Bursitis Basics

If you have pain on the outside part of your hip that radiates to your buttock, groin or lower back, you may think that you have a herniated disc or sciatica. But a more likely culprit is bursitis. Bursitis refers to inflammation (“itis”) of a bursa—a “deflated” sac containing a small amount of lubricating fluid that normally allows muscles and tendons to move painlessly and smoothly over bones. There are about 150 such sacs located throughout the body, ranging in diameter from pea- to lemon-sized.

Normally, bursae (the plural of bursa) cause no problems and you are not even aware of them. But if one becomes inflamed, the result is dull, persistent pain at rest, which may worsen with activity. There may also be redness and tenderness over the bursa, reduced range of motion in the joint and swelling. If there is an infection in the bursa, you may have a fever. Besides the hip, bursitis most commonly strikes the elbow (sometimes called “student’s elbow” or “miner’s elbow”), knee, shoulder and heel.

What’s behind bursitis

Bursitis can result from some sort of trauma or overuse, as during exercise or sports. And it can be acute or chronic. For instance, you can develop bursitis if you bang your elbow, due to bleeding in the bursa and the release of chemicals that spur inflammation, or if you lean on your elbow or knee too much. Or you may develop bursitis in the shoulder, say, if you frequently engage in sports that involve overhead arm motion, such as tennis or swimming. Bursitis can also occur in some medical conditions such as arthritis, lupus or gout. Sometimes it occurs for unknown reasons.

Bursitis in the hip can make it painful to walk (especially uphill), climb stairs and get up from a chair. Runners may get bursitis in the back of the foot between the Achilles tendon and the heel bone, which causes heel and ankle pain. You can even get bursitis in the toe from having a bunion.

Bursitis—or something else?

It’s often hard to distinguish bursitis from other conditions. For example, bursitis in the shoulder may have symptoms similar to tendinitis in the rotator cuff (such as difficulty lying on that side and problems reaching overhead). And Achilles bursitis may be mistaken for Achilles tendinitis. Moreover, bursitis may occur along with those other conditions—that is, you may have both bursitis and tendinitis. Your doctor can do a physical exam to help determine the correct diagnosis (or diagnoses). To rule out other conditions, you may need X-rays or an MRI. Sometimes, a doctor will test the fluid in a bursa to see if an infection is present.

Self-help and beyond

Depending on the type and cause of bursitis, treatment can involve icing; resting the body part that hurts; over-the-counter pain relievers; compression (with an ACE bandage, for example); modifying the activities that set off pain; wearing an orthotic in your shoe and exercise or physical therapy. If there’s an infection, you will likely need antibiotics.

In some cases, you may receive corticosteroid injections , though they carry a small risk of infection, and repeated use of steroids can cause skin atrophy and other long-term problems. The injections are often mixed with a local anesthetic such as lidocaine to provide pain relief until the corticosteroid has time to work.

As another possible treatment, researchers are testing Type B botulinum toxin injections (as opposed to Type A, used in cosmetic Botox injections). In a small study from South Korea, published in the Clinical Journal of Pain in 2011, people with shoulder bursitis were given botulinum toxin or corticosteroid injections; three months later, the botulinum group reported greater reduction in pain and disability.

Depending on the location of the bursa and other factors, your doctor may drain the fluid that accumulates in it to relieve pain and swelling—though, as with injections, this very slightly increases the risk of infection. A last resort is surgery, called bursectomy, to remove the bursa.

Keep Bursitis at Bay

  • Don’t overdo it. Sudden bouts of heavy housework or yard work or other activity can bring on bursitis. Pay attention to pain. If you hurt, stop the activity.
  • Make sure your techniques and posture are correct when you exercise, play a sport or musical instrument, or work. If you play golf or tennis, get professional advice on how to avoid shoulder strain. If you have to lean on your elbows to work at your desk, get a better chair or rearrange your workspace. If you have to kneel to do housework or yard work, use a cushion or knee pads and change position often.
  • Protect your feet, knees and elbows. High-heeled, worn-out or ill-fitting shoes can damage your hip and knee tendons and bursae; they can also cause bunions, which can lead to bursitis. Buy shoes that fit; keep them in good repair. Never wear shoes that hurt; save high heels for special occasions. Wear elbow and knee pads if your work or sport puts these joints at risk.

What not to do: Avoid massage—it can make bursitis worse. Don’t count on liniments and balms: they merely act as counterirritants—that is, they make the skin tingle and distract you from pain—and won’t reduce inflammation.

Bottom line: If you have swelling and/or pain in or near a joint, see your doctor, especially if the symptoms are severe or do not go away after two to three weeks. It may take up to several months for symptoms to resolve on their own, but self-care steps and medical treatment can speed the process.

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