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Bursitis

Bursitis

Definition

Bursitis is the painful inflammation of one or more bursae, which are padlike sacs found in parts of the body that are subject to friction. Bursae cushion the movements between the bones, tendons and muscles near the joints. Bursitis is most often caused by repetitive movement and is known by several common names, including weaver's bottom, clergyman's knee, housemaid's knee, and miner's elbow, depending on the area of injury.

Description

There are over 150 bursae in the human body. Usually bursae are present from birth, but they may form in response to repeated pressure. Each sac contains a small amount of synovial fluid, a clear liquid that acts as a lubricant. The bursae may become inflamed through traumatic injury, infection, or the development of arthritis. The inflammation then causes pain whenever the joint is moved. The most common site for bursitis to occur is the shoulder joint (subdeltoid), but it also is seen in the elbows (olecranon), hips (trochanteric), knees, heels (Achilles), and toes. The affected area may be referred to as "frozen," because movement is so limited. In the knee there are four bursae, and all can become inflamed with overuse.

Causes & symptoms

The most common cause of bursitis is repeated physical activity, but it can flare up for no known reason. It can also be caused by trauma, rheumatoid arthritis, gout , and acute or chronic infection.

Pain and tenderness are common symptoms of bursitis. If the affected joint is close to the skin, as with the shoulder, knee, elbow, or Achilles tendon, swelling and redness are seen and the area may feel warm to the touch. The bursae around the hip joint are deeper, and swelling is not as obvious. Movement may be limited and is painful. In the shoulder, it may be difficult to raise

the arm outward from the side of the body. Putting on a jacket or combing the hair, for example, become troublesome activities.

In acute bursitis symptoms appear suddenly; with chronic bursitis, pain, tenderness, and limited movement reappear after exercise or strain.

Diagnosis

When a patient has pain in a specific joint, a careful physical examination is needed to determine what type of movement is affected and if there is any swelling present. Bursitis will not show up on x rays, although sometimes there are also calcium deposits in the joint that can be seen. Inserting a thin needle into the affected bursa and removing (aspirating) some of the synovial fluid for examination can confirm the diagnosis. In most cases, the fluid will not be clear. It can be tested for the presence of microorganisms, which would indicate an infection, and for crystals, which could indicate gout. In instances where the diagnosis is difficult, a local anesthetic (a drug that numbs the area) is injected into the painful spot. If the discomfort stops temporarily, then bursitis is probably the correct diagnosis.

Treatment

Nutritional therapy

Naturopaths and nutritionists emphasize the role of diet as underlying causes of bursitis. They believe that the faulty use of calcium by the body, magnesium deficiencies, and food allergies may play a role. Their recommended diet may include the following:

  • fresh fruits, vegetables and whole grains
  • avoidance of foods that may cause allergies or digestive problems.
  • multivitamin and mineral supplements
  • vitamins A, C and E, selenium , and zinc supplements

Herbal therapy

Herbalists have recommended the following herbs or plant products for treatment of bursitis:

  • curcumin (turmeric)
  • bromelain (an enzyme found in pineapple)
  • ginger
  • grape-seed extract
  • pine-bark extract
  • citrus bioflavonoids

Homeopathy

Homeopathic remedies for bursitis include Belladonna, Bryonia and Rhus toxicodendron.

Hydrotherapy

The application of ice soon after an injury helps decrease the inflammation of acute bursitis. After two days of treatment with ice, however, heat instead of ice is more helpful. A warm heating pad or hot showers or baths can also relieve the symptoms of bursitis.

Acupuncture

Acupuncture has been proven effective in treating hip and shoulder pain caused by bursitis and other conditions.

Chiropractic

Spinal manipulation by a chiropractor may help improve movement in the affected joints by relieving some of the pressure on them.

Body work

Body work starts with adequate rest and massage of the bursitic area. Massage can increase blood circulation in the area, reducing the inflammation and pain. Following the initial phase of body work, patients may participate in yoga exercises that help to improve joint mobility and strengthen the muscles surrounding the joints.

