Bursitis (Inflammation of a bursa)

Also known as: Bursa inflammation, Inflamed bursa, Bursal inflammation, Joint bursa irritation, Swollen bursa

Last updated: December 18, 2024

Bursitis is inflammation of a bursa, a small fluid-filled sac that reduces friction between skin, tendons, muscles, and bone. Inflammation can increase bursal fluid and thicken its lining, leading to localized pain, tenderness, swelling or a lump, and reduced motion in nearby joints. It may be acute or chronic and can affect areas like the shoulder, elbow, hip, or knee.

Key Facts

•Bursitis describe inflammation of a bursa, a small synovial-lined, fluid-filled sac that reduce friction between skin, tendons, muscles, and bone
•Localized pain that worsens with activity and occurs at rest, near a prominent bony area
•Diagnosed through history, physical exam, and imaging
•First-line treatment includes exercise, weight management, and activity modification

What It Is

Bursitis may describe inflammation of a bursa, a small synovial-lined, fluid-filled sac that can reduce friction between skin, tendons, muscles, and bone. Inflammation can increase bursal fluid and thicken the bursal lining, which may contribute to localized pain, swelling, and reduced motion in nearby joints. Bursitis can be acute or chronic and may occur from repetitive mechanical irritation, direct trauma, crystal deposition, or infection. Commonly affected regions can include the shoulder (subacromial), elbow (olecranon), hip (trochanteric), and knee (prepatellar) bursae.

Affected Anatomy

This condition affects several structures in and around the joint:

•Subacromial-subdeltoid bursa adjacent to the supraspinatus tendon and acromion
•Olecranon bursa overlying the olecranon process of the ulna
•Greater trochanteric bursa adjacent to the gluteus medius/minimus tendons at the lateral hip
•Prepatellar bursa anterior to the patella and patellar tendon complex
•Pes anserine bursa between the conjoined tendons (sartorius, gracilis, semitendinosus) and the medial proximal tibia
•Retrocalcaneal bursa between the Achilles tendon and the posterosuperior calcaneus
•Iliopsoas (iliopectineal) bursa anterior to the hip joint capsule near the iliopsoas tendon
•Ischial bursa overlying the ischial tuberosity near the hamstring origin

Common Symptoms

Symptoms can vary in intensity and may change over time. Common experiences include:

•Localized pain that may worsen with activity and can occur at rest, often near a prominent bony area
•Tenderness to palpation over the involved bursa, which may be focal and reproducible
•Swelling or a visible/fluctuant lump, particularly with superficial bursae such as olecranon or prepatellar
•Reduced range of motion or pain-limited motion, which can reflect adjacent tendon irritation or guarding
•Warmth and erythema over the area, which may occur with inflammation and can raise concern for infectious bursitis
•Pain with specific movements or positions that increases friction or compression (e.g., overhead use for subacromial bursitis, kneeling for prepatellar bursitis)
•Night discomfort or difficulty lying on the affected side, often described with lateral hip (trochanteric) bursitis
•Systemic symptoms such as fever or malaise may occur when bursitis is infectious, although presentation can vary

Causes and Risk Factors

Multiple factors can contribute to the development of this condition:

Causes

•Repetitive microtrauma or overuse that can increase friction between tendons/soft tissues and bone, leading to bursal irritation and fluid accumulation
•Direct trauma or prolonged pressure (e.g., kneeling, leaning on elbows) that may inflame superficial bursae and contribute to swelling
•Infection (septic bursitis), often involving superficial bursae, which can occur after skin breaks, local cellulitis, or hematogenous spread
•Crystal deposition disease (gout or calcium pyrophosphate deposition) that can trigger acute inflammatory bursitis
•Inflammatory arthritides (e.g., rheumatoid arthritis) that may involve periarticular structures including bursae
•Biomechanical contributors such as tendon pathology, altered gait mechanics, or joint degeneration that can increase local friction and predispose to recurrent bursitis

Risk Factors

•Occupational or recreational activities involving repetitive motion or sustained pressure (e.g., kneeling, overhead work, leaning on elbows)
•Older age, which can be associated with tendon degeneration and altered tissue resilience around joints
•Prior joint or soft-tissue injury that can change mechanics and increases local friction near a bursa
•Diabetes mellitus or other conditions associated with impaired immune response, which may increase susceptibility to infection in superficial bursae
•Skin breaks, abrasions, or chronic skin conditions near superficial bursae that can facilitate bacterial entry and septic bursitis
•Crystal arthropathies (gout or calcium pyrophosphate deposition), which can precipitate acute inflammatory episodes
•Inflammatory arthritis (e.g., rheumatoid arthritis), which can be associated with periarticular inflammation including bursae
•Obesity or altered lower-limb biomechanics, which can increase compressive and frictional forces around hip and knee bursae

How It's Diagnosed

Diagnosis typically involves a combination of clinical assessment and imaging studies:

