From the Guidelines
Bursitis is a condition characterized by inflammation of a bursa, a small fluid-filled sac that cushions areas where tendons, skin, and muscle tissues slide across bones, typically occurring in joints like the shoulder, elbow, hip, or knee, and causing pain, swelling, and limited movement in the affected joint. This condition can be diagnosed using various imaging techniques, including MRI and US, which are useful for evaluating soft tissue abnormalities, such as tendonitis and bursitis 1. The treatment of bursitis usually involves nonpharmacological approaches, such as physical therapy, heat/cold, and orthotics, as well as pharmacological treatments, including nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroid injections 1.
Some key points to consider in the diagnosis and treatment of bursitis include:
- The use of MRI and US for evaluating soft tissue abnormalities, such as tendonitis and bursitis 1
- The importance of nonpharmacological approaches, such as physical therapy, heat/cold, and orthotics, in the treatment of bursitis 1
- The use of NSAIDs and corticosteroid injections in the treatment of bursitis, with the goal of reducing pain and inflammation 1
- The need to avoid activities that worsen symptoms and to take regular breaks during repetitive activities to prevent recurrence 1
In terms of specific treatment options, the use of ibuprofen (400-800mg three times daily with food) or naproxen (220-500mg twice daily) may be recommended for the treatment of bursitis, along with rest, ice application, and avoiding activities that worsen symptoms. Additionally, corticosteroid injections directly into the bursa or physical therapy may be recommended for severe cases 1.
It is also important to note that bursitis can result from repetitive motions, direct trauma to a joint, or prolonged pressure, and that people can prevent recurrence by taking regular breaks during repetitive activities, using proper technique during physical activities, maintaining a healthy weight to reduce joint stress, and using padding when kneeling or putting pressure on joints for extended periods 1.
From the Research
Definition of Bursitis
- Bursitis is the inflammation of a synovial bursa, a small synovial fluid-filled sac that acts as a cushion between muscles, tendons, and bones 2.
- A bursa is an extra-articular sac that may communicate with a joint and functions to decrease friction between tendons and either bone or skin 3.
- Bursae can be classified as native and non-native (adventitious) bursae, with native bursae lined with a synovial membrane and occurring at predictable anatomical sites 3.
Causes and Types of Bursitis
- Bursitis can be caused by chronic overuse injury, and can result in bursal distention, which is characteristically unilocular and compressible 3.
- Common types of bursitis include prepatellar, olecranon, trochanteric, and retrocalcaneal bursitis 4.
- Calcific bursitis results from calcium deposits on the synovial joint, which can exacerbate pain and swelling 2.
Diagnosis and Management
- Bursitis must be distinguished from arthritis, fracture, tendinitis, and nerve pathology 4.
- Most patients respond to nonsurgical management, including ice, activity modification, and nonsteroidal anti-inflammatory drugs 4.
- Local corticosteroid injection may be used in the management of prepatellar and olecranon bursitis, but steroid injection into the retrocalcaneal bursa may adversely affect the biomechanical properties of the Achilles tendon 4.
- Surgical intervention may be required for recalcitrant bursitis, such as refractory trochanteric bursitis 4.
- Ultrasound evaluation can be used to assess bursae and guide further management and treatment decisions 3.