Bursitis

Signs and Symptoms

Symptoms of bursitis may include:

• Aching or stiffness in the joint that gets worse when you move the joint. The pain may begin all at once or develop gradually over time.
• Swelling, tenderness
• Redness
• Warm joint area

What Causes It?

Usually the bursa becomes irritated or injured after overuse from repetitive motion or strenuous activity. A bacterial infection may also cause bursitis. Other health problems, such as gout or rheumatoid arthritis, can also cause bursitis.

What to Expect at Your Provider's Office

Your doctor will ask you where the joint hurts and feel the joint for swelling or tenderness. Your doctor may order an x-ray or use a small needle to remove fluid from the bursa to check for infection. You may also need a blood test to check for other health problems.

Treatment Options

Resting and elevating the joint can help. A splint, sling, or other device can support the joint and keep it from moving. Applying ice or heat may help relieve pain and swelling. Once the joint is no longer painful, you can work to strengthen the muscles around the joint, which may help prevent further flare-ups.

Drug Therapies

• Nonsteroidal anti-inflammatory drugs (NSAIDs). To reduce pain and inflammation. Over-the-counter NSAIDs include ibuprofen (Motrin, Advil) and naproxen (Aleve). Prescription NSAIDs include diclofenac (Voltaren), ketoprofen (Orudis), and naproxen. Using NSAIDs over a long period of time can increase the risk of stomach bleeding and heart attack.
• Corticosteroids. An injection into the bursa can reduce inflammation. Sometimes, oral corticosteroids are used for long-lasting inflammation. There are risks associated with corticosteroids. Speak to your doctor.

Surgical and Other Procedures

In rare cases, the bursa is surgically removed.

Complementary and Alternative Therapies

Alternative therapies may help reduce the pain and inflammation of bursitis.

Eat whole grains, fruits, vegetables, and fatty fish to help reduce inflammation. Avoid processed foods and foods high in sugar and fat. The following supplements may help. Supplements may not be appropriate for all people and may have side effects and/or interact with medications. If you are pregnant or breastfeeding, talk to your physician before adding a supplement to your regimen.

• Glucosamine sulfate. Glucosamine is a substance found in cartilage, the tissue that covers the ends of bones in a joint. Some evidence suggests it may help treat the pain of osteoarthritis. It may also help reduce inflammation in bursitis. Glucosamine increases the risk of bleeding. People who take blood-thinning medications, such as aspirin, clopidogrel (Plavix), or warfarin (Coumadin), should not take glucosamine. Glucosamine may increase cholesterol levels. Use special caution if you have a history of asthma or diabetes.
• Omega-3 fatty acids, such as fish oil or flaxseed oil. Although evidence is mixed on whether fish oil helps reduce inflammation, it seems to reduce the amount of inflammatory chemicals your body makes over time. Omega-3 fatty acids can increase the risk of bleeding. People who take blood-thinning medications, such as aspirin, clopidogrel (Plavix), or warfarin (Coumadin), should ask their doctor before taking fish oil.
• Vitamin C with flavonoids to help repair connective tissue (such as cartilage). Vitamin C supplements may interact with other medications, including chemotherapy drugs, estrogen, warfarin (Coumadin), and others.
• Bromelain, an enzyme that comes from pineapples, reduces inflammation. Bromelain may increase the risk of bleeding, so people who take blood thinners should not take bromelain without first talking to their doctor. People with peptic ulcers should avoid bromelain. If taken with antibiotics, bromelain may increase the level of the antibiotic in the body, which could be dangerous. Turmeric is sometimes combined with bromelain because it makes the effects of bromelain stronger. Turmeric and bromelain together can also increase the risk of bleeding.

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, you should take herbs with care under the supervision of a health care provider.

The herbs listed below may help reduce inflammation. They also can increase the risk of bleeding. People who take blood-thinning medications, such as aspirin, clopidogrel (Plavix), or warfarin (Coumadin), should ask their doctor before taking them.

• Boswellia (Boswellia serrate).
• Turmeric (Curcuma longa). Turmeric is sometimes combined with bromelain because it makes the effects of bromelain stronger.
• White willow (Salix alba) acts similar to aspirin. It can be made into a tea by boiling 1/2 tsp. (2 grams) of bark in 8 ounces of water. Drink up to 5 cups per day. DO NOT take white willow if you are also taking aspirin or blood-thinning medications. Check with your doctor if you are allergic to aspirin or salicylates before taking white willow. DO NOT give white willow to children under the age of 18. Turmeric and white willow also can be used to reduce swelling.

Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for the treatment of bursitis based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type, includes your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.

