Bursitis: Symptoms, Causes & Treatment Guide

What Is Bursitis and How Does It Develop?

Bursitis is inflammation of a bursa, a small fluid-filled sac that acts as a cushion between bones and soft tissues. The condition develops when repeated pressure, overuse, or injury causes the bursa to become irritated and inflamed, leading to pain, swelling, and limited movement in the affected area.

Throughout your body, there are over 150 bursae strategically positioned at points where friction occurs between bones, muscles, tendons, and skin. These small, jelly-like sacs are lined with synovial membrane and contain a thin layer of synovial fluid. Under normal circumstances, bursae facilitate smooth, frictionless movement during activities like walking, reaching, or bending.

When a bursa becomes inflamed, the normally thin sac swells and fills with excess fluid. This inflammation can result from various causes, including repetitive motions, prolonged pressure, acute injury, or underlying conditions such as rheumatoid arthritis or gout. The inflammation triggers a cascade of responses: increased blood flow to the area, accumulation of immune cells, and the release of inflammatory chemicals that cause the characteristic symptoms of pain, warmth, and swelling.

Bursitis can be classified as either acute or chronic. Acute bursitis develops suddenly, often after an injury or intense activity, and typically resolves within a few weeks with appropriate treatment. Chronic bursitis, on the other hand, develops gradually from repeated episodes of acute bursitis or persistent overuse, and may last for months or become a recurring problem.

Anatomy of a Bursa

Understanding the anatomy helps explain why bursitis occurs in specific locations. A bursa consists of an outer fibrous membrane and an inner synovial lining. The synovial cells produce lubricating fluid that reduces friction during movement. When healthy, a bursa contains only a few drops of fluid and is virtually flat. When inflamed, it can swell to several centimeters in diameter and become filled with excess inflammatory fluid.

The most commonly affected bursae are found in areas subject to repetitive motion or pressure: the subacromial bursa in the shoulder (beneath the acromion bone), the olecranon bursa at the elbow tip, the prepatellar bursa in front of the kneecap, the trochanteric bursa on the outer hip, and the retrocalcaneal bursa at the heel.

Types of Bursitis by Location

Different locations have distinct characteristics and are often associated with specific activities or occupations. Shoulder bursitis (subacromial bursitis) commonly affects people who perform overhead activities like painting, swimming, or throwing. Elbow bursitis (olecranon bursitis) is sometimes called "student's elbow" because it can develop from prolonged leaning on hard surfaces. Knee bursitis (prepatellar bursitis) has historically been called "housemaid's knee" due to its association with kneeling activities.

What Are the Symptoms of Bursitis?

The main symptoms of bursitis include localized pain that worsens with movement or pressure, swelling and tenderness around the affected joint, stiffness and reduced range of motion, and sometimes visible redness and warmth. Symptoms typically develop gradually but can appear suddenly after injury.

The presentation of bursitis varies depending on the location and severity of inflammation. However, certain symptoms are consistently present across all types of bursitis. Understanding these symptoms helps in early recognition and appropriate management of the condition.

Pain is usually the first and most prominent symptom. Unlike the deep, aching pain of arthritis, bursitis pain tends to be more localized and superficial. The pain typically worsens with specific movements that compress or stretch the inflamed bursa. For example, shoulder bursitis pain often intensifies when reaching overhead or behind the back, while hip bursitis may cause pain when lying on the affected side or climbing stairs.

Swelling is another hallmark of bursitis, particularly in superficial bursae like those at the elbow or knee. The swelling may appear as a soft, fluid-filled lump that can be moved slightly under the skin. In deeper bursae, such as the hip, swelling may not be visible but can be detected on imaging studies.

Common Symptoms by Location

Symptoms Requiring Immediate Medical Attention

While most bursitis is not dangerous, certain symptoms may indicate a more serious condition called septic (infected) bursitis. This occurs when bacteria enter the bursa, usually through a break in the skin, and cause a potentially dangerous infection.

What Causes Bursitis to Develop?

Bursitis is most commonly caused by repetitive movements or prolonged pressure on a joint. Other causes include acute injury, infection, underlying inflammatory conditions like rheumatoid arthritis or gout, and age-related changes. Risk increases with certain occupations and activities that stress specific joints.

