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 OCTOBER 2, 2002 Bursitis -- The Other Joint Pain Some people call any kind of shoulder pain "bursitis." However, true bursitis occurs only in the pillow-like sacs of fluid, called bursa, found throughout the body. These sacs vary tremendously from the size of a lemon pit to a large lemon. Bursas occur where a tendon has to turn a corner and go around a bone. They allow the tendon to slide freely without wearing itself out as it rubs against the bone. Overstressing these little sacs causes them to become inflamed. Once they swell up, they become extremely painful. Bursitis is different than tendinitis, although both can be very painful. Usually, you don't feel the pain of tendinitis unless you use the tender body part. With bursitis, the body part is painful whether you move it or not. Also, you feel the tenderness of tendinitis all along the length of the tendon, but you feel it in one specific spot with bursitis. The pain from bursitis is often similar to the pain caused by arthritis or tendinitis, particularly in the hip, elbow, shoulder, and knee, says Raymond Scheetz, MD, staff rheumatologist at the Cleveland Clinic. Bursitis pain is likely related to overuse of these particular joints from activity. At the hip, excessive climbing or hiking may cause bursitis pain. For the elbow, golf or tennis often lead to bursitis. For the shoulder, the pain may be from throwing sports, such as softball, bowling, swimming (freestyle, backstroke, butterfly), tennis (serving), and weight training (lifting overhead). Knee bursitis can be caused by running, swimming the breaststroke, climbing, and stepping. HIP BURSITIS What Happens. The bursa at the side of the hip is the most common site of inflammation. The bursa is tender when you press on it, and you may be unable to sleep on that side. What You Can Do. Use an anti-inflammatory drug such as ibuprofen, and do stretching exercises to increase your hip flexibility. You can stretch the iliotibial band, the fibrous band running down the outside of the thigh, with the following stretch: Lie flat on your back and bend your right leg and bring it across your body to the left side. Hold the right knee down with the left hand and lean your shoulders and head back to the right. Hold for 20 seconds, and then repeat on the other side. You should feel the stretch on the outside of your leg. What Your Doctor Can Do. If the pain doesn't improve, a cortisone injection into the inflamed bursa can provide relief. ELBOW BURSITIS What Happens. Bumping at the point of the elbow can bring on swelling in the bursa overlying the bone. Swelling due to fluid collection can reach golf-ball size. The swelling is usually painless except for the bump on the bone itself. What You Can Do. Swelling generally resolves after one week, but it can last for a month or more. In the meantime, avoid leaning on the elbow. What Your Doctor Can Do. Ordinarily the fluid doesn't need to be removed. If the swollen area becomes reddened, warm, or tender, see your doctor. There may be an infection that requires antibiotics and fluid drainage. SHOULDER BURSITIS What Happens. Overuse can inflame the major bursae of the side of the shoulder. The shoulder aches, and it hurts to press on the area above the bursae. Discomfort can worsen while resting after activity, and it can keep you up at night. When you raise your arm straight out at your side, the shoulder begins to hurt as the arm becomes horizontal and then again when it's overhead and nearly vertical. What You Can Do. Rest, ice, and nonprescription anti-inflammatory medications should provide relief. What Your Doctor Can Do. Prescription anti-inflammatory medications or cortisone injections into the inflamed area provide additional relief. KNEE BURSITIS What Happens. Overuse can irritate the bursa at the inside lower part of the knee. At the start of exercise, you may experience grating and knee stiffness that go away during activity, but may return at rest. What You Can Do. Ice and ibuprofen can help. Cut down or stop the activity causing the inflammation. Strengthening the thigh muscles, the quadriceps in the front of the thigh and the hamstrings in the back of the thigh, are an important part of treatment. Most often, knee bursitis responds to self-help, but if the pain persists, see a doctor. What Your Doctor Can Do. Cortisone injections or prescription anti-inflammatory medication and a professionally supervised rehabilitation program may be needed. |
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