Allopathic treatment

Conservative treatment of bursitis is usually effective. The application of heat, rest, and immobilization of the affected joint area is the first step. A sling can be used for a shoulder injury; a cane is helpful for hip problems. The patient can take nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen, and naproxen to relieve the pain and inflammation. Once the pain decreases, exercises of the affected area can begin. If the nearby muscles have become weak because of the disease or prolonged immobility, then exercises to build strength and improve movement are best. A doctor or physical therapist can prescribe an effective regimen.

If the bursitis is related to an inflammatory condition like arthritis or gout, then management of that disease is needed to control the bursitis.

When bursitis does not respond to conservative treatment, an injection into the joint of a long-acting corticosteroid preparation like prednisone can bring immediate and lasting relief. The drug is mixed with a local anesthetic and works on the joint within five minutes. Usually one injection is all that is needed.

Surgery to remove the damaged bursa may be performed in extreme cases.

If the bursitis is caused by an infection, then additional treatment is needed. Septic bursitis is caused by the presence of a pus-forming organism, usually Staphylococcus aureus. Septic bursitis requires treatment with antibiotics, which can be taken by mouth, injected into a muscle, or injected directly into a vein (intravenously). The bursa will also need to be drained by needle two or three times over the first week of treatment.

Expected results

Bursitis usually responds well to treatment, but it may develop into a chronic condition if the underlying cause is not corrected.

Prevention

Aggravating factors should be eliminated to prevent bursitis. Overexercising or the repetition of a movement that triggers the condition should be avoided. Doing exercises to strengthen the muscles around the joint will also help. When doing repetitive tasks, the patient should take frequent breaks and alternate the repetitive activity with others that use different parts of the body. To cushion the joints, it is a good idea to use cushioned chairs when sitting and foam kneeling pads for the knees. Leaning on the elbows, kneeling, or sitting on a hard surface for a long period of time should be avoided. Not wearing high heels can help prevent bursitis in the heel, as can changing to new running shoes as soon as the old ones are worn out.

Resources

BOOKS

Bennett, J. Claude, and Fred Plum. Cecil's Textbook of Medicine. Philadelphia: W. B. Saunders Co., 1994.

Bennett, Robert M. "Bursitis, Tendinitis, Myofascial Pain, and Fibromyalgia." In Conn's Current Therapy. Edited by Robert E. Rakel. Philadelphia: W. B. Saunders Co., 1998.

"Bursitis" In The Medical Advisor: The Complete Guide to Alternative and Medical Treatments. Richmond, VA: Time-Life Inc., 1997.

The Burton Goldberg Group. Alternative Medicine: The Definitive Guide. Fife, WA: Future Medicine Publishing, 1995.

Murray, Michael, and Joseph Pizzorno. Encyclopedia of Natural Medicine, revised 2nd ed., Rocklin, CA: Prima Health, 1998.

OTHER

Applied Medical Infomatics Inc., 1997. "Bursitis." http://www.healthanswers.com.

Mai Tran

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"Bursitis." Gale Encyclopedia of Alternative Medicine. . Retrieved August 22, 2017 from Encyclopedia.com: http://www.encyclopedia.com/medicine/encyclopedias-almanacs-transcripts-and-maps/bursitis-0

Bursitis

Bursitis

Definition

Bursitis is the painful inflammation of the bursa, a padlike sac found in areas subject to friction. Bursae cushion the movement between the bones, tendons and muscles near the joints. Bursitis is most often caused by repetitive movement and is known by several common names including weaver's bottom, clergyman's knee, and miner's elbow, depending on the affected individual's occupation and area of injury.

