Bursitis
Wherever a tendon, a muscle or simply the skin slides over a bony prominence, there is a flat pouch holding a drop of thick fluid.
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Medicines commonly prescribed for Bursitis
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: TABLET, 46.5 mgActive substance: diclofenacManufacturer: Novartis Farmaceutica S.A.Prescription requiredDosage form: TABLET, 600 mgActive substance: ibuprofenManufacturer: Farmalider S.A.Prescription requiredDosage form: TABLET, 600 mgActive substance: ibuprofenManufacturer: Laboratorios Cinfa S.A.Prescription required
Wherever a tendon, a muscle or simply the skin slides over a bony prominence, there is a flat pouch holding a drop of thick fluid. This is a bursa; the body has around a hundred and fifty of them, and they all do one job — absorbing friction. As long as everything works, nobody gives them a thought. An inflamed bursa fills with fluid, swells and gets in the way of every movement: the joint aches, puffs up and hurts when pressed. That is bursitis. Most of the time it settles within two or three weeks, but there is one form of it — the infected kind — that will never settle on its own. It has a section to itself below, and that is the most important part of this page.
Why a bursa fills with fluid
The cause is nearly always mechanical. The pouch is flattened under a load or rubbed over and over, the tissue answers with inflammation, and more fluid collects inside than there should be.
- long spells of kneeling — tiling, scrubbing floors, weeding;
- the habit of leaning on your elbows against a desk, an armrest, a steering wheel;
- repetitive overhead movements: painting, assembly work, swimming, throwing sports;
- a direct blow to the elbow, knee, hip or heel;
- stiff, tight shoes with a hard back, for the bursa beside the Achilles tendon;
- bacteria entering through a graze, a puncture or a scratched patch of skin right over the bursa;
- gout, rheumatoid arthritis, psoriatic arthritis — the inflammation in these conditions reaches the bursae too.
Quite often none of this can be recalled and the bursa flares up for no obvious reason. That does not mean the cause was looked for badly: it simply happens.
How it feels and where it usually strikes
The pain is usually dull and aching, worse on pressure and on movement, and it eases at rest. The skin over the sore spot may feel warmer than the skin next to it and sometimes looks red — on brown and black skin redness is harder to see, so go by warmth and swelling instead.
- Shoulder. It hurts to lift the arm and to reach behind your back, especially in the middle part of the arc. There is nothing to see from the outside — the bursa sits deep, under the shoulder blade's bony spur.
- Elbow. A soft, mobile lump appears at the back, anywhere from cherry to egg size. It gets in the way of bending, but the joint itself still works.
- Knee. Swelling right on or just below the kneecap, at the front. Kneeling hurts; walking is usually possible.
- Hip. Pain down the outer side, spreading towards the thigh, making it hard to lie on that side or climb stairs.
- Heel. Pain at the back, where the Achilles tendon attaches, worse in stiff footwear.
At the elbow and in front of the kneecap the bursae lie directly under the skin — you can see and feel them. That is exactly why infection gets in there most often. The hip is a separate story: what was called trochanteric bursitis for decades is now more often described as greater trochanteric pain syndrome, and the source of the pain turns out to be the gluteal tendons rather than the bursa. This matters for treatment, because the emphasis shifts to exercise rather than injections.
Infected bursitis — the thing you must not miss
If bacteria from the skin get inside the bursa through a wound, a scratch or a puncture, the inflammation becomes septic. Almost always this involves the superficial bursae — at the elbow and in front of the kneecap; microbes rarely reach the deep bursae of the shoulder and hip.
Suspect infection if:
- the skin over the swelling is bright red and clearly hot to the touch;
- the pain is markedly worse than ordinary bursitis pain and keeps you awake;
- you have a fever, chills or aching all over;
- redness is spreading up or down the limb from the lump;
- there is a graze, bite, spot or fresh wound nearby;
- something is leaking from the swelling.
