Also known as olecranial bursitis, the elbow bursa lies between the loose skin and the pointed bone at the back of the elbow. It is a common problem among tennis players, golfers and other sportsmen who perform repetitive elbow flexion, which eventually leads to injury or inflammation.
The bursa located on the thighs can become inflamed with the wrong stretching.
The bursa located on the buttocks can become inflamed after sitting on hard surfaces for a long time, such as on bicycles.
The trochanteric bursa is superficially located in the greater trochanter bone, the part of the femur that protrudes from the side of the hip. Every individual has four or more bursae in each hip, with trochanteric bursitis being the most common inflammation to occur in this region.
In minor incidences, there are other bursae that can cause symptoms in the hip, such as the sciatic bursa and the iliopsoas muscle, located next to the groin. Medium- and long-distance runners are more likely to acquire this type of bursitis.
Ankles and Heels
The retrocalcaneal bursa is located between the heel and the calcaneus tendon, popularly called the Achilles tendon. This type of bursitis can be caused after long walks, by wearing the wrong shoes or excessive loads and repetitive movements in the heel.
Knee bursae can become inflamed with bruises, continuous pressure when spending a lot of time on your knees or by repeated gestures. The knee joint is surrounded by five main bursae, which are:
- Prepatellar bursa: Located between the patella and the skin. Among knee bursae, it is the one that has the greatest chance of developing inflammation;
- Anserine bursa: Also called goose paw bursa, it is located on the internal surface of the knee, between the tendons of the gracilis, sartorius and semitendinosus muscles;
- Infrapatellar bursa: Located below the patella under the patella tendon;
- Deep infrapatellar bursa: Located between the patellar tendon and Hoffa’s fat;
- Semimembranous bursa: Located between the medial side of the knee and the semimembranous tendon, at a higher level than the anserine bursa.
Causes of Bursitis
In a few cases, bursitis does not have a determined origin. In general, the disease can be caused by injuries, infections or inflammatory diseases that cause the formation of crystals in the bursa.
The most common injury that leads to bursitis is caused by overuse of the joints and repetitive movements of the muscles and tendons. According to doctors, inflammation of the bursa from injuries takes time to develop, so certain professions and daily actions, such as putting pressure on the knees and elbows, can contribute to triggering the disease. Stress and trauma produced by violent blows under the joints can also irritate the tissue inside the bursa and cause swelling and inflammation.
Some diseases can generate the formation of crystals inside the bursa, which causes excess fluids and swelling. Are they:
- Rheumatoid arthritis;
- Psoriatic arthritis;
- Polymyalgia rheumatica.
Bursitis acquired from infections tends to be in areas where the bursa is close to the surface of the skin, especially on the elbows. Cuts, insect bites, injuries and wounds are the necessary openings for bacteria to cause internal infections, which, if left untreated, can produce pus.
Because of their weakened immune system, cancer patients undergoing chemotherapy, diabetics, HIV patients , steroid users and alcoholics are more likely to get this type of bursitis.
Excess weight and dehydration of the tendon, bursa or joint are also triggers for acquiring bursitis. Age is another decisive factor, as as the tendons age, they are able to tolerate less stress, in addition to being less elastic and easier to tear.
Groups of risk
The presence of bursitis becomes more common with age, after the musculature and bone structure have completed its growth. For this reason, it has a higher incidence in adults, especially from the age of 40.
People with certain hobbies and occupations are vulnerable to acquiring bursitis over time, as they undergo repetitive daily actions, as in the case of musicians, athletes, painters, among other professions.
People with certain diseases, such as rheumatoid arthritis, gout and diabetes have a higher risk of developing bursitis.
Symptoms of Bursitis
Pain, stiffness and difficulty in moving the affected joint are the most common symptoms of bursitis. The area may be swollen, tender, reddish or with small increases in temperature due to inflammation. The symptoms appear gradually and worsen over the days or weeks. Initially, they cause minor discomfort by limiting daily mobility and, over time, the pain becomes present even when the joint is at rest.
