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Bursitis: description, causes, treatment

by Josephine Andrews
Published: Last Updated on 404 views

Inflammation of the bursa (bursitis) usually occurs after excessive physical exertion. Sudden onset of severe pain, which usually occurs for the first time at night after the overload, is characteristic. Sometimes the bursitis is caused by a bacterial infection or another condition instead. Wear and tear and chronic overload can also cause bursitis. Read more about the forms, causes, treatment, diagnosis and course of bursitis here.

ICD codes for this disease:

ICD codes are internationally valid codes for medical diagnoses. They can be found, for example, in doctor’s letters or on certificates of incapacity for work.

M70 M75 M71 M76

quick overview

  • Description: Painful, acute or chronic inflammation of a bursa. Bursae are fluid-filled tissue sacs that protect joints, muscles, tendons, and ligaments from movement-related friction and pressure. The inflammation often affects the bursae of large joints, such as the shoulder, elbow, knee, and hip.
  • Causes: usually overload as a result of unusual, force-intensive, repetitive movements. Other possible causes: age-related wear and tear, underlying diseases such as rheumatism or gout, bacterial infection. Certain professional groups such as tilers, musicians and athletes are particularly often affected by bursitis.
  • Diagnostics: Doctor-patient discussion to collect the medical history (anamnesis), physical examination, possibly blood test, tissue sample, imaging procedures ( ultrasound , X – ray ,magnetic resonance imaging = MRI).
  • Treatment: Immobilization of the affected joint, pain killers, cortisone if necessary, shock wave therapy, puncture to suck out excess fluid, physiotherapy. For bacterial bursitis: often surgical removal of the bursa, antibiotics. For bursitis due to an underlying disease: targeted treatment of the underlying disease.
  • Prognosis: Mostly rapid improvement if the affected joint is immobilized. If overloaded further, there is a risk of chronicity with persistent, recurring symptoms.

Bursitis: description

Bursitis is an acute or chronic inflammation of a bursa. There are about 160 bursae in the human body. The tissue cushions, which are several centimeters long and filled with fluid, are mainly found in the area of ​​​​the joints. But bursae also sit where skin, muscle, tendons, or ligaments directly overlie a bony prominence—for example, in the greater trochanter area (bony prominence at the top of the outside of the femur). Like a cushion between muscles, bones, tendons and ligaments, bursa cushion the friction and pressure on these elements that arise during movement.

Normally, bursae are rather flat and not completely filled with fluid. However, when they become inflamed, they swell and painfully press on the surrounding body structures.

Acute bursitis is usually the result of overuse. If not treated properly or if the cause is not eliminated, it can become chronic. Chronic bursitis can also be the result of an underlying disease such as rheumatism. Then partitions of connective tissue can form in the bursa ( bursa hygroma ). Limescale can also be deposited in it.

Bursitis in the shoulder joint
In joints, bursa serve as a buffer between tendons and ligaments and can become inflamed if overloaded.

Common forms of bursitis

In theory, any bursa can become inflamed. In practice, however, the most common forms of bursitis are:

  • Bursitis in the shoulder joint: subacromial bursitis and subdeltoid bursitis
  • Bursitis in the elbow joint: Bursitis olecrani
  • Bursitis in the hip: trochanteric bursitis
  • Bursitis of the knee: prepatellar bursitis and infrapatellar bursitis
  • Bursitis in the ankle: Subachillea bursitis

Symptoms of bursitis

Bursitis is always painful . In addition, the affected area is swollen, often red and warm, and very sensitive to touch. In the case of bursitis in the vicinity of the joint, the affected joint can only move to a limited extent.

Bacterial bursitis is often accompanied by fever and general malaise.

To prevent the bacterial infection from spreading, it should be treated immediately.

Bursitis: causes

Bursitis usually occurs when the structures involved (joints, muscles, tendons, ligaments) are overloaded . This can be the case, for example, with unusual, recurring movements. Sometimes bursitis is also caused by age-related wear and tear or an underlying disease such as rheumatism. Rarely is a bacterial infection the cause of bursitis. Men are affected somewhat more often than women.

Bursitis from overload

Bursae act as a buffer between joints, muscles, tendons and ligaments by protecting them from pressure and allowing smooth movement. If this function is overused by unfamiliar, forceful and repeated movements, the bursa can react with inflammation.

