muscles in your affected leg by pushing the back of your knee flat down to the floor. Hold your knee straight.
  3. Keeping the thigh muscles tight and your leg straight, lift your affected leg up off the ground.
  4. Hold for about 4-5 seconds, then relax and slowly bring your leg back down. Rest for up to 10 seconds between each repetition.
  5. Repeat up to 15 times.
  6. If you can’t do this exercise daily, try to do it between 2-3 times a week.

Hip rotator stretch

  1. Lie on your back, bend your knees with your feet flat on the floor. Put the ankle of your affected leg on your opposite thigh.
  2. Use your hand to gently push your knee away from your body, you should feel a stretch around your hip.
  3. Hold the stretch for 25 seconds.
  4. Repeat 3 up to 5 times.
  5. Repeat the entire exercise, but this time use your hand to gently pull your knee diagonally in the direction of your opposite shoulder. Again hold the stretch for 25 seconds and repeat 3 – 5 times .
  6. Repeat daily.

Do I need to go to the GP or visit my local hospital?

You should see your local GP or go to your local hospital if you’re experiencing:

  • Fever or chills
  • Sudden lack of ability to move a joint
  • Severe pain in the affected joint during simple movements
  • Extreme redness or swelling
  • Presence of a rash or bruising in the affected area
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