The sore regions vary according to the bursa affected by the disease, such as stitches in the hips when sitting, discomfort when running, climbing stairs, crouching or resting the elbows on a table. If symptoms are not treated, patients’ sleep may be compromised by night pains, such as sleeping on their side and lying on the infected shoulder.
In the case of septic bursitis, bursitis caused by an infection, the patient may show fever as an additional symptom.
The diagnosis of bursitis is made by an orthopedist or physiotherapist, who palpates the inflamed area and checks for the characteristic symptoms of the disease. In a joint assessment of the patient’s medical history, physical exams, laboratory exams and imaging exams, the cause for the discomfort is investigated and the patient is directed to the specific treatment of their problem.
Physical examinations are carried out with a physiotherapist, who prepares a set of movements to test flexibility, mobility, strength, smoothness, inflammation and joint pain.
- Blood tests: check for rheumatoid arthritis;
- Analysis of the bursa fluid: by collecting a small sample of the bursa fluid near the affected joint, it is possible to diagnose whether the bursitis is caused by bacterial infections or the formation of crystals, as in the case of gout.
- Radiography: does not diagnose bursitis, but rules out the possibility of factors that may be causing pain, such as bone spurs, often found at the tip of the elbow in patients who have already had olecranial bursitis, injuries or broken bones;
- Tomography and magnetic resonance: performs the verification if the patient does not have any torn tendon;
- Ultrasonography: confirmation of bursitis comes through this exam, which shows all soft tissues, such as muscles, tendons, ligaments, among others, including bursae.
Treatment of Bursitis
The initial treatment of bursitis consists of rest, application of ice and pain control with analgesics and anti-inflammatory drugs. After pain control, physiotherapy helps to restore muscle strength and range of joint movement.
Infectious bursitis, on the other hand, is treated with antibiotics and surgically, to drain the fluid from the bursa or remove it, when other treatments have no effect.
Bursitis caused by injuries can be treated at home if they are still at an early stage. Home treatment consists of adopting habits and care to relieve pain and inflammation, such as:
- Ice bags : Place ice for 20 minutes, about 3 times a day. The ice will reduce inflammation, but it should never come into direct contact with the skin, otherwise it will cause burns. The ideal is to cover the skin with a cloth or paper towel and, on top, place the bag;
- Heat the spot: After the initial swelling has reduced, the heat from a thermal bag will help to increase circulation in the affected area and eliminate excess fluid in the bursa;
- Protect the affected area: Protection varies according to the area of inflammation of the bursa. Using knee pads , elbow pads , not sleeping on the side of the hip or sore shoulder, etc., can help in protection. When sleeping, put pillows to support the joint. To reach, pull or push objects overhead, choose to use stairs so as not to force your shoulder;
- Food: Increase the consumption of foods with anti-inflammatory properties, such as: citrus fruits (orange, acerola, guava and pineapple), red fruits (pomegranate, watermelon, cherry, strawberry and grape), oil fruits (chestnuts and walnuts), fish rich in omega-3 (tuna, sardines and salmon), seeds with omega-3 (flaxseed, chia and sesame), vegetables (broccoli, cauliflower, cabbage and ginger), aromatic herbs (macerated garlic, saffron, curry and onion) ), coconut oil and olive oil.
- Rest: Rest and, if possible, do not exert force on the joints of the affected area. However, the patient should not stop with all movements, especially if the inflammation is in the shoulder;
- Footwear: Swap tight shoes for new ones that fit your feet size. In cases of heel bursitis, opt for open shoes during treatment, so as not to make the pain worse;
- Stretching and posture: Stop, temporarily, with activities that helped you acquire the disease, such as sports and repetitive exercises. Correcting the posture and performing stretches indicated by the specialist doctor will help increase the efficiency of the inflamed joint, reduce pain when moving and prevent the problem from returning.