Description

There are over 150 bursae in the human body. Usually bursae are present from birth, but they may form in response to repeated pressure. Each sac contains a small amount of synovial fluid, a clear liquid that acts as a lubricant. Inflammation causes pain on movement. The most common site for bursitis to occur is the shoulder (subdeltoid), but it also is seen in the elbows (olecranon), hips (trochanteric), knees, heels (Achilles), and toes. The affected area may be referred to as "frozen," because movement is so limited. In the knee there are four bursae, and all can become inflamed with overuse.

Causes and symptoms

The most common cause of bursitis is repeated physical activity, but it can flare up for no known reason. It can also be caused by trauma, rheumatoid arthritis, gout, and acute or chronic infection.

Pain and tenderness are common symptoms. If the affected joint is close to the skin, as with the shoulder, knee, elbow, or Achilles tendon, swelling and redness are seen and the area may feel warm to the touch. The bursae around the hip joint are deeper, and swelling is not obvious. Movement may be limited and is painful. In the shoulder, it may be difficult to raise the arm out from the side of the body. Putting on a jacket or combing the hair becomes a troublesome activity.

In acute bursitis symptoms appear suddenly; with chronic bursitis, pain, tenderness, and limited movement reappear after exercise or strain.

Diagnosis

When a patient has pain in a joint, a careful physical examination is needed to determine what type of movement is affected and if there is any swelling present. Bursitis will not show up on x-rays, although sometimes there are also calcium deposits in the joint that can be seen. Inserting a thin needle into the affected bursa and removing (aspirating) some of the synovial fluid for examination can confirm the diagnosis. In most cases, the fluid will not be clear. It can be tested for the presence of microorganisms, which would indicate an infection, and crystals, which could indicate gout. In instances where the diagnosis is difficult, a local anesthetic (a drug that numbs the area) is injected into the painful spot. If the discomfort stops temporarily, then bursitis is probably the correct diagnosis.

Treatment

Conservative treatment of bursitis is usually effective. The application of heat, rest, and immobilization of the affected joint area is the first step. A sling can be used for a shoulder injury; a cane is helpful for hip problems. The patient can take nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofin, and naproxen. They can be obtained without a prescription and relieve the pain and inflammation. Once the pain decreases, exercises of the affected area can begin. If the nearby muscles have become weak because of the disease or prolonged immobility, then exercises to build strength and improve movement are best. A doctor or physical therapist can prescribe an effective regimen.

If the bursitis is related to an inflammatory condition like arthritis or gout, then management of that disease is needed to control the bursitis.

When bursitis does not respond to conservative treatment, an injection into the joint of a long-acting corticosteroid preparation, like prednisone, can bring immediate and lasting relief. A corticosteroid is a hormonal substance that is the most effective drug for reducing inflammation. The drug is mixed with a local anesthetic and works on the joint within five minutes. Usually one injection is all that is needed.

Surgery to remove the damaged bursa may be performed in extreme cases.

If the bursitis is caused by an infection, then additional treatment is needed. Septic bursitis is caused by the presence of a pus-forming organism, usually staphylococcus aureus. This is confirmed by examining a sample of the fluid in the bursa and requires treatment with antibiotics taken by mouth, injected into a muscle or into a vein (intravenously). The bursa will also need to be drained by needle two or three times over the first week of treatment. When a patient has such a serious infection, there may be underlying causes. There could be undiscovered diabetes, or an inefficient immune system caused by human immunodeficiency virus infection (HIV).

KEY TERMS

Arthritis Inflammation of a joint that may lead to changes in the joint's structure. It causes pain and swelling. Rheumatoid arthritis is a chronic disease that leads to crippling deformities.

Diabetes mellitus A metabolic disease caused by a deficiency of insulin, which is essential to process carbohydrates in the body.

Gout A hereditary metabolic disease that is a form of arthritis and causes inflammation of the joints. It is more common in men.

Inflammation The reaction of tissue to injury.

Kinesiology The science or study of movement.

