Things to know about bursitis
Hip bursitis occurs as a result of inflammation of one of two bursae located around the hip.
A bursa is a fluid-filled sac that cushions an area of friction between tissues, such as tendons and bones. Bursae reduce friction between moving parts of the body, such as around the joints of the shoulder, elbow, hip, knee, and adjacent to the Achilles tendon in the heel.
The number varies, but most people have about 160 bursae throughout the body. Bursae are lined with special cells, called synovial cells, which secrete a fluid rich in collagen and proteins. This synovial fluid acts as a lubricant when parts of the body move. Inflammation of a bursa is referred to as bursitis.
What are causes of bursitis?
The three most common causes of bursitis are trauma, Infection, and rheumatoid conditions
The three most common causes of bursitis are repetitive motions (for example, repeated throwing of a ball), trauma (extensive kneeling or hitting your knee on a table), infection, and preexisting rheumatoid conditions.
Trauma
Trauma causes inflammatory bursitis from repetitive injury or direct impact.
- Chronic bursitis: The most common cause of chronic bursitis is minor trauma that may occur to the shoulder (subdeltoid) bursa from repetitive motion, for example, throwing a baseball. Another example is prepatellar bursitis (in front of the knee) from prolonged or repetitive kneeling on a hard surface to scrub a floor or lay carpet.
- Acute bursitis: A direct blow (let's say you accidentally bang your knee into a table) can cause blood to leak into the bursa. This causes inflammation with pain as well as swelling.
Infections
Bursae close to the surface of the skin are the most likely to get infected with bacteria, a condition that is called septic bursitis. The most common bacteria to cause septic bursitis is Staphylococcus aureus or Staphylococcus epidermis. People with diabetes, alcoholism, certain kidney conditions, those with suppressed immune systems such as from cortisone medications (steroid treatments), and those with wounds to the skin over a bursa are at higher risk for septic bursitis. About 85% of septic bursitis occurs in men.
Rheumatoid conditions
People with certain rheumatoid diseases such as gout and pseudogout can develop bursitis from crystal deposits. When these crystals form in a bursa, they cause inflammation leading to bursitis.
Bursitis Symptoms
What are symptoms of ischial bursitis?
Ischial bursitis is inflammation of the bursa that separates the gluteus maximus muscle of the buttocks from the underlying bony prominence of the bone that we sit on, the ischial tuberosity. Ischial bursitis is a form of bursitis that is usually caused by prolonged sitting on hard surfaces that press against the bones of the bottom or mid-buttocks.
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What are bursitis treatments?
The doctor will probably recommend home care with P-R-I-C-E-M: protection, rest, ice, compression, elevation, and medications (discussed below).
Are
there bursitis home remedies?
The treatment for bursitis can be remembered with the following memory device: P-R-I-C-E-M.
- Protection includes padding especially for bursae close to the surface of the skin on the ankles and knees.
- Relative rest of the affected area if possible may help symptoms. Choose alternate types of exercise activities that eliminate painful motions. Swimming may help rather than hurt.
- Ice is very effective in reducing inflammation and pain. Small ice packs, such as packages of frozen vegetables, applied to the area for 10 minutes at least twice a day may help decrease inflammation.
- Compression and elevation are helpful when it is feasible to compress the area. An elastic bandage can be applied (especially to knees and elbows). Keep the area elevated above the heart to keep blood from pooling there.
- Medications such as aspirin or ibuprofen (Advil) can be helpful to reduce inflammation and pain. Consult your doctor before taking these if you are on any blood-thinning medications or have a history of stomach ulcers or kidney disease.
What is the medical treatment for bursitis?
If your bursitis is not infectious, the doctor may inject the bursa with a corticosteroid to reduce inflammation.
If your bursitis is infectious, the bursa will be drained with a needle. The doctor will prescribe antibiotics to be taken in pill form. If the infection is very serious, does not respond to oral antibiotics, or if your immune system is weakened for another reason, you may be admitted to the hospital for IV antibiotics. Most causes of infectious bursitis, however, can be managed safely at home. Occasionally, a surgical operation to remove the bursa can be required.
How often is follow-up needed after treatment of bursitis?
After you leave the doctor's office, try to change whatever caused the bursitis in the first place. Wear different shoes. Use kneepads when kneeling for activities or work.
Rest the area and apply ice at least twice a day, keeping the area elevated when possible.
Schedule a follow-up visit with your doctor in one week. If your bursitis is infectious, a follow-up visit in three to four days is appropriate for reevaluation and possible fluid removal.
Is
there a way to prevent bursitis?
If a certain activity causes you to develop bursitis, then limit that activity or use protective measures. Use kneepads or cushioning for gardening and scrubbing floors. Workers such as plumbers, roofers, and carpet layers should wear knee protection. Choose more appropriate shoes or cushion the ankles with pads.
You can improve your flexibility and strengthen muscles involved in joint motion through rehabilitative exercise.
Be concerned about muscle tone if you have bursitis that tends to return. A physical rehabilitation program can guide you in the proper exercises to strengthen weak muscles.
What is the prognosis for bursitis?
Most people respond to therapy in three to four days and can follow up with their doctor in a week. If the bursitis is infectious, however, the area may have to be drained with a needle every three to five days until the infectious fluid does not return.
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Bursitis pictures
Media file 1: Acute infectious bursitis (septic bursitis) of the elbow. Courtesy of Christopher Kabrhel, MD.
Media type: Photo
Media file 2: Infectious bursitis (septic bursitis) of the elbow. Courtesy of Christopher Kabrhel, MD.
Media type: Photo
Media file 3: Infectious bursitis. Note the swelling at the elbow and redness of the skin. Courtesy of Christopher Kabrhel, MD.
Media type: Photo
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