Understanding the causes of bursitis is essential for both treatment and prevention. While the inflammation can sometimes appear without an obvious trigger, most cases can be traced to specific factors that irritate or damage the bursa.

Repetitive motion is the most common cause of bursitis. When the same movement is performed repeatedly, it creates friction and microtrauma to the bursa. Over time, this cumulative damage exceeds the bursa's ability to heal, leading to chronic inflammation. This mechanism explains why certain professions have higher rates of specific types of bursitis.

Prolonged pressure on a bursa can also cause inflammation. Spending extended periods in positions that compress a bursa—such as kneeling on hard floors, leaning on elbows, or lying on one hip—can trigger bursitis. This type often develops gradually and may not be immediately connected to the causative activity.

Acute injury such as a fall, direct blow, or sudden strain can cause immediate inflammation of a bursa. Traumatic bursitis typically presents with rapid onset of symptoms and may be accompanied by bruising. Unlike overuse bursitis, the cause is usually obvious to the patient.

Risk Factors for Developing Bursitis

Several factors increase susceptibility to bursitis. Age is a significant factor, as bursae become less resilient and more prone to inflammation after age 40. The tissues lose some of their ability to recover from stress, making older adults more vulnerable to overuse injuries.

Certain occupations carry elevated risk due to the nature of the work involved:

• Carpenters and tile setters: Frequent kneeling leads to prepatellar bursitis
• Plumbers and electricians: Working in cramped spaces with pressure on elbows and knees
• Gardeners and landscapers: Kneeling and repetitive digging motions
• Musicians: Repetitive instrument-specific movements
• Athletes: Sport-specific overuse patterns (tennis elbow, runner's hip)

Underlying medical conditions can predispose individuals to bursitis or make it more likely to become chronic:

• Rheumatoid arthritis: Chronic inflammation affects bursae along with joints
• Gout: Crystal deposits can accumulate in bursae, causing inflammation
• Diabetes: Impaired healing and increased infection risk
• Thyroid disorders: Can affect connective tissue health
• Obesity: Excess weight increases stress on hip, knee, and ankle bursae

Infectious Causes

Septic bursitis occurs when bacteria enter a bursa, usually through a cut, scrape, or insect bite over a superficial bursa. The elbow and knee are most commonly affected because of their exposure to minor trauma. Staphylococcus aureus is the most common causative organism. People with weakened immune systems, diabetes, or alcoholism have increased risk of developing infected bursitis.

How Is Bursitis Diagnosed?

Bursitis is primarily diagnosed through physical examination, where the doctor assesses swelling, tenderness, and range of motion. Imaging tests like ultrasound or MRI may be used to confirm the diagnosis or rule out other conditions. Fluid aspiration may be performed if infection is suspected.

Accurate diagnosis of bursitis involves differentiating it from other conditions that can cause similar symptoms, such as arthritis, tendinitis, or fractures. The diagnostic process typically begins with a thorough history and physical examination.

During the medical history, your healthcare provider will ask about the onset and duration of symptoms, activities that worsen or improve the pain, any recent injuries or changes in activity level, occupational factors, and any underlying health conditions. This information helps narrow down the likely cause and location of the problem.

The physical examination is often the most informative part of the diagnostic process. The examiner will look for visible swelling or deformity, assess the exact location of tenderness, evaluate range of motion in the affected joint, test for specific signs that indicate bursitis versus other conditions, and check for signs of infection such as fever, redness, and warmth.

Imaging Studies

While bursitis can often be diagnosed clinically, imaging studies may be helpful in certain situations. Ultrasound is particularly useful for visualizing superficial bursae and can show fluid accumulation, bursal wall thickening, and adjacent soft tissue changes. It has the advantages of being quick, non-invasive, and allowing real-time guidance for aspiration procedures.

MRI (Magnetic Resonance Imaging) provides detailed images of soft tissues and is useful when the diagnosis is unclear or when deep structures like the hip bursa need to be evaluated. MRI can also identify other conditions that may be contributing to symptoms, such as tendon tears or cartilage damage.

X-rays are not typically needed for bursitis but may be ordered to rule out other causes of joint pain such as fractures, arthritis, or bone spurs. In chronic cases, X-rays can show calcifications within the bursa.

