Bursitis

Bursitis is an inflammation of a bursa a small structure inside every joint that helps to lubricate and cushion it. Usually bursitis occurs in the larger joints such as the shoulder hip knee or elbow. It can happen once or can recur over time. Without seeing your health care provider you usually can't easily tell the difference between bursitis and pain caused by a strain or arthritis.

Signs and Symptoms

• Pain in the joint that gets worse when you move the joint (the pain may come all at once or develop gradually over time)
• Swelling
• Redness
• Fever and warm joint area (if an infection is present)

What Causes It?

Typically the bursa becomes irritated or injured when the area is overused with repetitive motion or strenuous activity. It may also be caused by a bacterial infection. Certain other medical conditions such as gout or rheumatoid arthritis can also cause bursitis.

What to Expect at Your Provider's Office

Your health care provider will ask you to identify exactly where the joint hurts and feel the joint for swelling or particular areas of tenderness. Your health care provider may remove some fluid from the bursa with a small needle to check for signs of infection. You may also be given a blood test to check for other medical conditions.

Treatment Options

Treatment Plan

Sometimes simply resting and elevating the joint is the only treatment needed to let the joint heal. A splint or sling can support the joint and keep it from moving. Applying heat or cold can reduce pain and swelling. For more severe bursitis your health care provider may prescribe ultrasound therapy or drugs that can further reduce swelling and pain. In rare instances the bursa is surgically removed.

Drug Therapies

Prescription

• Corticosteroids—injections into the bursa or taken orally help to reduce inflammation; side effects include blurred vision frequent urination and increased thirst; may be given with a local anesthetic to reduce pain
• Acetaminophen ibuprofen—prescription strength to reduce pain; side effects include nausea gastrointestinal bleeding and kidney damage
• Antibiotics—for bursitis that is infected

Over the Counter

• Aspirin acetaminophen and ibuprofen—reduce pain; side effects may include nausea vomiting gastrointestinal bleeding and kidney damage

Complementary and Alternative Therapies

Alternative therapies may be useful in reducing the pain and inflammation of bursitis while supporting healthy connective tissue.

Nutrition

Include in your diet anti-inflammatory oils such as those found in cold-water fish nuts and seeds. The following supplements may help.

• Glucosamine sulfate (500 mg two or three times a day) for connective tissue support
• Omega-3 oils (1 000 mg two or three times a day) such as flaxseed oil as an anti-inflammatory agent
• Vitamin C with bioflavonoids (1 000 mg three times a day) for connective tissue repair
• Proteolytic enzymes such as bromelain (250 mg twice a day) to reduce inflammation
• Bioflavonoids and oral digestive enzymes for inflammation

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy it is important to work with your provider on getting your problem diagnosed before you start any treatment. Herbs may be used as dried extracts (capsules powders teas) glycerites (glycerine extracts) or tinctures (alcohol extracts). Unless otherwise indicated teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers and 10 to 20 minutes for roots. Drink 2 to 4 cups per day. Tinctures may be used alone or in combination as noted.

• Herbs that reduce swelling include meadowsweet (Filipendula ulmaria) white willow (Salix alba) Jamaican dogwood (Piscidia erythrina) and turmeric (Curcuma longa). A tincture of one or a combination of these may be taken at 15 drops every 15 minutes up to four doses for acute pain relief or 30 drops four times per day for general pain relief. Turmeric increases the effects of bromelain.
• For bursitis with muscle spasm add valerian (Valeriana officinalis).
• For chronic bursitis add hawthorn (Crataegus oxyanthoides).

Homeopathy

Some of the most common remedies are listed below. Usually the dose is 12X to 30C every one to four hours.

• Arnica gel applied topically (to the skin) as directed gives excellent short-term pain relief.
• Arnica for bursitis occuring after an injury to the joint
• Ruta graveolons for rheumatic pains in the joint
• Bellis perennis for injury with a great deal of bruising
• Rhus-toxicodendron for pain that gets better with movement
• "Traumeel" injections as an alternative to corticosteroids

Acupuncture

Acupuncture can be helpful in reducing swelling and inflammation and especially in relieving pain.

Massage

You should not use massage if your bursitis is caused by an infection. Otherwise massage (especially myofascial release therapy) can be used for general relaxation and to reduce discomfort from inflammation and from compensating for a sore joint.

Following Up

Tell your health care provider if your symptoms are not relieved by your treatment. Be sure to follow your provider's instructions for resting the joint to allow the swelling to subside before returning to your usual routines. You can help prevent bursitis from recurring by avoiding repetitive motions resting between periods of intense activity and doing stretching exercises before starting an activity.

Special Considerations

Do not take aspirin acetaminophen or ibuprofen for more than a few days unless so directed by your provider. Be sure to tell your health care provider if you are pregnant.

Supporting Research

Andreoli TE Bennett JC Carpenter CCJ. Cecil Essentials of Medicine. 3rd ed. Philadelphia Pa: W.B. Saunders; 1993.

Barker LR Burton JR Zieve PD eds. Principles of Ambulatory Medicine. 4th ed. Baltimore Md: Williams & Wilkins; 1995:885–894.

Dambro MR ed. Griffith's 5 Minute Clinical Consult 1999. Baltimore Md: Lippincott Williams & Wilkins; 1999.

Murray MT. The Healing Power of Herbs: The Enlightened Person's Guide to the Wonders of Medicinal Plants. Rocklin Calif: Prima Publishing; 1998.

Stein JH ed. Internal Medicine. 4th ed. St. Louis Mo: Mosby-Year Book;

1994:2400–2404.

Copyright © 2000 Integrative Medicine Communications

The publisher does not accept any responsibility for the accuracy of the information or the consequences arising from the application use or misuse of any of the information contained herein including any injury and/or damage to any person or property as a matter of product liability negligence or otherwise. No warranty expressed or implied is made in regard to the contents of this material. No claims or endorsements are made for any drugs or compounds currently marketed or in investigative use. This material is not intended as a guide to self-medication. The reader is advised to discuss the information provided here with a doctor pharmacist nurse or other authorized healthcare practitioner and to check product information (including package inserts) regarding dosage precautions warnings interactions and contraindications before administering any drug herb or supplement discussed herein.