Bursitis



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


The term “bursitis” refers to inflammation or irritation of a bursa. Bursae (the pleural of bursa) are small sacs located between moving connective tissue structures such as bones, muscles, skin and tendons. The bursa acts as a cushion to allow smooth gliding between these structures.



Both tendons, ropes that connect muscles to bone, and bursae are located near joints. Inflammation of these structures can often be mistakenly perceived by patients as being due to arthritis.

Symptoms of bursitis and tendonitis are similar: pain and stiffness aggravated by movement. Pain may be worse at night or it may be worse following use.

The most common cause of tendonitis and bursitis is injury or overuse. On rare occasion, infection within the bursa or tendon sheath will be responsible for inflammation. Certain antibiotics, such as the fluoroquinolones (eg., ciprofloxacin and related drugs) may cause tendonitis. Tendonitis or bursitis may be associated with diseases such as rheumatoid arthritis, gout, psoriatic arthritis, thyroid disease and diabetes.



The diagnosis of bursitis requires a careful medical history and physical examination. MRI and ultrasound may be useful in the detection of bursitis and tendonitis. Needle aspiration of a swollen bursa may be done to exclude infection or gout. Blood tests may be ordered to confirm underlying conditions but are generally not necessary to diagnose either tendonitis or bursitis.

The first step of bursitis treatment is to limit the activity of the affected area. Movement of the inflamed area will exacerbate the symptoms.

Ice will help to control the inflammation and decrease swelling.

The use of braces or splints for bursitis in the upper extremity can decrease the stress on the area. Orthotics and the temporary use of a cane can help unload the lower extremity to decrease pain and inflammation if bursitis affects the leg.

Sometimes anti-inflammatory medications are needed to reduce inflammation and pain. Corticosteroid injections into the affected bursa are frequently helpful if symptoms persist.

Once the acute attack of tendonitis or bursitis subsides, preventing recurrences is important in order to prevent the development of a chronic problem. Splints or pads to protect susceptible areas can help to prevent recurrences.

Stretching and strengthening are very helpful to address any muscle imbalances to prevent a re-occurrence of symptoms. Occupational and physical therapists offer a tremendous resource for instructing patients on proper posture and body mechanics that also may help to prevent recurrent problems with bursitis.

Patients should avoid repetitive motion tasks that can bring on an attack of bursitis. Taking breaks is important.

Prolonged kneeling can cause knee bursitis. Protective cushions can be purchased at hardware stores (roofers pads).

Learning to avoid activities that may cause a bursitis flare-up is obviously important.

As mentioned earlier, some cases of bursitis are due to bacterial infection. If this is the case, then the bursa will have to be drained, and antibiotic therapy instituted.

Bursitis due to underlying conditions such as rheumatoid arthritis and gout are more difficult to treat and recur more frequently. The treatment approach is generally similar; however, better control of the underlying disease is also critical.


FLASH

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 takes place.

Surgery is rarely, if ever, indicated.



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