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Bursitis


Signs and Symptoms
What Causes It?
What to Expect at Your Provider's Office
Treatment Options
Following Up
Special Considerations
Supporting Research
  

Bursitis occurs when the small sac (bursa) found inside joints becomes inflamed. The fluid-filled sac helps to lubricate and cushion the joint. When it is inflamed, it can hurt to move.

Usually bursitis occurs in larger joints, such as the shoulder, hip, knee, or elbow. It is often caused by repetitive motion. Although bursitis usually goes away in a few weeks with treatment, you can get bursitis once or several times.

Without seeing your health care provider, you usually can't tell the difference between bursitis and pain caused by a strain or arthritis.

Signs and Symptoms

Symptoms of bursitis may include:

  • Aching or stiffness in the joint that gets worse when you move the joint. The pain may come all at once or develop gradually over time.
  • Swelling
  • Redness
  • Warm joint area

What Causes It?

Usually the bursa becomes irritated or injured after overuse from repetitive motion or strenuous activity. A bacterial infection may also cause bursitis. Other health problems, such as gout or rheumatoid arthritis, can also cause bursitis.

What to Expect at Your Provider's Office

Your doctor will ask you where the joint hurts and feel the joint for swelling or tenderness. Your doctor may order an x-ray or remove some fluid from the bursa with a small needle to check for infection. You may also need a blood test to check for other health problems.

Treatment Options

Often just resting and elevating the joint can help. A splint, sling, or other device can support the joint and keep it from moving. Applying ice or heat may help relieve pain and swelling. Once the joint is no longer painful, you can work to strengthen the muscles around the joint and prevent further flare-ups.

Drug Therapies

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) -- to reduce pain and inflammation. Over-the-counter NSAIDs include ibuprofen (Motrin, Advil) and naproxen (Aleve). Prescription NSAIDs include diclofenac (Voltaren), ketoprofen (Orudis), and naproxen. Using NSAIDs over a long period of time can increase the risk of stomach bleeding and heart attack.
  • Corticosteroids -- An injection into the bursa can reduce inflammation. Usually only one shot is needed. Sometimes oral corticosteroids are used for long-lasting inflammation.

Surgical and Other Procedures

In rare cases, the bursa is surgically removed.

Complementary and Alternative Therapies

Alternative therapies may help reduce the pain and inflammation of bursitis.

Nutrition and Supplements

Eat whole grains, fruits, vegetables, and fatty fish to help reduce inflammation. Avoid processed foods and foods high in sugar and fat. The following supplements may help:

  • Glucosamine sulfate (500 mg two or three times a day) -- Glucosamine is a substance found in cartilage, the tissue that covers the ends of bones in a joint. There is mixed evidence that suggests it may help treat the pain of osteoarthritis, and it may also help reduce inflammation in bursitis. Glucosamine increases the risk of bleeding. People who take blood-thinning medications -- such as aspirin, clopidogrel (Plavix), or warfarin (Coumadin) -- should not take glucosamine.
  • Omega-3 fatty acids (1,000 mg two or three times a day), such as fish oil or flaxseed oil. Although evidence is mixed on whether fish oil helps reduce inflammation, it seems to reduce the amount of inflammatory chemicals your body makes over time. Omega-3 fatty acids can increase the risk of bleeding. People who take blood-thinning medications -- such as aspirin, clopidogrel (Plavix), or warfarin (Coumadin) -- should ask their doctor before taking them.
  • Vitamin C with flavonoids (250 - 3,000 mg two times a day), to help repair connective tissue (such as cartilage). Vitamin C supplements may interact with other medications, including chemotherapy drugs, estrogen, warfarin (Coumadin), and others.
  • Bromelain (250 mg twice a day), an enzyme that comes from pineapples, reduces inflammation. Bromelain may increase the risk of bleeding, so people who take blood thinners should not take bromelain without first talking to their doctor. People with peptic ulcers should avoid bromelain. If taken with antibiotics, bromelain may increase the levels of the antibiotic in the body, which could be dangerous. Turmeric is sometimes combined with bromelain because it makes the effects of bromelain stronger. Turmeric and bromelain together can also increase the risk of bleeding.

Herbs

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, herbs should be taken with care, under the supervision of a health care provider.

The below herbs may help reduce inflammation. They also can increase the risk of bleeding. People who take blood-thinning medications -- such as aspirin, clopidogrel (Plavix), or warfarin (Coumadin) -- should ask their doctor before taking them.

