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Bursae are thin sac-like structures located throughout the body whose function is to alleviate the pressure or friction between bones and adjacent soft tissue such as tendons, ligaments, muscles, and skin. There are more than 160 different bursae in the average person’s body; some bursae are just under the skin (as with the bursa in the elbow) and some are deep inside a joint (as with some of the bursae in the shoulder).
Synovial membrane tissue makes up the thin lining of the bursa and secretes a small amount of lubricating synovial fluid into the cavity of the “sac.” Healthy bursae are thin but may vary in overall size depending on the location in the body.
Uric acid crystals that build up in the joints of people suffering from gout can also cause irritation and inflammation of nearby bursae. Inflammation can occur in any of the bursae in the body, but the bursae of the shoulder, elbow, hip, and knee are most often affected.
Bursitis: Hip Issues
There are two main bursae in the hip: the greater trochanteric bursa and the iliopsoas bursa, but it is usually the bursa covering the bony point of the hip or greater trochanter that is the source of bursitis hip pain.
Hip bursitis tends to occur more often in women and in middle-aged or older people. Traumatic injury to the hip may cause the bursa to fill with blood and become inflamed causing hip pain. Repetitive stress from activities such as long-distance running or climbing can cause repetitive stress on hip bursae leading to inflammation and pain.
Bone spurs can occur in joints for a variety of reasons , including as a result of two bony surfaces rubbing against one another as in osteoarthritis when cartilage has degenerated. These bone spurs can then irritate and inflame the hip bursae, causing bursitis. Hip pain that results from bursitis is typically characterized by pain and tenderness over the point of the hip that sometimes can extend to the outer thigh. It is often sharp and intense in the early stages, but can become more of a constant ache over time. Lying on the affected hip may worsen the pain as can any increased pressure on the bony point of the hip.
Treatment for hip bursitis often includes rest and avoidance of activities that aggravate the bursa. Your doctor may recommend physical therapy to help strengthen the hip muscles and nonsteroidal anti-inflammatory drugs (NSAIDs) to help with pain control. Steroid injections into the bursa are sometimes administered. Antibiotics and medications to treat underlying disease are indicated in the case of infectious bursitis or inflammatory disease bursitis. Surgical removal of the bursa is rarely performed for hip bursitis but is occasionally performed in certain cases of chronic hip bursitis that do not respond to other measures.
Bursitis: Elbow Issues
The olecranon bursa lies between the skin and the olecranon, the bony protrusion at the proximal end of the ulna bone that forms the so-called “point” of the elbow when you bend your arm 90 degrees. Because of its proximity to the body surface, the olecranon bursa is particularly prone to injury from trauma or prolonged pressure. A forceful blow to the tip of the elbow and/or prolonged or repetitive pressure to the tip of the elbow can irritate and inflame the bursa, causing significant elbow pain. Infection of the bursa from a puncture wound or other break in the skin around the elbow or from bacteria in the blood can cause infectious bursitis.
Systemic diseases such as rheumatoid arthritis and gout can also result in inflammation of the bursa. Symptoms typically begin with swelling followed by increasing pain and tenderness, particularly with bending of the elbow. Infectious bursitis or bursitis associated with an inflammatory arthritis may cause redness or warmth over the elbow as well.
Treatment is usually non-surgical and consists of pain control medications, elbow pads to protect the bursa, avoidance of activities that aggravate the bursa, antibiotics if it is infectious in origin, or treatment of the underlying disease. Rarely, surgical drainage or removal of the bursa may be indicated if these more conservative treatments are not successful.
Bursitis: Knee Pain
While there are 11 bursae in the knee joint, knee bursitis most often occurs in the prepatellar bursa (between the skin and patella or knee cap) and in the superficial infrapatellar bursa, which lies just below the knee joint between the skin and tibial tubercle (the bony prominence just below the knee cap).
A traumatic direct blow to the knee cap, pressure from prolonged kneeling, infection, and inflammatory disease can all result in knee bursitis. Symptoms include swelling and tenderness of the front of the knee, which is typically gradual in onset unless precipitated by a traumatic injury. Pain with activity or with pressure to the knee, along with limited flexibility of the knee, are common. Infectious and inflammatory knee bursitis may be accompanied by redness and warmth.
Treatment involves rest, ice, NSAIDs, and activity modification. For injury-related knee bursitis that doesn’t respond to these therapies, steroid injection into the bursa may be indicated. In some instances, such as with infectious bursitis that does not respond to antibiotics, an orthopedist may drain the bursa. Surgical removal of the bursa is usually a last resort.
Bursitis: Shoulder Symptoms
The main bursae of the shoulder are the subacromial bursa, the subdeltoid bursa, and the subcoracoid bursa; however, the vast majority of cases of shoulder bursitis occur in the subacromial bursa, located between the tendons of the rotator cuff muscles and the acromion, a bony extension on the front of the shoulder blade or scapula.
Subacromial bursitis most often occurs as the bursa gets irritated between the rotator cuff tendons and bone from shoulder overuse injuries. Rotator cuff tendonitis is commonly associated with shoulder bursitis. Symptoms of shoulder bursitis include a gradual onset of pain on the outside of your shoulder that worsens when raising your arm above your head or lying on the affected shoulder. In some instances the rotator cuff tendon and subacromial bursa can become impinged by the acromion, causing muscle weakness in addition to the more common bursitis symptoms of pain and tenderness.
Treatment of shoulder bursitis almost always involves anti-inflammatory medications such as non-steroidal anti-inflammatory drugs (NSAIDs) and physical therapy. In some cases, you may need surgical repair of the rotator cuff or surgical removal of the bursa, particularly in cases of chronic bursitis, in which calcifications form in the bursal sac. If the bursitis is secondary to an underlying disease such as rheumatoid arthritis or gout, treatment also includes therapy for the causative disease.
Originally published in May 2016 and updated.