• Arnica gel. Applied topically (to the skin) as directed, gives excellent short-term pain relief.
• Arnica. For bursitis occurring after an injury to the joint.
• Ruta graveolons. For rheumatic pains in the joint.
• Bellis perennis. For injury with a great deal of bruising.
• Rhus toxicodendron. For pain that gets better with movement.

Acupuncture can help reduce swelling and inflammation and relieve pain.

Although no well-designed scientific studies have looked at whether chiropractic treatment helps bursitis, chiropractors often treat people with this condition. They report that some persons have less pain and increased range of motion. In addition to spine and joint manipulation, chiropractors are likely to use other treatments to treat bursitis, including ice massage and ultrasound therapy.

Exercising the muscles around your joints helps reduce pressure on the joint and bursa. Gentle yoga may help bursitis by increasing flexibility and reducing muscle tension. Other movement therapies, such as Pilates and Tai Chi, may also help improve muscle and ligament strength and reduce the tension caused by repetitive motions.

You should not use massage if your bursitis is caused by an infection. Otherwise, massage, especially myofascial release therapy, may help you relax and may reduce the discomfort from a sore joint.

Following Up

Tell your health care provider if your symptoms do not get better with treatment. Be sure to follow your doctor's instructions for resting the joint to relieve the swelling.

You can help prevent bursitis from coming back by avoiding repetitive motions, resting between periods of intense activity and warming up before starting an activity.

Special Considerations

DO NOT take aspirin, acetaminophen (Tylenol), or ibuprofen (Advil, Motrin) for more than a few days unless instructed to do so by your health care provider.

Be sure to tell your provider if you are pregnant.

Supporting Research

Bope & Kellerman: Conn's Current Therapy 2013. 1st ed. Philadelphia, PA: Elsevier Saunders; 2012.

Bron C, Wensing M, Franssen JL, Oostendorp RA. Treatment of myofascial trigger points in common shoulder disorders by physical therapy: a randomized controlled trial [ISRCTN75722066]. BMC Musculoskelet Disord. 2007 Nov 5;8:107.

De Silva V, El-Metwally A, Ernst E, Lewith G, Macfarlane GJ; Arthritis Research UK Working Group on Complementary and Alternative Medicines. Evidence for the efficacy of complementary and alternative medicines in the management of osteoarthritis: a systematic review. Rheumatology (Oxford). 2011 May;50(5):911-20. Review.

Del Buono A, Franceschi F, Palumbo A, Denaro V, Maffulli N. Diagnosis and management of olecranon bursitis. Surgeon. 2012;10(5):297-300.

Huang HH, Qureshi AA, Biundo JJ Jr. Sports and other soft tissue injuries, tendinitis, bursitis, and occupation-related syndromes. Curr Opin Rheumatol. 2000 Mar;12(2):150-4. Review.

Ferri: Ferri's Clinical Advisor 2016. 1st ed. Philadelphia, PA: Elsevier Mosby; 2016.

Goldman: Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011.

Kimmatkar N, Thawani V, Hingorani L, et al. Efficacy and tolerability of Boswellia serrata extract in treatment of osteoarthritis of knee -- a randomized double blind placebo controlled trial. Phytomedicine. 2003;10:3-7.

Klein G, Kullich W. Short-term treatment of painful osteoarthritis of the knee with oral enzymes. Clin Drug Invest. 2000;19:15-23.

Lewis JS, Sandford FM. Rotator cuff tendinopathy: is there a role for polyunsaturated fatty acids and antioxidants? J Hand Ther. 2009 Jan-Mar;22(1):49-55. Review.

Paoloni JA, Orchard JW. The use of therapeutic medications for soft-tissue injuries in sports medicine. Med J Aust. 2005 Oct 3;183(7):384-8. Review.

Reginster JY, Deroisy R, Rovati L, et al. Long-term effects of glucosamine sulphate on osteoarthritis progression: a randomised, placebo-controlled clinical trial. Lancet. 2001;357:251-6.

Sayegh ET, Strauch RJ. Treatment of olecranon bursitis: a systematic review. Arch Orthop Trauma Surg. 2014; 134(11):1517-36.

Schmid B, Ludtke R, Selbmann HK, et al. Efficacy and tolerability of a standardized willow bark extract in patients with osteoarthritis: randomized, placebo-controlled, double blind clinical trial. Z Rheumatol. 2000;59:314-20.

Vas J, Perea-Milla E, Mendez C, Galante AH, Madrazo F, Medina I, et al. Acupuncture and rehabilitation of the painful shoulder: study protocol of an ongoing multicentre randomised controlled clinical trial [ISRCTN28687220]. BMC Complement Altern Med. 2005 Oct 14;5:19.