by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
Click here: Second Opinion Arthritis Treatment Kit
Bursitis is inflammation or irritation of a bursa. Bursae (the pleural of bursa) are small sacs located between moving parts of the musculoskeletal system. The bursae act as cushions to allow smooth gliding between these structures.
Bursae are often located adjacent to tendons. Symptoms of bursitis and tendonitis are similar: pain and stiffness aggravated by movement. Pain may be severe at night or after use. While almost any tendon or bursa can be affected, those located around a joint are affected most often. Tendonitis and bursitis are usually temporary, but may become chronic problems. They can cause significant pain and limited ability to perform the activities of daily living.
The most common cause of tendonitis and bursitis is injury or overuse. Certain antibiotics, such as the fluoroquinolones (ciprofloxacin, others) may produce tendonitis. Tendonitis or bursitis may be associated with diseases such as rheumatoid arthritis, gout, psoriatic arthritis, thyroid disease and diabetes.
Diagnosis of tendonitis and bursitis requires a careful history and physical examination. MRI and ultrasound may be useful in the detection of bursitis and tendonitis. Ultrasound-guided aspiration of a swollen bursa may be performed to exclude infection or gout. Blood tests may be ordered to confirm underlying conditions.
Treatment of these two conditions is based on the underlying cause. In overuse or injury, rest is useful. The use of other modalities such as ice, may help to reduce inflammation and pain.
The ice will help to control the inflammation and decrease swelling.
The use of braces or splints for the affected area are helpful while symptoms are acute. Orthotics and the temporary use of a cane can help unload the leg to decrease pain and inflammation. Sometimes anti-inflammatory medications are needed to reduce inflammation and pain. Corticosteroid injections into the affected area are frequently helpful if symptoms persist.
Those patients who don't respond to conservative measures will require ultrasound-guided needle tenotomy with administration of platelet-rich plasma (PRP).
Once the acute attack of tendonitis or bursitis subsides, preventing recurrences is important.
Stretching and strengthening are very helpful to address any muscle imbalance issues to prevent a re-occurrence of symptoms.
As mentioned above, a truly effective treatment for bursitis seems to be available in the form of percutaneous needle tenotomy with autologous tissue grafting. This is a minimally invasive procedure using a small needle with ultrasound guidance. Blood is drawn from a patient and spun in a special centrifuge in order to harvest the platelet rich plasma component. Platelets are cells that contain multiple growth and healing factors. The patient then has the skin over the inflamed bursa anesthetized with local lidocaine. A small needle is introduced into the bursa and multiple tiny holes are made. The platelet rich plasma is then injected. Healing then occurs.
A few other tips...
Alternate repetitive tasks with breaks to relieve pressure. Don't perform one activity continuously for hours at a time.
If your work involves an activity such as prolonged kneeling, use protective pads. These can be purchased at hardware stores--ask for roofers pads.
Some cases of bursitis are due to bacterial infection. If this is the case, then the bursa will have to be drained, and the patient will require antibiotic treatment.
Bursitis due to underlying conditions such as arthritis and gout are responsive to tighter control of the underlying disease.
Surgery is rarely if ever indicated.
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