Hobby runners often contract bursitis in their heels, knees or hips. Typical is subachillea bursitis , the inflammation of a bursa on the Achilles tendon. This can later spread to the Achilles tendon and eventually lead to an Achilles tendon rupture . The affected foot is then not fully resilient for a long time. Regeneration can take months or even years.

Overloading the arms, especially the upper arms, often leads to bursitis.

Bursitis as a result of an underlying disease

Bursitis can also accompany common diseases such as rheumatism or gout . This should be taken into account, especially in the case of recurring bursitis.

Infection-related bursitis (septic bursitis)

Sometimes bursitis is caused by an infection ( septic bursitis ). Bacteria such as Staphylococcus aureus can enter the body after skin injuries or broken bones and cause bursitis.

Risk factors for bursitis

Obesity and age are considered risk factors for bursitis. Certain professional groups such as tilers, musicians and athletes are also more susceptible to bursitis because they place a strain on certain parts of the body with one-sided, repetitive movements.

Important: Anyone who suffers from chronic bursitis due to work can possibly have this recognized as an occupational disease.

Bursitis: treatment

If a bursitis caused by overuse is recognized early enough, it is usually sufficient to immobilize the joint for a few days . Painkillers and anti-inflammatory drugs such as ibuprofen or diclofenac (eg as an ointment) also help . The cold can also alleviate the symptoms: it is recommended, for example, to cool the affected area with a cool pad.

If the symptoms do not subside despite rest and anti-inflammatory painkillers and there is no bacterial infection, the doctor can inject cortisone into the inflamed bursa. It has a stronger anti-inflammatory effect than NSAIDs.

Some experts recommend shock wave therapy for bursitis. The inflamed region is treated with pressure waves. This should relieve the pain and remove any calcium deposits that may be present.

Excess fluid can be suctioned out by puncturing the bursa. This can speed up healing.

Physiotherapeutic measures are also recommended . They help to make the affected joint mobile again.

Sometimes, however, the measures described do not help in the long term and the affected bursa keeps getting inflamed ( chronic bursitis ). Then it may be advisable to surgically remove the bursa . Even with bacterial bursitis, the bursa usually has to be removed. In addition, an antibiotic is necessary to prevent the bacteria from spreading in the body.

If another underlying disease is behind the bursitis, it must be treated accordingly.

Bursitis: shoulder

Mud bursitis is one of the most common forms of bursitis. It is often accompanied by very severe, stabbing pain. Depending on which of the four bursae in the shoulder area is inflamed, a distinction is made between the following forms of bursitis:

Subacromial bursitis and subdeltoid bursitis

The two bursa subacromial and bursa subdeltoidea usually become inflamed when chronically overloaded :

  • The bursa above the roof of the shoulder joint ( bursa subacromialis ) prevents the humerus from hitting the bony roof of the shoulder when the arm is raised. In the shoulder area it is most often affected by inflammation ( subacromial bursitis ).
  • The subdeltoid bursa is located between the deltoid muscle of the shoulder and the shoulder joint. Inflammation of this bursa is called subdeltoid bursitis .

People who work a lot with their arms overhead are particularly susceptible to these two forms of bursitis. These include, for example, painters and forest workers. Sports such as badminton or climbing also promote inflammation of the subacromial or subdeltoid bursa.

Subcoracoid bursitis and subtendinea musculi subscapularis bursitis

The shoulder bursa, bursa subcoracoidea and bursa subtendinea musculi subscapularis, usually become inflamed as a result of natural age-related wear and tear . Overload plays no role in these forms of bursitis. Wear and tear narrows the space above the shoulder joint, which can lead to tendons and muscle tears. In addition, calcium deposits in tendons and bursae can trigger inflammatory processes and cause long-lasting symptoms.

The pain caused by inflammation usually occurs gradually. Those affected then gradually adopt a relieving posture, which in the medium term will result in further shoulder problems.

