Bursitis

What is bursitis?

Dotted around your joints are small, fluid-filled sacs called bursae, which stop bone rubbing against muscle, skin or tendon as you move. Bursitis happens when one of these cushions becomes inflamed, leaving the area around it sore and swollen.

What are the symptoms of bursitis?

Bursitis usually affects one joint at a time, most often the shoulder, hip, elbow or knee, though it can develop around any joint in the body. You might notice:

• a dull, aching pain that worsens when you move the joint or press on it
• swelling, sometimes with a visible outline if the bursa sits just under your skin
• skin that feels warmer than usual, or looks red (people with darker skin tones may notice this less easily)
• stiffness, and discomfort even while resting the joint.

What are the causes of bursitis and who is at risk?

Bursitis is usually the result of a bursa being put under repeated strain, whether from friction and pressure or from an old injury that keeps flaring up. Your body can even grow an extra bursa, or produce more fluid in an existing one, if it senses a joint needs extra cushioning against constant rubbing.

Common triggers include:

• jobs or hobbies involving a lot of kneeling, leaning on the elbows, or standing for long periods
• tight shoes, high heels, or high-impact exercise such as running or jumping
• gout or other conditions that cause crystals to build up around a joint
• an infection getting into the bursa
• inflammatory conditions such as rheumatoid arthritis.

You're also somewhat more likely to develop bursitis if you carry extra weight, are older, or live with diabetes, although it can affect younger, otherwise healthy people too, sometimes without any obvious trigger.

Are there different types of bursitis?

The main distinction doctors make is between bursitis caused by an infection and bursitis that isn't. Infected bursitis needs antibiotics, and sometimes drainage, while the non-infected kind is usually managed with rest and anti-inflammatory treatment instead, so working out which type you have will shape your treatment plan.

Bursitis is also often named after wherever it happens to strike, since almost any joint has its own bursae that can become inflamed, from the shoulder and elbow down to the hip, knee and heel.

How is bursitis diagnosed?

A doctor will usually ask about your symptoms, any recent injury, and your job or hobbies, then examine the joint and press on it to see whether the pain matches up with a bursa. Your normal range of movement is often unaffected, even though moving the joint yourself may feel painful.

X-rays are sometimes taken to rule out other problems, though these are often normal in bursitis. Further imaging, such as an ultrasound scan or an MRI, may be used if there's been an injury or the diagnosis isn't clear.

If an infection or gout is suspected, a needle can be used to draw a small amount of fluid out of the bursa (aspiration), which is then sent to a lab to confirm what's causing the problem and guide treatment.

How is bursitis treated?

Many cases settle with simple self-care. Resting the joint, holding a wrapped ice pack against the area for short spells several times a day, and taking paracetamol or ibuprofen for the pain. Extra cushioning or padding around the joint, and comfortable, well-fitted shoes if your feet are affected, can also help.

Where self-care isn't enough, your doctor may suggest:

• aspiration, which can ease pressure and pain alongside helping with diagnosis
• a steroid injection into the joint to bring down swelling, though this isn't used if there's an infection
• antibiotics, typically for at least a week, if the bursitis is infected
• physiotherapy, to work on movement and reduce the strain that's aggravating the joint.

Surgery to drain or remove the bursa is rarely needed. It's mainly kept in reserve for bursitis that's severe or keeps recurring in the same spot, or for an infection that antibiotics alone can't clear.

When should I see a doctor?

See a GP if self-treatment hasn't helped, or symptoms are getting worse, after 1 to 2 weeks. Get medical advice sooner if you're running a temperature or suddenly feel shivery, if the joint won't move at all, if the skin over the swelling has split open or if the pain becomes intense and sharp.