Alternative treatment

Alternative treatments take into consideration the role of diet in causing bursitis. The faulty use of calcium by the body, magnesium deficiency, and food allergies may have a role. Diet changes and vitamin supplements may be helpful. The use of herbs, homeopathy, aromatherapy, and hydrotherapy can help relieve symptoms. Ginger is useful in reducing inflammation. Acupuncture has been proven effective in treating hip and shoulder pain caused by bursitis and other conditions. Other therapies that deal effectively with musculoskeletal problems (relating to the muscles and skeleton), may also be helpful, such as body work, magnetic field therapy, naturopathic medicine, chiropractic, and applied kinesiology.

Prognosis

Bursitis usually responds well to treatment, but it may develop into a chronic condition if the underlying cause is not corrected.

Prevention

Aggravating factors should be eliminated to prevent bursitis. Overexercising or the repetition of a movement that triggers the condition should be avoided. Doing exercises to strengthen the muscles around the joint will also help. When doing repetitive tasks, frequent breaks should be taken and the activity should be alternated with others using different parts of the body. To cushion the joints, it is a good idea to use cushioned chairs when sitting and foam kneeling pads for the knees. Leaning on the elbows, kneeling or sitting on a hard surface for a long period of time should be avoided. Not wearing high heels can help prevent bursitis in the heel, as can changing to new running shoes as soon as the old ones are worn out.

Resources

OTHER

"Bursitis." HealthAnswers.com. 1998. http://www.healthanswers.com.

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bursitis

bursitis (bərsī´təs), acute or chronic inflammation of a bursa, or fluid sac, located close to a joint. In response to irritation or injury the bursa may become inflamed, causing pain, restricting motion, and producing more fluid than can be absorbed readily. An attack of bursitis usually causes great pain and tenderness in the affected area. Common areas of involvement include the shoulder and big toe (see bunion). Depending on the cause and the degree of involvement, bursitis is treated with nonsteroidal anti-inflammatory drugs (NSAIDs), antibiotics, corticosteroids, and immobility until the pain subsides. Superficial bursas, not necessary to the function of a joint, or bursas that have become calcified, may be excised.

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"bursitis." The Columbia Encyclopedia, 6th ed.. . Encyclopedia.com. 22 Aug. 2017 <http://www.encyclopedia.com>.

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"bursitis." The Columbia Encyclopedia, 6th ed.. . Retrieved August 22, 2017 from Encyclopedia.com: http://www.encyclopedia.com/reference/encyclopedias-almanacs-transcripts-and-maps/bursitis

bursitis

bursitis Inflammation of the fluid-filled sac (bursa) surrounding a joint. It is characterized by pain, swelling and restricted movement. Treatment generally includes rest, heat and gentle exercise. ‘Housemaid's knee’, ‘tennis elbow’, and bunions are common forms of bursitis.

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"bursitis." World Encyclopedia. . Retrieved August 22, 2017 from Encyclopedia.com: http://www.encyclopedia.com/environment/encyclopedias-almanacs-transcripts-and-maps/bursitis

bursitis

bursitis (bursal synovitis) (ber-sy-tis) n. inflammation of a bursa, resulting from repetitive slight injury, pressure, friction, infection, or inflammatory conditions. It produces pain and sometimes restricts joint movement. See also housemaid's knee.

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"bursitis." A Dictionary of Nursing. . Retrieved August 22, 2017 from Encyclopedia.com: http://www.encyclopedia.com/caregiving/dictionaries-thesauruses-pictures-and-press-releases/bursitis

bursitis

bur·si·tis / bərˈsītis/ • n. Med. inflammation of a bursa, typically one in the knee, elbow or shoulder.

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"bursitis." The Oxford Pocket Dictionary of Current English. . Encyclopedia.com. 22 Aug. 2017 <http://www.encyclopedia.com>.

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"bursitis." The Oxford Pocket Dictionary of Current English. . Retrieved August 22, 2017 from Encyclopedia.com: http://www.encyclopedia.com/humanities/dictionaries-thesauruses-pictures-and-press-releases/bursitis