Laboratory Tests and Aspiration

If septic bursitis is suspected, the doctor may perform aspiration—using a needle to withdraw fluid from the swollen bursa. The fluid is then analyzed for white blood cells (indicating infection), bacteria (through culture), crystals (suggesting gout or pseudogout), and blood (indicating injury).

Blood tests are generally not needed to diagnose simple bursitis but may be ordered if an underlying systemic condition is suspected. These might include inflammatory markers, rheumatoid factor, or uric acid levels.

How Is Bursitis Treated?

Treatment for bursitis follows a stepwise approach, starting with conservative measures like rest, ice, and anti-inflammatory medications. If these don't provide relief, options include corticosteroid injections, physical therapy, aspiration, and rarely, surgery. Most cases resolve with home treatment alone.

The treatment of bursitis aims to reduce inflammation, relieve pain, and prevent recurrence. The approach is typically conservative initially, with more invasive treatments reserved for cases that don't respond to basic measures.

First-Line Treatment: The RICE Protocol

For most cases of non-infectious bursitis, the initial treatment follows the RICE protocol, which has proven effective for reducing inflammation and promoting healing:

Rest: The most important step is to stop or modify the activity that caused the bursitis. Complete immobilization is rarely necessary, but avoiding movements that aggravate the bursa is essential. This doesn't mean total inactivity—gentle movement within pain-free ranges helps maintain flexibility and promotes healing.

Ice: Applying cold to the affected area helps reduce swelling and provides pain relief. Use an ice pack wrapped in a thin towel for 15-20 minutes at a time, several times daily, especially in the first 48-72 hours. Never apply ice directly to skin, as this can cause frostbite.

Compression: For bursitis in areas like the elbow or knee, an elastic bandage can help control swelling. The wrap should be snug but not so tight that it impairs circulation. Remove it if you notice increased pain, numbness, or skin color changes.

Elevation: When possible, elevate the affected limb above heart level to help fluid drain away from the inflamed bursa. This is particularly helpful for elbow and knee bursitis.

Medications

Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen are effective at reducing both pain and inflammation. They can be taken orally or applied topically. Oral NSAIDs should be taken with food to reduce stomach irritation, and prolonged use should be discussed with a healthcare provider due to potential side effects on the stomach, kidneys, and cardiovascular system.

Acetaminophen (paracetamol) can help with pain relief but doesn't have anti-inflammatory effects. It may be preferred for people who cannot take NSAIDs.

Topical anti-inflammatory gels applied directly to the affected area can provide relief with fewer systemic side effects than oral medications. These are particularly useful for superficial bursae.

Corticosteroid Injections

When conservative measures don't provide adequate relief after 2-4 weeks, a corticosteroid injection into or near the inflamed bursa may be recommended. Corticosteroids are powerful anti-inflammatory medications that can provide rapid and sometimes lasting relief. The injection is typically performed in a doctor's office and may be guided by ultrasound for accuracy.

While effective, corticosteroid injections are not without risks. Potential complications include temporary increase in pain (steroid flare), skin depigmentation at the injection site, weakening of nearby tendons with repeated injections, and infection (rare). Most doctors limit the number of injections to a specific area to minimize these risks.

Physical Therapy

Physical therapy plays an important role in treating bursitis, particularly for chronic or recurrent cases. A physical therapist can design a program that includes stretching exercises to improve flexibility, strengthening exercises to support the affected joint, manual therapy techniques to improve mobility, education on proper body mechanics and posture, and work or sport-specific modifications to prevent recurrence.

Aspiration and Surgery

Aspiration involves removing excess fluid from a swollen bursa using a needle. This can provide immediate relief of pressure and pain and may be combined with a corticosteroid injection. For septic bursitis, aspiration is both diagnostic (allowing fluid analysis) and therapeutic (removing infected material).

Surgery (bursectomy) is rarely needed for bursitis. It may be considered for chronic cases that don't respond to other treatments, recurrent infections, or when the bursa has become severely thickened. The procedure involves removing the inflamed bursa, after which a new bursa typically forms during healing.

How Can You Prevent Bursitis?

Preventing bursitis involves avoiding or modifying activities that cause repetitive stress, using protective padding when kneeling or leaning on joints, maintaining good posture and body mechanics, taking regular breaks during repetitive tasks, and strengthening muscles around vulnerable joints.

While not all cases of bursitis can be prevented, many can be avoided by taking steps to protect vulnerable bursae from excessive stress. Prevention strategies focus on reducing repetitive trauma, protecting pressure points, and maintaining overall musculoskeletal health.