The risk is higher with diabetes, a weakened immune system, treatment with corticosteroids, and in people who work on their knees. Infected bursitis needs antibiotics and often drainage with a needle; it does not clear up by itself, and if neglected it spreads into the surrounding tissue and can end in blood poisoning.
There is a similar but far more dangerous condition — infection inside the joint itself. One simple sign separates them: with bursitis the joint still bends and straightens, however reluctantly, whereas with infection inside the joint almost any movement causes sharp pain and the person holds the limb rigidly in one position. That combination — a frozen joint, fever, severe pain — means going to hospital straight away rather than waiting for morning.
What you can do in the first few days
- remove the load that started it: stay off the knee, stop leaning on the elbow, postpone overhead work;
- apply something cold through a cloth for 10–15 minutes several times a day;
- keep the limb raised while sitting or lying down;
- for pain, an over-the-counter painkiller — paracetamol or a non-steroidal anti-inflammatory drug; a pharmacist can say which suits you given your other conditions;
- pad the joint at night so it does not press into the mattress;
- wear knee or elbow pads if the work cannot be postponed.
What not to do: massage or rub the swelling, apply heat in the first days, and above all try to drain it at home. A home puncture is the shortest route from ordinary bursitis to the infected kind.
When you need a doctor
- one to two weeks of self-care have brought no relief, or things are worse;
- you have developed a fever, chills or a feeling of heat;
- you cannot move the joint;
- the pain is very severe, sharp or shooting;
- the redness around the swelling is spreading;
- it all began after a cut, a bite or a puncture in that spot.
If you have diabetes, are on chemotherapy, take corticosteroids or other medicines that suppress the immune system, do not wait a week — seek help right away.
What the doctor does
Usually an examination and a comparison with the other side are enough. After that it depends. If there is even a hint of infection, fluid is drawn from the bursa with a needle and sent for culture; it is also examined under the microscope for crystals, because gout and the related calcium deposition disease produce exactly the same picture. Drainage does not only answer the question, it relieves the pressure at once. An ultrasound scan shows how much fluid there is and whether nearby tendons are involved. An X-ray is needed after an injury or when calcium deposits are suspected. Blood tests are worth doing when infection is the question.
How it is treated
For infected bursitis, antibiotics are prescribed — usually a course of a week or more, sometimes longer — and the fluid is drawn off with a needle, occasionally more than once. Severe cases are treated in hospital, starting intravenously. The course must be finished: the swelling goes down long before the infection is cleared.
If there is no infection, treatment comes down to rest, cold, anti-inflammatory medication and a gradual return to movement. Once the pain has settled, restoring the range of motion and the strength of the surrounding muscles matters — with the shoulder and the hip, skipping this makes recurrence almost certain. A corticosteroid injection into the bursa is sometimes offered for stubborn pain, but only once infection has been ruled out: given into an infected bursa, it makes matters sharply worse. Surgical removal of the bursa is rare and reserved for bursitis that keeps coming back despite everything else.
Keeping it from coming back
- knee pads for any work on your knees, and a break every half hour;
- do not rest bare elbows on hard surfaces — put something soft underneath;
- build up sporting loads gradually and never skip the warm-up;
- wash and cover cuts and grazes over joints straight away;
- shoes with a soft heel counter and no pressure on the heel, if that is where the bursa flared;
- lose excess weight — knees and hips have an easier time of it;
- keep gout and blood sugar under control if you have them.
Online consultation
During an online appointment the doctor will ask how the swelling started and how it has changed, ask you to show the joint to the camera and describe how it feels to the touch, and above all work out whether there is reason to suspect infection. By the end it will be clear whether rest and painkillers are enough, whether drainage and a culture are needed, or whether the situation calls for an urgent face-to-face examination. You can also discuss which movements are safe to resume and how to change the way you work so that bursitis does not return.
This material is for information only and does not replace medical advice.
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