•Clinical history focusing on activity patterns, occupational exposures, recent trauma, systemic symptoms, and prior episodes, which can help distinguish overuse, inflammatory, and infectious patterns
•Physical examination including inspection for swelling/erythema, palpation for focal tenderness and fluctuance, range-of-motion assessment, strength testing, and region-specific provocative maneuvers
•Ultrasound imaging, which can identify bursal fluid, synovial thickening, hyperemia on Doppler, and can help differentiate bursitis from tendon tears or soft-tissue masses
•Plain radiography (X-ray), which can evaluate for calcifications, bone spurs, degenerative joint changes, or alternative diagnoses, even when the bursa itself may not be directly visualized
•Magnetic resonance imaging (MRI), which can characterize deep bursae, adjacent tendon pathology, and soft-tissue edema when diagnosis is uncertain or symptoms persist
•Bursal aspiration (when clinically indicated), which can allow fluid analysis for cell count, Gram stain/culture, and crystal analysis to evaluate for septic bursitis or crystal-induced inflammation
•Laboratory testing (when clinically indicated), such as inflammatory markers or blood counts, which can support evaluation for infection or systemic inflammatory disease in the appropriate context

Treatment Options

Treatment approaches range from conservative measures to surgical interventions, often starting with the least invasive options:

Self-Care and Activity Modification

•Activity modification and relative rest, which may reduce repetitive friction or pressure on the involved bursa and allow inflammation to subside
•Protective padding, ergonomic adjustments, or offloading strategies (e.g., knee pads for kneeling, elbow padding), which can reduce recurrent compression of superficial bursae
•Antibiotic therapy for suspected or confirmed septic bursitis, which can be guided by clinical severity and culture results when available

Physical Therapy and Exercise

•Cold or heat modalities, which can be used symptomatically depending on timing and individual response, and may help with pain and swelling
•Physical therapy approaches, which can include stretching, strengthening, posture or gait retraining, and correction of biomechanical contributors that may perpetuate symptoms

Medications

•Nonsteroidal anti-inflammatory drugs (NSAIDs) or other analgesics, which may reduce pain and inflammation when appropriate for an individual’s health profile

Injections and Office-Based Procedures

•Aspiration of bursal fluid in selected cases, which can relieve pressure and can support diagnostic evaluation for infection or crystals
•Corticosteroid injection into or around the bursa in selected noninfectious cases, which may reduce inflammation and pain and is often paired with rehabilitation strategies

Surgery

•Surgical management (e.g., bursectomy or drainage) in selected cases such as recurrent, refractory, or complicated bursitis, including some cases of septic bursitis not responding to other measures

Prognosis and Recovery

The course of this condition varies between individuals:

•Symptoms may improve over days to weeks with reduction of provoking factors and targeted conservative care, particularly for noninfectious overuse-related bursitis
•Recurrence can occur when repetitive pressure, biomechanical contributors, or occupational exposures persist, and chronic bursitis may involve thickened bursal walls and intermittent flares
•Septic bursitis can require more intensive evaluation and longer treatment spans, and outcomes may depend on timeliness of diagnosis, organism factors, and host comorbidities
•Crystal-associated bursitis can present with abrupt, painful flares and may recur in association with underlying metabolic risk factors
•Deep bursae (e.g., iliopsoas) can be more challenging to diagnose clinically, and symptom duration may be longer when concurrent tendon or joint pathology is present
•Functional recovery often depends on addressing contributing mechanics and adjacent tendon involvement, which can coexist with bursitis in regions such as the shoulder and lateral hip

Corticosteroid Injection (Joint Injection)(Procedure)
Physical Therapy (Physiotherapy)(Procedure)
Hip Bursitis (Trochanteric Bursitis)(Condition)

Frequently Asked Questions

Common symptoms include: Localized pain that may worsen with activity and can occur at rest, often near a prominent bony area; Tenderness to palpation over the involved bursa, which may be focal and reproducible; Swelling or a visible/fluctuant lump, particularly with superficial bursae such as olecranon or prepatellar; Reduced range of motion or pain-limited motion, which can reflect adjacent tendon irritation or guarding; Warmth and erythema over the area, which may occur with inflammation and can raise concern for infectious bursitis.

Diagnosis typically involves: Clinical history focusing on activity patterns, occupational exposures, recent trauma, systemic symptoms, and prior episodes, which can help distinguish overuse, inflammatory, and infectious patterns; Physical examination including inspection for swelling/erythema, palpation for focal tenderness and fluctuance, range-of-motion assessment, strength testing, and region-specific provocative maneuvers; Ultrasound imaging, which can identify bursal fluid, synovial thickening, hyperemia on Doppler, and can help differentiate bursitis from tendon tears or soft-tissue masses; Plain radiography (X-ray), which can evaluate for calcifications, bone spurs, degenerative joint changes, or alternative diagnoses, even when the bursa itself may not be directly visualized.

Treatment options range from conservative measures to surgical interventions, including: Activity modification and relative rest, which may reduce repetitive friction or pressure on the involved bursa and allow inflammation to subside; Cold or heat modalities, which can be used symptomatically depending on timing and individual response, and may help with pain and swelling; Nonsteroidal anti-inflammatory drugs (NSAIDs) or other analgesics, which may reduce pain and inflammation when appropriate for an individual’s health profile; Physical therapy approaches, which can include stretching, strengthening, posture or gait retraining, and correction of biomechanical contributors that may perpetuate symptoms; Protective padding, ergonomic adjustments, or offloading strategies (e.g., knee pads for kneeling, elbow padding), which can reduce recurrent compression of superficial bursae.