As warm weather arrives and the great outdoors beckons, more and more men and women will be taking to the trails, the beaches, or their yards and gardens, embarking on physical activities that may result in sore, aching, swollen joints. While it may be tempting to ignore these aches and pains or treat them with a little over-the-counter liniment, a wiser choice is to visit a physician who can determine if the symptoms are due to bursitis, inflammation of the fluid-filled bursae, or sacs, that surround and cushion the joints.
Bursitis occurs when the bursae become irritated or infected, often causing pain on movement. When infection is involved, medical intervention is necessary to fight the underlying infection and prevent it from spreading; when infection is not involved, prompt medical attention can prevent the condition from becoming worse over time.
Four of the most common types of bursitis, affecting the hips (trochanteric bursitis), knees (prepatellar bursitis), elbows (olecranon bursitis) and heels (retrocalcaneal bursitis), are examined in a new review article published in the Journal of the American Academy of Orthopaedic Surgeons (JAAOS).
"Bursitis is a common cause of musculoskeletal pain and often prompts orthopaedic consultation," said study author Daniel Aaron, MD, a clinical instructor in the department of orthopaedics at Brown University in Providence, R.I. "One of the challenges facing clinicians is to differentiate bursitis from conditions with similar symptoms, including arthritis, tendinitis, fracture, tendon or ligament injury and tumor. Additionally, bursitis arises from infectious and noninfectious causes, and distinguishing between the two can be challenging.
"A thorough history and physical examination is required for accurate diagnosis, and in some cases, medical tests also may be used to help the clinician identify bursitis and determine whether or not infection is involved," he added.
Trauma or infection is usually the root cause of all four types of bursitis, Dr. Aaron said.
"Hip and heel bursitis usually result from 'overuse' syndromes involving underlying structures related to the tendons," he noted. "Elbow and knee bursitis can be traumatic, due to either chronic low-level trauma or acute trauma, or infectious. Other inflammatory conditions can lead to bursitis as well."
Typical symptoms of bursitis include:
Dr. Aaron noted not all types of bursitis will involve the same kinds of symptoms. For instance:
All types of bursitis often can be successfully managed non-surgically, and possible treatments include:
Surgery may be required in patients whose symptoms remain following these treatments and in certain situations when infection is involved.
Dr. Aaron said in most cases, the best way to prevent bursitis is to vary physical activity, avoiding repetitive activities that may increase stress and trauma on the joints. Padding surrounding the knee or elbow joints may help prevent repetitive trauma which could lead to bursitis in those areas. Finally, losing extra weight which may be causing stress on joints, particularly of the hips and knees, is also recommended.
"By recognizing the presence of bursitis and determining whether or not infection is involved, clinicians can identify the best mode of treatment which will resolve symptoms and help the patient regain mobility," Dr. Aaron said.
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