Physiotherapy consists of the use of analgesic and anti-inflammatory devices, such as Tens (therapy with electrical currents applied superficially to the skin through electrodes), ultrasound, galvanic current or microcurrents, used to strengthen muscles. In addition to recovery exercises, techniques are passed on to patients to increase joint mobility, performed along with muscle stretches.
The treatment of any joint, including the Achilles tendon, must be daily and usually takes around 6 months to complete.
Along with physical therapy, some exercises are performed to increase the efficiency of the inflamed joint and restore its normal functioning. Exercises, usually intended for shoulder injuries, are not a substitute for professional assistance, so it is recommended that the patient be accompanied by a physical therapist.
- Scapular range of motion: Standing, bring your shoulders up, compress your shoulder blades, one against the other, and then push them down. Hold the position for 5 seconds, relax and repeat 10 times.
- Shoulder flexion: While standing, hold a stick with your palms facing down. Bring your arms straight up to your head and hold for 5 seconds. The patient must repeat the exercise 10 times.
- Shoulder extension: When standing, hold a stick with your hands behind your body and move it away from your back. Hold the position for 5 seconds, relax and do 10 repetitions.
- External rotation: Standing, facing an open door, bend your elbow at 90º and apply the force on the back of your hand with the back of your hand. Hold for 5 seconds, relax and repeat 10 more times.
- Internal rotation: Standing in front of an open door, bend your elbow to 90º and apply force to the stop with the palm of your hand. Hold for 5 seconds, relax and repeat 10 more times.
- External rotation with therapeutic band: First, attach a band to the door handle on the opposite side of the inflamed shoulder. Standing, side to the door and with the hand of the injured side at rest under the abdomen, grasp the band and pull it by rotating the arm outwards to move the hand away from the waist, without disengaging the elbow from the body. Repeat the exercise 10 times. Over time, the patient can progress to 3 sets of 10 repetitions.
- Supraspinatus: Standing, arms suspended on the side of the body and thumbs pointing to the floor, slightly tilt the trunk forward and raise the arms laterally, keeping them extended. Bring your hands to shoulder height and hold for 10 seconds. Rest and repeat 10 more times.
Acupuncture is an alternative treatment that uses the application of needles in the region affected by bursitis to reduce pain and inflammation.
For cases where physiotherapy is not fully effective, there is a new treatment called Shock Waves. This is not an electric shock, but impact waves, initially used only to break kidney stones. The therapy consists of the penetration of mechanical energy under the injured tissue to cause a phenomenon called cavitation, which releases local anti-inflammatory substances and stimulates circulation.
The intensity of the waves generates variations in their effects:
- Low energy: produces pain relief and muscle relaxation;
- Medium energy: tissue repair occurs;
- High energy: bone stimulation occurs.
Treatment is outpatient and does not require hospitalization or anesthesia. The waves act only on the injured tissues and have no effect on normal tissues.
This treatment is rarely necessary, but if the case is chronic bursitis, or the bursa remains infected or inflamed after the patient has undergone all treatments, surgical removal is recommended.
- Surgery for infected bursa: The infected bursa will be removed in an operation performed under local anesthesia, usually with a hospitalization process. Surgery can be combined with the additional use of oral or intravenous antibiotics. After weeks or months of surgery, a new non-inflamed bursal sac grows;
- Surgery for inflamed bursa: The uninfected bursa will be removed as an outpatient procedure. The surgery does not disturb any muscle, ligament or joint.
In both surgical procedures, a splint will be applied to protect the skin. In addition, the doctor will recommend specific exercises to improve range of motion, which are generally allowed shortly after surgery.
Medicines for Bursitis
Painkillers and anti-inflammatories
Intake of painkillers and non-steroidal anti-inflammatory drugs can relieve pain and control inflammation. They are found in tablets or ointments and should be used with caution and for limited periods.
The most suitable drugs for the treatment of bursitis are:
- Paracetamol ;
- Ibuprofen ;
- Diclofenac ;
- Naproxen ;
- Piroxicam ;
- Celecoxib ;
- Androcortil ;
- Ketoprofen ;
- Profenid ;
- Ibupril ;
- Cataflam ;
- Artrosil ;
- Flanax ;
- Fenaflan ;
- Dexalgen .
