Bursitis Treatment

Irritation or inflammation of a bursa can develop due to one or more combined causes. Different forms are distinguished according to the causes.

• Acute injury or overloading of the bursa, e.g. from a fall, blow (acute, aseptic bursitis).
• Chronic overload due to frequent, strong pressure or friction on the bursa, e.g. by kneeling or resting on your elbows (chronic, aseptic bursitis).
• Infection, e.g. by bacteria that get into the bursa via small, superficial skin injuries (septic bursitis).
• Inflammatory diseases, e.g. Rheumatoid arthritis, gout.

Typical signs of bursitis are:

• Swelling due to an increased accumulation of fluid in the bursa,
• pain, especially when pressure is applied to the bursa or when the joint moves,
• restrictions on the mobility of the joint,
• reddening of the skin, noticeable warmth in the area of the bursa,
• fever and rapid inflammation can also be signs of an infection of the bursa.

Irritation of the bursa is often only shown by pressure pain, without other typical signs of inflammation. The symptoms also depend on the location of the bursa.

Bursitis can occur in different areas of the body. Examples are:

Bursitis shoulder

If the bursa is inflamed at the shoulder corner joint (subacromial bursitis), pain in the shoulder can occur, which also radiates into the upper arm and is particularly pronounced. reinforce when lifting the arm. The complaints can also have other causes, e.g. tendinitis or other injuries to the shoulder joint. In sports where the shoulder joints are under a lot of stress, the risk of shoulder bursitis is increased. These include e.g. Badminton, basketball, swimming or volleyball.

Elbow bursitis

The bursa on the elbow is usually significantly swollen in inflammation (bursitis olecrani). Pain occurs when you bend your elbow, but not when you stretch. Bursitis on the elbow can arise from repeated support, but can also have other causes, e.g. Injury, infection of the bursa or other inflammatory disease.

Bursitis knee

One bursa of the knee is in front of the patella, another under the patella tendon. Inflammation of these bursae (prepatellar bursitis, infrapatellar bursitis) can result from repeated kneeling. Pain is typical in the area of the two bursae, which subside with the knee straight. The bursa under the inner ligament of the knee (medial collateral ligament) can also be affected by painful inflammation, e.g. due to an overload during sport (e.g. running). Possible other causes of the pain are e.g. Knee ligament injury, meniscus injury, infection of the bursa, etc.

Hip bursitis

A large bursa is located between the hamstring muscle (lat. Muculus iliopsoas) and the hip bone. Inflammation of this bursa (iliopectinic bursitis) can cause pain in the groin area during certain movements, e.g. when climbing stairs. Sometimes a painful snap can be felt in the groin. One possible cause is overwork due to sports, e.g. long running.

Bursitis heel

Inflammation of the bursa between the heel bone and the attachment of the Achilles tendon (retrocalcaneal bursitis) causes swelling in the heel and pain when walking or touching. The inflammation can be caused by a single or repeated overload, e.g. through long running, walking, dancing or jumping. Another common cause of heel pain is inflammation of the Achilles tendon.

The doctor collects the medical history, asks about symptoms and examines the affected part of the body. Ev. movement tests are carried out. Imaging examinations, e.g. X-rays, ultrasound or MRI are used to clarify a possible injury to the joint or a capsule-ligament injury. Inflammation can be determined by taking a blood sample and taking a laboratory test. In order to check whether there is bacterial inflammation or gout arthrosis, the doctor can remove liquid from the bursa using a sterile puncture.

Treatment is based on the cause of the inflammation and location of the bursa.

For the initial treatment of bursitis, the so-called PECH rule (break, ice, compression, high camp) is helpful, which is mainly used for sports injuries. The measures can also be carried out by laypersons.

Treatment without surgery

In most cases, bursitis is treated conservatively (without surgery). The measures include:

• Immobilization (pause): It is important to immobilize and protect the affected bursa or joint so that the inflammation can subside. The bursa should be protected against stress (sports break), pressure or bumps. The doctor explains to the patient which measures and means are helpful, e.g. Avoid certain movements or overloads, use cushioning insoles in shoes, adapt work equipment, etc.
• Cooling (ice): Repeated cooling can alleviate the pain, especially in the case of superficial inflammation of the gin, e.g. on the elbow, outer knee or heel. Coolpacks or ice should always be wrapped in a cloth and must never be placed directly on the skin to avoid skin damage.
• Heat may be helpful in the case of deeper inflammation, e.g. Hip, inner knee or shoulder. The doctor can inform the patient about the exact application of the cold or heat treatment.
• Compression: A compression bandage with an elastic bandage can prevent further swelling and also immobilizes the joint.
• Lag Elevation: If a knee or foot is affected, repeated elevation can help reduce swelling.
• Medications: The doctor prescribes anti-inflammatory drugs for pain treatment, usually so-called non-steroidal anti-inflammatory drugs (NSAIDs). A bacterial infection of a bursa (septic bursitis) is treated with antibiotics.
• Glucocorticoid injection: With certain aseptic inflammation of the goblet, especially If other conservative therapies do not improve, the doctor can suggest the injection of a long-acting glucocorticoid (cortisone), possibly in combination with a pain reliever. The agents have anti-inflammatory and analgesic effects. The injection is usually used for inflammation of the deeper lying bursae of the shoulder, hip or knee. For superficial forms, the injection of glucocorticoids is usually not helpful, e.g. in bursitis olecrani on the elbow, bursitis retrocalcanea on the heel or bursitis prepatellar on the knee.
• Puncture: In the case of severely swollen, painful bursae, the doctor may suggest puncturing the bursa. The doctor removes liquid from the bursa using a hollow needle to reduce the swelling. Most of the time, however, the liquid forms again. If there is a puncture, there is a risk that bacteria will get into the bursa. A puncture can also be used to clarify a possible existing infection.

Treatment with surgery

Surgery may be necessary in rare cases. Indications include chronic, aseptic inflammation of the goblet or serious infections that, despite treatment, do not subside even after several weeks. The bursa is removed surgically (bursectomy).