Workplace and Activity Modifications

If your work or hobbies involve repetitive motions or prolonged positions that stress certain joints, consider these modifications:

• Take regular breaks: Every 20-30 minutes, stop repetitive activities and change position
• Use ergonomic tools: Choose equipment designed to reduce joint stress
• Vary your tasks: Alternate between different activities to avoid overusing one area
• Warm up properly: Before physical activity, do gentle stretching and warm-up exercises
• Gradually increase intensity: Don't suddenly increase the duration or intensity of activities

Protective Equipment

Using appropriate protective gear can significantly reduce the risk of bursitis:

• Knee pads: Essential for anyone who kneels regularly—gardeners, carpet installers, mechanics
• Elbow pads: Helpful for activities that involve leaning on elbows
• Cushioned surfaces: Use padding when working on hard floors
• Proper footwear: Well-cushioned shoes reduce stress on heel and hip bursae
• Ergonomic supports: Wrist rests, chair armrests, and standing mats

Exercise and Strengthening

Strong, flexible muscles help protect joints and bursae from injury. A balanced exercise program should include:

• Stretching: Regular flexibility exercises for all major muscle groups
• Strengthening: Exercises that build muscle support around joints
• Core stability: Strong core muscles improve overall body mechanics
• Proper form: Learn and maintain correct technique during exercise and work activities

When Should You See a Doctor for Bursitis?

See a doctor if your bursitis symptoms don't improve after 1-2 weeks of home treatment, if you have fever along with joint swelling, if pain is severe or prevents normal activities, if swelling appears suddenly without obvious cause, or if you have recurring episodes of bursitis.

While most cases of bursitis can be managed at home, certain situations warrant professional medical evaluation. Knowing when to seek care helps ensure appropriate treatment and prevents complications.

Signs that indicate you should see a healthcare provider include:

• Symptoms that persist or worsen despite 1-2 weeks of home treatment
• Fever (temperature above 38°C/100.4°F) along with joint symptoms
• Rapidly spreading redness around the affected area
• Severe pain that limits normal activities
• Joint swelling that appears without injury
• Multiple episodes of bursitis in the same location
• Underlying conditions like diabetes, rheumatoid arthritis, or weakened immune system
• Open wound or recent skin infection near the swollen area

For routine bursitis concerns, you can typically start with your primary care physician or general practitioner. They can diagnose most cases and initiate treatment. If your case is complex or doesn't respond to initial treatment, you may be referred to a specialist such as a rheumatologist (for inflammatory conditions), orthopedic surgeon (for chronic or severe cases), sports medicine physician (for activity-related bursitis), or physical therapist (for rehabilitation and prevention).

What Is the Outlook for People with Bursitis?

The prognosis for bursitis is generally excellent. Most cases resolve completely within 2-4 weeks with appropriate rest and treatment. Even chronic bursitis usually responds well to a combination of physical therapy, activity modification, and occasional medical interventions.

Understanding the expected course of bursitis can help set realistic expectations and guide treatment decisions. The outlook depends on several factors, including the cause, location, duration, and whether any underlying conditions are present.

Acute bursitis caused by a single episode of trauma or overuse typically resolves within 2-4 weeks when the aggravating activity is stopped and appropriate treatment is applied. With proper rest and anti-inflammatory measures, most people experience complete resolution of symptoms and can return to normal activities without restrictions.

Chronic bursitis may take longer to resolve and has a higher likelihood of recurrence. However, with comprehensive treatment including physical therapy, activity modification, and addressing any underlying causes, even long-standing cases can improve significantly. Some people may experience occasional flare-ups but can manage them effectively with the strategies they've learned.

Septic bursitis requires prompt antibiotic treatment but has a good prognosis when treated early. Most cases resolve completely with appropriate antimicrobial therapy, though some may require drainage or more aggressive treatment. Delays in treatment can lead to more serious complications.

Factors associated with a better prognosis include early diagnosis and treatment, ability to rest the affected area, no underlying inflammatory conditions, adherence to prevention strategies, and good overall health. Factors that may complicate recovery include continued exposure to the causative activity, underlying conditions like diabetes or rheumatoid arthritis, delayed treatment of infection, and repeated corticosteroid injections.