If symptoms do not subside after 3 to 4 weeks, it is recommended to remove the bursa fluid and use corticosteroid injection, an anti-inflammatory substance stronger than oral medication.
Injections usually relieve pain and swelling, however, they may return within a period of time and another application will be required. But be aware, patients with long-term steroid use are at risk of experiencing high blood pressure and contracting an infection.
The most suitable steroidal anti-inflammatory drugs are:
- Celestone ;
- Duoflam ;
- Decadron ;
- Diprospan ;
- Predsim ;
- Prednisolone ;
- Betatrinta ;
- Betamethasone ;
- Dexamethasone .
Removing fluids from the bursa is a simple procedure and helps to alleviate the symptoms that cause discomfort to the patient. A sample of this liquid will be analyzed to identify if there are bacteria and what specific antibiotic is needed to fight the infection. The duration of use of the medication will be determined by the doctor and should not be interrupted before the end of treatment.
The following antibiotics can be prescribed for septic bursitis:
- Erythromycin ;
- Clarithromycin .
In the initial phase, the use of green clay is effective in treating the symptoms caused by the inflamed bursa. It is necessary to wet and apply over the area for at least 30 minutes.
The patient can also choose to apply the arnica montana cream to help relieve joint pain.
NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained on this site is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.
Healing and coexisting
The cure of bursitis, even after the proper treatment, can take around six months. The recovery time depends on the cause of the disease and the care that the patient will have when following the recommendations to prevent new crises. In cases of infection, the individual improves after using antibiotics, however, if the disorder is caused by trauma or injury, the recovery time is longer. If there is no correct treatment, the problem can become chronic and last for more than a year.
Bursitis tends to reappear even after healing, so as soon as there is improvement, the patient should start practicing light exercises and gradually increase the effort, to keep the joints hydrated and the muscles strengthened. To return to the sport, the individual must realize if he can move his joints without pain, if he is not sensitive to touch and normal strength has resumed. There is a risk of worsening the injury if you return to physical exercise without the doctor confirming your recovery.
As bursitis is caused by repetitive manual labor, ideally, activities and certain professions should be removed until healing is achieved. Retirement disability is characterized by the loss of some body part, mental alienation and contagious, incurable and serious diseases, so the patient with inflammation of the bursa, a curable joint disease, only guarantees the sickness benefit as long as he remains disabled.
If bursitis is not treated in its early stages, the inflammation can become chronic and difficult to resolve. Extending the lack of treatment can lead to the availability of calcium and cause calcification, stiffness and reduced ability to protect the joint.
In infected bursae, if they do not receive immediate treatment, the bacteria can spread to other parts of the joint or move into the bloodstream. Infection bursitis can produce pus and cause other serious illnesses.
In the case of shoulder bursitis, the patient tends to limit his actions with his arm since his actions become painful. The restriction of movements can lead to the appearance of another disease, called adhesive capsulitis or frozen shoulder, which causes joint stiffness and pain in greater intensities.
Not all types of bursitis can be prevented, but the patient can take some measures that reduce the chance of acquiring or being hit again by the disease. Here are some recommended guidelines:
- Avoid tasks that require repetitive movements for a long time, including sitting or kneeling. If this is not possible, take breaks throughout the day to rest your muscles or vary your movements to use different parts of your body;
- Do physical activities with the guidance of a professional, with stretching and warming up between 5 to 10 minutes before exercising;
- Try to maintain good posture throughout the day, especially during work;
- If you need to, invest in dietary reeducation and weight loss. Excess weight can cause pressure on the bursae, such as those on the hips;
- Protect vulnerable areas of the body, especially when playing sports. Invest in good quality knee pads, elbow pads and sneakers when hiking;
- Use both hands to hold tools or heavy objects and avoid using your shoulder as a support to carry them.