What is Bursitis?

Bursitis describes inflammation of the bursa. There are over 140 bursae scattered through multiple areas throughout the body. The bursa is a small sac that is lubricated by a slippery layer of synovial fluid. Its role is to reduce friction and allow movement between multiple structures in the body (e.g. soft tissue, bones, tendon, etc.). Irritation of the bursa, such as overuse and infection, can cause this condition. According to the Australian Institute of Health and Welfare, more than 7000 visits to Australian hospitals occurred where bursitis was the main diagnosis [1]. This is most likely an underestimate as many people living with bursitis will usually seek help from GPs or other healthcare professionals. There are many bursae around the body, so there are several possible sources of inflammation and pain. Many people will only be able to recognise the location of bursitis after a formal assessment. Common types of bursitis include:

• Greater trochanteric bursitis
• Hip bursitis
• Shoulder bursitis
• Subacromial bursitis
• Prepatellar bursitis
• Olecranon bursitis
• Subdeltoid bursitis
• Knee bursitis

 

What Causes Bursitis?

Bursitis occurs when the bursa becomes irritated and inflamed. The bursa is wrapped in a thin film called a synovial lining. When irritated, the synovial lining produces synovial fluid, which builds up inside the bursa and eventually causes it to swell. As it swells and enlarges, it can become squeezed against specific structures, such as bone, tendons, ligaments or skin. There are many reasons why bursae become inflamed. Examples include [2]:

• Long periods of direct pressure onto the affected area (e.g. kneeling on the knees, side-lying on the outer hip, etc.)
• Repetitive movements (e.g. shoulder movement while swimming and weightlifting, etc.)
• Direct impact on the affected area
• Infections caused by bacteria after trauma and/or being pierced through the skin
• Autoimmune conditions, such as rheumatoid arthritis and scleroderma

 

Bursitis Symptoms

Symptoms are generally consistent but also depend on the location and the type of bursitis experienced. Common symptoms of bursitis include:

• Pain around the joint
• Specific areas of tenderness
• Reduced movement
• Swelling and redness of bursa that is located near the skin

However, bursitis caused by infections can have additional symptoms, such as fever, malaise (feeling unwell) and increased swelling/redness of the affected bursa.
 

Tests and Diagnosis

For an accurate diagnosis of bursitis, it’s essential to seek a consultation from an appropriate healthcare professional, such as a GP. Before requesting tests, your GP may ask questions about your symptoms, daily routine and other necessary information. Following this, a physical examination of the affected area may be required. Depending on the findings, your GP may recommend you for further testing (which will be detailed below).

Imaging

Your doctor may provide a referral for imaging tests, such as MRIs, X-rays and ultrasounds (click here for more information). These machines will use technology to provide 2D and 3D images of the structures inside the body. They will be able to pick up any changes to the bursa with the assistance of the machine operators and a radiologist(s) to help interpret the findings. However, there are also instances where bursitis is picked up on the images but is not relevant to your symptoms. It’s always important to talk to your GP to help put your image findings into context.

Blood Tests

Blood tests will be recommended to help diagnose septic bursitis (bursitis caused by an infection). After your blood is drawn, it will be taken to the laboratory for analysis. Depending on these findings, your GP may be able to make a diagnosis [2].

Aspiration

Aspiration is the process where your doctor will use a needle to draw fluid around the area of bursitis. The fluid will then be taken away for laboratory analysis. Findings from the fluid around the bursa are often the most reliable way your doctor can diagnose septic bursitis [2].
 

Is Bursitis Contagious?

Usually, bursitis cannot be based from person to person. However, pathogens (such as bacteria, viruses and fungus) responsible for septic bursitis can be spread.
 

Bursitis Treatment

Treatment for bursitis will depend on several considerations, such as location, severity and the cause of bursitis. Afterwards, your GP can suggest what type of treatments may be appropriate for you.

Medications

Your GP may recommend over-the-counter or prescribe anti-inflammatory medications to help relieve inflammation, pain and discomfort. Antibiotics may also be prescribed if your GP suspects your bursitis has been caused by infection [3]. Always take your medicine as directed by your GP.

Injections

Medicines, such as non-steroid anti-inflammatory drugs and corticosteroids, can be injected along the site of bursitis. Injections help specifically target the affected area and are used when other treatments are ineffective [3].

Physiotherapy

In some circumstances, bursitis is caused by inefficient movement, poor ergonomics and improper training techniques. Your GP may refer you to a physiotherapist to help correct these problems to prevent and manage bursitis naturally. For more information about physiotherapy, please click here to read more.

Aspiration

Fluid from your swollen bursitis can be drained with a needle and syringe. While it may help reduce swelling and provide relief, the swelling can return afterwards [2].

Surgery

Surgery is often the last resort if the bursitis is persistent and does not respond to other treatments. Your GP will refer you to a specialist, such as a rheumatologist and/or orthopaedic specialist, for more advice and treatment [3].
 

Recovery

Aseptic bursitis (not caused by an infection) is generally non-fatal and will recover over time. However, suppose individuals continue to perform aggravating activities and irritate the affected area. In that case, the condition can persist and take longer to recover [2]. Septic bursitis (caused by an infection) can become severe and even fatal, which requires urgent medical treatment for recovery. If you suspect septic bursitis, contact your GP immediately [3]. The recovery timeline for bursitis can vary depending on several factors, such as your general health, age and the location/type/severity of your condition.
 

Complications

Symptoms from your bursitis can lead to several complications, such as pain and restriction. These physical limitations can impact your ability to carry out daily tasks, such as exercise, shopping and work. If not addressed, it can lead to long-term physical restrictions, bursa ruptures, osteomyelitis and recurring symptoms [3]. Septic bursitis carries more severe complications if not managed appropriately. Long-term infections can permanently damage nearby structures, such as tendons and ligaments. This can lead to the tearing and rupturing of these structures. In the worst-case scenario, septic bursitis can cause septic shock, where the infection can cause organ failure and even death.
 
 

Receiving quality care from highly experienced doctors is essential for a prompt diagnosis and receiving the correct medical treatment. With 24-7 MedCare, you can experience telemedicine from the convenience of your own home. Our friendly online doctors will be available 24/7 for a consultation, anytime and anywhere in Australia.

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References

1. https://www.aihw.gov.au/reports/hospitals/principal-diagnosis-data-cubes/contents/data-cubes
2. Williams, C. H., & Sternard, B. T. (2018). Bursitis.
3. Momodu, I. I., & Savaliya, V. (2019). Septic arthritis.