Bursitis

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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.

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