Some shoulder bursae are connected to each other. If one bursa is inflamed, this can therefore spread to the others. Since some bursae are also connected to the joint, inflammation can also spread there.

treatment

If the shoulder is not moved for a long time due to pain, it can become permanently stiff. Doctors refer to this phenomenon as ” frozen shoulder syndrome “. To avoid this, efficient pain therapy with anti-inflammatory drugs such as ibuprofen is very important. If that is not enough, the administration of cortisone can help.

In the case of wear-related and chronic bursitis, pain therapy is often not sufficient. Then the inflamed bursa must be surgically removed .

Naturopathic experts also recommend homeopathic remedies such as Silicea or Sticta to treat shoulder bursitis. However, the effect of homeopathic medicines has not yet been scientifically proven.

Bursitis: elbow

Inflammation of the bursa in the elbow is referred to by physicians as olecranon bursitis . It is expressed by a reddened, visibly swollen elbow tip. Tenderness to pressure may also occur (in the case of acute inflammation).

This form of bursitis often affects people who spend a lot of time at their desks with their elbows propped up. The resulting pressure triggers the inflammatory reaction. However, bacteria or other underlying diseases can also cause olecranon bursitis.

A non-bacterial bursitis on the elbow is treated with cold compresses, relief of the elbow and anti-inflammatory painkillers or cortisone. In infectious olecranon bursitis, the bursa usually has to be removed. An antibiotic is also given.

You can read more about the development, symptoms and treatment of the disease in the article bursitis – elbow .

Bursitis: knees

Knee bursitis is one of the most common forms of bursitis. There are several bursae in the knee area that can become inflamed. People who have to work a lot on their knees, such as floor layers, are particularly susceptible to this.

A bursitis in the knee area is noticeable by painful swelling and reddening of the knee. Depending on which bursa is inflamed, the symptoms may appear above or below the kneecap or below the knee towards the shinbone.

You can read everything you need to know about the causes, symptoms and treatment of this form of bursitis in the article Bursitis – Knee .

Bursitis: Hip

Various bursae can also be affected in the case of bursitis in the hip area. Most often, the bursa on the outside of the hip become inflamed – more precisely: on the greater trochanter (trochanteric bursitis) – and in the groin (iliopectine bursitis). Women are affected slightly more often than men.

Bursitis in the hip area is usually the result of excessive strain. It is accompanied by pain, which is usually aggravated by movements in the hip.

Treatment generally consists of rest and the use of pain-relieving, anti-inflammatory drugs. Cortisone injections and/or shock wave therapy may be added. In the case of frequently recurring inflammations, the affected bursa is often removed.

To learn more about the causes, symptoms, and treatment of hip bursitis, see Hip Bursitis .

Bursitis: investigations and diagnosis

If bursitis is suspected, the doctor will first ask you about your medical history (anamnesis): He will have the symptoms described in detail, ask about recent physical stress and any underlying diseases.

This is followed by a physical examination : the doctor takes a close look at the affected body region. He can recognize bursitis by the reddened skin and the swollen, immobile joint.

If the doctor suspects a bacterial infection as the cause of the bursitis, he will measure your body temperature and draw blood from you . The inflammation values ​​(number of white blood cells, CRP, etc.) are determined in the laboratory. If a bacterial infection is actually present, a tissue sample is taken from the bursa ( biopsy ) to find out the type of pathogen. In this way, the doctor can adjust the treatment individually to the triggering bacterium (selection of a suitable antibiotic).

In unclear cases, further investigations are necessary. The inflamed structures can be visualized using ultrasound or magnetic resonance imaging (MRI ) in order to be able to assess them more precisely. An X-ray can show whether calcium has already been deposited in the bursa.

As part of the examinations, the doctor must rule out diseases with symptoms similar to bursitis. These so-called differential diagnoses include rheumatism, tuberculosis, lipomas (benign tumors of fatty tissue) and liposarcomas (malignant tumors of fatty tissue).

Bursitis: course and prognosis

How long bursitis lasts and how severe the symptoms are depends in particular on the cause of the inflammation. If the bursitis is treated effectively and the joint is immobilized, the symptoms usually improve after a few days.

However, if the inflammation is ignored and the joint is not sufficiently relieved, the inflammation can become chronic (chronic) and cause symptoms for months or even years. Such a chronic bursitis is much more difficult to treat than an acute one. Therefore, the following applies: Bursitis should be taken seriously at an early stage.

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