Bursitis

A healthy bursa is a thin jelly-like sac that forms a cushion in your joints where bones meet soft tissue — the muscles, tendons or ligaments. Bursae minimise rubbing between these surfaces, making movement easier.

You have around 160 bursae in your body and any one of them can become inflamed; those most often affected are in your:

• Elbows (olecranon bursitis)
• Feet
• Hip joints (trochanteric bursitis)
• Knees (housemaid’s knee or prepatellar bursitis)
• Shoulders (impingement)

Bursitis happens when these cushions become enlarged (inflamed) for some reason. Rotator cuff injury can lead to bursitis.

Treatment for bursitis involves protecting the affected joint from more damage and resting it. With treatment, bursitis pain usually goes away in a few weeks. However, flare-ups are common. 

The most common bursitis symptoms (or warning signs) are:

• Joints that feel warm
• Pain
• Swollen joints
• Tenderness — even when the joint isn’t moving

If the swelling doesn’t go away, your joint may become stiff — this can lead to muscle wastage. 

See your doctor if your bursitis symptoms get worse or don’t improve after a couple of weeks.

Make an appointment if you have:

• A high temperature or feel shivery
• A sudden inability to move the affected joint
• Disabling joint pain
• Excessive bruising, redness, swelling or a rash in the affected area
• Sharp or shooting pain, especially on doing physical activity

It's important to get an accurate diagnosis for bursitis as symptoms may be a sign of rheumatoid arthritis or gout. Tests for bursitis include:

• A fluid sample from the swelling to check for infection or signs of any blood from an injury
• An ultrasound scan or MRI scan to check for any muscle damage
• Blood tests
• X-ray to see if you’ve broken a bone

Bursitis is commonly caused by repetitive movements or positions that apply pressure on the bursae around a joint, such as:

• Extensive kneeling (eg when laying carpet or scrubbing floors)
• Leaning on your elbows for extended periods of time
• Repeatedly throwing a ball or lifting something over your head

Other causes include: 

• Gout
• Infection
• Inflammatory arthritis 
• Injury or trauma that causes bleeding into the bursa
• Prior hip surgery

However, in many cases, the cause of bursitis is unknown (idiopathic).

You can’t always prevent bursitis, but you can reduce the risk of a flare-up by:

• Lifting heavy weights correctly by bending your knees
• Maintaining a healthy weight
• Strengthening your muscles

Bursitis can affect anyone but there are several risk factors: 

• Age — bursitis is more common as you get older
• Medical conditions (eg diabetes, gout, rheumatoid arthritis)
• Occupations or hobbies — tasks that involve repetitive movements or positions that apply pressure on the bursae around a joint increase your risk of bursitis, eg carpet laying, gardening, playing a musical instrument or tile setting

Bursitis treatments include some simple things you can do yourself:

• Elevate — keep the swelling level with your heart if possible
• Ice — take an ice pack (or similar) wrapped in a tea towel, put this on the swelling for about 10 minutes and repeat regularly every few hours
• Medication — use over-the-counter anti-inflammatory medication, if advised by your GP (eg ibuprofen)
• Rest — don’t move or exercise your joint too much

If the swelling doesn’t go away in a couple of weeks, see your GP.

Your GP may advise treatment with:

• Antibiotics — when the cause is an infection
• Further rest — when the possibility of infection has been ruled out
• High-dose non-steroidal anti-inflammatory drugs (NSAIDs) eg ibuprofen

Further treatment

Bursitis treatment doesn’t usually include surgery.

In some cases, a steroid injection may be given by your GP or at hospital. A steroid injection won’t cure your bursitis but should reduce inflammation and pain for a couple of months. Steroids can have side effects so your doctor will discuss these with you and decide whether it's right for you.

For severe or recurring bursitis, surgery may be needed to drain the inflamed bursa, or in rare cases, remove it. 

To reduce your risk of bursitis coming back, make sure you:

• Clean any cuts on your joints to prevent infection
• Maintain a healthy weight — being overweight applies more pressure to your joints
• Use padding if you're applying a lot of pressure to your joints eg when kneeling
• Warm up before you exercise or play sport 

Try to avoid banging or knocking your joints and if you’re carrying out repetitive movements of your joints, take regular breaks. 

What is the best way to treat bursitis?

Bursitis can usually be treated by resting the affected joint and if necessary, taking medication recommended by your GP. Surgery is usually not needed. To treat your bursitis there are some simple things you can do yourself:

• Elevate — keep the swelling level with your heart if possible
• Ice — take an ice pack (or similar) wrapped in a tea towel, put this on the swelling for about 10 minutes and repeat regularly every few hours
• Medication — use over-the-counter anti-inflammatory medication, if advised by your GP (eg ibuprofen)
• Rest — don’t move or exercise your joint too much

If your bursitis does not go away after a couple of weeks, your GP may recommend treatment with:

• Antibiotics — when the cause is an infection
• Further rest — when the possibility of infection has been ruled out
• High-dose non-steroidal anti-inflammatory drugs (NSAIDs) eg ibuprofen

In some cases, your GP may recommend a steroid injection to reduce your inflammation and pain for a couple of months. For severe or recurring bursitis, surgery may be needed to drain the inflamed bursa, or in rare cases, remove it. 

What causes bursitis to flare up?

Bursitis can be caused by repetitive movements or positions that apply pressure to your joint — activities that involve doing this can therefore trigger a flare-up. Flare-ups are also more likely if you’re overweight as this applies more pressure to your joints, and if you incorrectly lift heavy weights without bending your knees. Losing weight, lifting heavy weights correctly and strengthening your muscles can all help prevent flare-ups. 

How long does bursitis last?

With treatment, bursitis usually lasts a few weeks. If your bursitis doesn’t improve in this time or gets worse, see your GP. 

What happens if you leave bursitis untreated?

Bursitis leads to swelling of your affected joint, which can cause it to become stiff and difficult to move. Without treatment, this can lead to muscle wastage. 

What foods should you avoid if you have bursitis?

In cases where bursitis is caused by rheumatoid arthritis or gout, certain foods should be avoided to reduce the symptoms associated with these underlying conditions. 

For gout, foods and drinks high in the substance purine should be avoided, such as alcohol, beer, organ meats, red meats and seafood — high-purine vegetables do not worsen gout and can be eaten. Food and drinks rich in fructose should also be avoided, such as sugary fizzy drinks, fruit juices, honey and agave nectar. 

For rheumatoid arthritis, foods that can worsen inflammation should be reduced or avoided, such as fried and processed foods, ready-meals, high-sugar foods such as cakes and sweets, and foods containing corn oil. 

How do you get rid of bursitis naturally?

Bursitis can, in some cases, be treated without medication or surgery. To treat your bursitis naturally, you can do some simple things yourself.

Elevate your swelling so it is level with your heart if you can do so comfortably. You can also apply an ice pack, wrapped in a clean cloth, to your swelling — keep it there for 10 minutes and repeat this every few hours. It is also important to rest your affected joint.