BURSITIS

Bursitis is inflammation of a closed sac of fluid known as a bursa. Bursae are located in many areas of the body, usually where tendons and muscles move directly over bony prominences. The bursa helps this motion by providing a gliding surface between the two structures. Several bursae are found in and around the shoulder, elbow, hip, knee, and foot. Overuse injuries and chronic irritation are the usual causes of bursitis; however, direct trauma, systemic disorders such as rheumatoid arthritis and gout, and puncture wounds with subsequent infection may lead to this painful condition.

Localized pain combined with swelling, redness, and tenderness are the usual presenting signs and symptoms. Pain usually worsens when resistance is placed against the muscle that is affected. Radiographs (x-rays) may show calcium deposits in the region around the bursa, but this finding should rarely affect the treatment. Radiographs are helpful for eliminating other possible causes of pain in the area, such as a stress fracture.

Bursitis can become a frustrating diagnosis. It tends to return, even after successful treatment, unless the offending activity is eliminated or altered. A physical therapist, occupational therapist, or athletic trainer may be able to provide retraining for certain activities to minimize the bursitis. Substituting other forms of exercise for those that are producing the symptoms is an important first step.

The area is rested by means of discontinuation of the offending activities for at least 2 weeks. Immobilizing the extremity with a splint or cast for 7 to 10 days sometimes is effective. Ice is placed on the acutely inflamed area to reduce swelling and provide pain relief. Antiinflammatory medications such as aspirin, ibuprofen, or naproxen are available without a prescription and are used to manage mild to moderate cases of bursitis. Prescription-strength antiinflammatory drugs are used to manage severe bursitis that has not responded to initial treatment and to manage extreme pain.

Aspiration, or removal of fluid from the bursa, can provide temporary relief and gives the physician the opportunity to evaluate the fluid for signs of infection or gout. The fluid may quickly return, however, which may lead to repeated aspiration and possible infection. An injection of steroid medication sometimes can be given to provide temporary relief, but this therapy is used sparingly.

If infection of the bursa is confirmed by means of culture of the fluid, an operation may be required to remove the infected tissue. Intravenous antibiotics may be necessary to cure the infection.

• Take as directed over-the-counter antiinflammatory medications such as aspirin, ibuprofen, or naproxen if the bursitis is mild to moderate. You may need prescription antiinflammatory drugs to relieve severe symptoms.
• Eliminate the offending activity and allow the affected area to rest for at least 2 weeks. Immobilizing the area may speed recovery.
• Substitute the offending activity with those that do not cause symptoms.
• Return to activity gradually, as long as you are entirely free of pain.

• Do not return to activity too soon or too suddenly. Six weeks is the usual time needed for inflammation to subside. Symptoms, not your level of frustration, dictate whether you are ready to resume activity.

• If the usual treatments have failed. Your bursitis symptoms may be due to something else, and your doctor should be consulted to rule out other, more dangerous conditions.

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