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.
Bursitis usually 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, it can recur.
Without seeing your health care provider, you usually cannot 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 begin all at once or develop gradually over time.
- Swelling, tenderness
- 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 use a small needle to remove some fluid from the bursa to check for infection. You may also need a blood test to check for other health problems.
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, which may help prevent further flare-ups.
- 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. Only one shot is usually 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, 2 to 3 times a day) -- Glucosamine is a substance found in cartilage, the tissue that covers the ends of bones in a joint. Some evidence 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, 2 to 3 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 fish oil.
- Vitamin C with flavonoids (250 to 3,000 mg, twice 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 level 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.
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 herbs listed below 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.
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 can help reduce swelling and inflammation, and relieve pain.
Although no well-designed scientific studies have looked at whether chiropractic treatment helps bursitis, chiropractors often treat persons with this condition. They report that some persons 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.
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.
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.
Tell your health care provider if your symptoms do not 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.
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.
Bope & Kellerman: Conn's Current Therapy 2013. 1st ed. Philadelphia, PA: Elsevier Saunders; 2012.
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.
Del Buono A, Franceschi F, Palumbo A, Denaro V, Maffulli N. Diagnosis and management of olecranon bursitis. Surgeon. 2012; 10(5):297-300.
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.
Ferri: Ferri's Clinical Advisor 2014. 1st ed. Philadelphia, PA: Elsevier Mosby; 2013.
Goldman: Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011.
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.
Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.
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