Is Bursitis Busting Up the Joint?

Pity the poor bursa. We have about 150 of these simple, fluid-filled sacs, but few of us ever hear of them until they start hurting.

Known collectively as "bursae," they cushion and lubricate joints, reducing friction as bones, tendons, muscles, and ligaments do their jobs. Bursae vary in size, but many (like those in the shoulder) are about the size of a silver dollar.

But bursae can become swollen and painful—a condition called bursitis. That makes simple movements of your shoulder, elbow, hip or knee seem monumental. "Overuse and the trauma of direct impact are the most common causes of bursitis," says Robert Stanton, M.D., an orthopedic surgeon in Fairfield, Conn.

As you age, you can injure bursae more easily. The sacs become drier over the years, and at the same time damage is mounting from wear and tear in your joints, says John M. Fenlin Jr., M.D., an orthopedic surgeon and shoulder specialist in Philadelphia.

"We don't see much bursitis in someone under 20 years old," he says. "We see bursitis in a 30- to 40-year-old tennis player and in people 65 or 70 years old who have shoulder pain from serving a tennis ball, putting dishes in a cupboard or washing their hair."

"Frequently, people mistake bursitis for tendinitis," adds Lewis G. Maharam, M.D., a past president of the New York chapter of the American College of Sports Medicine. In tendinitis, an inflamed tendon (a fibrous band tying muscle to bone) can cause joint pain.

A softball player might suffer bursitis of the elbow or shoulder from repeated throwing or in the knees from crouching to serve as a catcher. Dr. Maharam even treated a violinist who injured a bursa using the repeated motions needed to play the instrument.

Housework causes bursitis, too. For example, Dr. Stanton says, people who kneel to clean, garden or work on a roof are susceptible to bursitis of the knee.

"Prevention is better than treatment," Dr. Stanton emphasizes. "It's important to listen to your body and not to overdo it when you're getting pain or fatigue." If you're kneeling to garden, for instance, you can help your knees by taking frequent breaks and using a rubber pad as a cushion.

"If you're playing a sport, pay close attention to the fundamental movements and seek quality coaching. You'll be less likely to use poor mechanics and you'll reduce the chance for injury," Dr. Maharam adds.

Dr. Fenlin laments that we've embraced resistance training but not stretching. "I would like to see people stretching much more. If every person spent one minute stretching for every minute on a weight machine, there'd be a lot less bursitis and other injuries."

Most bursitis goes away without medical attention in a week or two. Many people never realize that an inflamed bursa caused the pain.

Self-treatment of bursitis includes:

  • Avoiding the activity that led to pain.

  • Using ice for the first 48 hours after an activity causes pain. "Use ice wrapped in a towel, 15 to 20 minutes, three to four times a day," Dr. Stanton says. After a couple of days, use moist heat before physical activity and ice after activity if your doctor agrees.

  • Elevating the injury (when it's possible and not painful) to reduce swelling.

  • Taking over-the-counter anti-inflammatory drugs like ibuprofen for pain and swelling. Ask your doctor first.

If your pain is severe, lingers or hampers daily activities, it may be time to see a doctor to rule out other causes.

A doctor diagnoses bursitis by putting your injured joint through a gentle range of motion and by pushing lightly on the skin above the painful joint. "If I push on the bursa and it's much more tender than the rest of the area, there's a good chance we're treating bursitis," says Dr. Maharam.

Your doctor may prescribe stronger anti-inflammatory medicine or inject the injured bursa with cortisone to ease swelling and pain. The doctor also may prescribe gentle exercise at home to improve blood flow to the joint and the bursa and to increase the range of motion.


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