  • Boswellia (Boswellia serrata), 150 mg 3 times per day
  • Turmeric (Curcuma longa), 375 mg 3 times per day for 12 weeks. Turmeric is sometimes combined with bromelain because it makes the effects of bromelain stronger.
  • White willow (Salix alba) acts similar to aspirin. It can be made into a tea by boiling 1/2 tsp. (2 grams) of bark in 8 ounces of water. Drink up to 5 cups per day. Do not take white willow if you are also taking aspirin or blood-thinning medications. Check with your doctor if you are allergic to aspirin or salicylates before taking white willow. Do not give white willow to children under the age of 18. Turmeric and white willow also can be used to reduce swelling.

Homeopathy

Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for the treatment of bursitis based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.

  • Arnica gel -- applied topically (to the skin) as directed gives excellent short-term pain relief
  • Arnica -- for bursitis occurring after an injury to the joint
  • Ruta graveolons -- for rheumatic pains in the joint
  • Bellis perennis -- for injury with a great deal of bruising.
  • Rhus toxicodendron -- for pain that gets better with movement

Acupuncture

Acupuncture can help reduce swelling and inflammation, and relieve pain.

Chiropractic

Although no well-designed scientific studies have looked at whether chiropractic treatment helps bursitis, chiropractors often treat people with this condition. They report that some people have less pain and increased range of motion. Chiropractors are likely to use other treatments in addition to spine and joint manipulation, such as ice massage and ultrasound therapy, in treating bursitis.

Movement Therapy

Exercising the muscles around your joints will help reduce pressure on the joint and bursa. Gentle yoga may help bursitis by increasing flexibility and reducing muscle tension. Other movement therapies, such as Pilates and Tai Chi, may also help improve muscle and ligament strength and reduce the tension caused by repetitive motions.

Massage

You should not use massage if your bursitis is caused by an infection. Otherwise, massage -- especially myofascial release therapy -- may help you relax and may reduce the discomfort from a sore joint.

Following Up

Tell your health care provider if your symptoms don’t get better with treatment. Be sure to follow your doctor’s instructions for resting the joint to allow the swelling to go away.

You can help prevent bursitis from coming back by avoiding repetitive motions, resting between periods of intense activity, and warming up before starting an activity.

Special Considerations

Do not take aspirin, acetaminophen (Tylenol), or ibuprofen (Advil, Motrin) for more than a few days unless your health care provider tells you to.

Be sure to tell your health care provider if you are pregnant.

Supporting Research

Bron C, Wensing M, Franssen JL, Oostendorp RA. Treatment of myofascial trigger points in common shoulder disorders by physical therapy: a randomized controlled trial [ISRCTN75722066]. BMC Musculoskelet Disord. 2007 Nov 5;8:107.

De Silva V, El-Metwally A, Ernst E, Lewith G, Macfarlane GJ; Arthritis Research UK Working Group on Complementary and Alternative Medicines. Evidence for the efficacy of complementary and alternative medicines in the management of osteoarthritis: a systematic review. Rheumatology (Oxford). 2011 May;50(5):911-20. Review.

Huang HH, Qureshi AA, Biundo JJ Jr. Sports and other soft tissue injuries, tendinitis, bursitis, and occupation-related syndromes. Curr Opin Rheumatol. 2000 Mar;12(2):150-4. Review.

Kimmatkar N, Thawani V, Hingorani L, et al. Efficacy and tolerability of Boswellia serrata extract in treatment of osteoarthritis of knee -- a randomized double blind placebo controlled trial. Phytomedicine. 2003;10:3-7.

Klein G, Kullich W. Short-term treatment of painful osteoarthritis of the knee with oral enzymes. Clin Drug Invest. 2000;19:15-23.

Lewis JS, Sandford FM. Rotator cuff tendinopathy: is there a role for polyunsaturated fatty acids and antioxidants? J Hand Ther. 2009 Jan-Mar;22(1):49-55. Review.

Paoloni JA, Orchard JW. The use of therapeutic medications for soft-tissue injuries in sports medicine. Med J Aust. 2005 Oct 3;183(7):384-8. Review.

Reginster JY, Deroisy R, Rovati L, et al. Long-term effects of glucosamine sulphate on osteoarthritis progression: a randomised, placebo-controlled clinical trial. Lancet 2001;357:251-256.

Schmid B, Ludtke R, Selbmann HK, et al. Efficacy and tolerability of a standardized willow bark extract in patients with osteoarthritis: randomized, placebo-controlled, double blind clinical trial. Z Rheumatol. 2000;59:314-320.

Vas J, Perea-Milla E, Mendez C, Galante AH, Madrazo F, Medina I, et al. Acupuncture and rehabilitation of the painful shoulder: study protocol of an ongoing multicentre randomised controlled clinical trial [ISRCTN28687220]. BMC Complement Altern Med. 2005 Oct 14;5:19.


Review Date: 12/31/2011
Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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