Acute and Chronic Bursitis (cont.)
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
In this Article
- Bursitis Overview
- Bursitis Causes
- Bursitis Symptoms and Signs
- When to Seek Medical Care
- Bursitis Diagnosis
- Bursitis Treatment
- Self-Care at Home
- Medical Treatment
- Bursitis Prevention
- Bursitis Prognosis
- Bursitis Pictures
- Authors and Editors
- Pictures of Gout - Slideshow
- Find a local Rheumatologist in your town
Bursitis Symptoms and Signs
Bursitis causes pain and tenderness around the affected bone or tendon. The bursae sacs may swell, often making movement difficult. The most commonly affected joints are the shoulder, elbow, knee, and foot.
In the shoulder, the subacromial bursa (subdeltoid bursa) separates the supraspinatus tendon from the overlying bone and deltoid muscle. Inflammation of this bursa is usually a result of injury to surrounding structures, most commonly the rotator cuff. This limits the range of motion of the shoulder resulting in an "impingement syndrome." The condition causes pain in the side or front of the shoulder.
- Overhead lifting or reaching activities are uncomfortable.
- Pain is often worse at night.
- The shoulder will usually have decreased range of active motion and be tender at specific spots.
Bursitis of the tip of the elbow, olecranon bursitis, is the most common form of bursitis.
- The pain may increase if the elbow is bent because tension increases over the bursa.
- This bursa is frequently exposed to direct trauma (bumping your arm) or repeated motions from bending and extending the elbow (while painting, for example).
- Infection is common in this bursa.
- Bursitis in front of the kneecap (prepatellar): Swelling on the front of the kneecap can be caused by chronic trauma (as from kneeling) or an acute blow to the knee. Swelling may occur as late as seven to 10 days after a single blow to the area, usually from a fall. Prepatellar bursitis has also been called carpet-layer's knee, housemaid's knee, and clergyman's knee.
- Anserine bursitis: The anserine bursa is fan shaped and lies among three of the major tendons at the inner knee.
- This type of bursitis is most often seen in people with arthritis, especially overweight middle-aged women with osteoarthritis.
- The pain of anserine bursitis is typically produced when the knee is bent and is particularly troublesome at night. People often seek comfort in bed by sleeping with a pillow between their thighs.
- The pain can radiate to the inner thigh and mid-calf and usually increases on climbing stairs and at extremes of bending and extending.
- Anserine bursitis also occurs as an overuse or traumatic injury among athletes, particularly long-distance runners.
Retrocalcaneal bursitis occurs when the bursa under the Achilles tendon at the back of the heel becomes inflamed. This is commonly caused by local trauma associated with wearing a poorly designed shoe (often high heels) or prolonged walking. It can also occur with Achilles tendonitis.
Bursitis in this part of the body often occurs as an overuse injury in young athletes, ice skaters, and female adolescents transitioning to higher heels. The pain is usually on the back of the heel and increases with passive extension or resisted flexion.
Ischiogluteal bursitis causes inflammation of the ischial bursa, which lies between the bottom of the pelvic bone and the overlying gluteus maximus muscle (one side of the buttocks). Inflammation can come from sitting for a long time on a hard surface or from bicycling. Ischiogluteal bursitis has also been called weaver's bottom.
- The pain occurs when sitting and walking.
- There will be tenderness over the pubic bone, which may be made worse by bending and extending the leg.
- The pain may radiate down the back of the thigh.
- Direct pressure over the area causes sharp pain.
- The person may hold the painful buttock elevated when sitting.
- The pain is worse when person is lying down and the hip is passively bent.
- The person may have difficulty standing on tiptoe on the affected side.
The iliopsoas bursa is the largest in the body and lies in front of, and deep to, the hip joint. Bursitis here is usually associated with hip problems such as arthritis or injury (especially from running).
- The pain of iliopsoas bursitis radiates down the front and middle areas of the thigh to the knee and is increased when the hip is extended and rotated.
- Extension of the hip during walking causes pain so the person may limit the stride on the affected side and take a shorter step.
- There may be tenderness in the groin area.
- Sometimes a mass may be felt resembling a hernia. The person may also feel numbness or tingling if adjacent nerves are compressed by the inflamed bursa.
The trochanteric bursa, at the outer thigh over the hip, can become inflamed to cause trochanteric bursitis. Trochanteric bursitis occurs most frequently in overweight, middle-aged women.
- Trochanteric bursitis causes deep, aching hip pain along the side of the hip that may extend into the buttocks or to the side of the knee.
- Pain is aggravated by activity, local pressure, or stretching.
- Pain is often worse at night and can make it difficult to sleep on the involved side.
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