Any bursa may become inflamed, though the bursae near certain joints are particularly prone to do so. Here is an overview of how bursitis commonly affects some of the larger joints of the body.
Bursitis symptoms depend on which bursa is affected and how much inflammation there is. People with bursitis often experience the following in the area of the affected bursa:
The inflammation may also make the area sensitive to pressure. For example, lying on your side with your knees one on top of the other may be painful if you have bursitis in your knee. If you have bursitis in your hip, it may hurt to lie on that side of the body.
You should see your doctor if you have pain lasting more than two weeks; joint pain severe enough to keep you from moving the joint; sharp or shooting pain, particularly during exertion or exercise; or a rash near the affected joint or severe bruising, swelling, or redness.
If you have a fever in addition to these symptoms, see your doctor immediately. If the bursitis is caused by an infection, it could spread throughout your body or into your blood.
Olecranon bursitis is inflammation in the bursa that sits at the tip of the elbow, near the olecranon, a hard point at the end of the ulna (one of the two primary bones of the forearm). Although normally flat, if inflamed or irritated, the olecranon bursa may fill with extra fluid and expand.
Hitting the elbow on something; repeated, long-term pressure on the tip of the elbow from, say, leaning on a counter, desk, or table; and frequently crawling on the elbows may all cause elbow bursitis. Rheumatoid arthritis and gout have also been linked to bursitis of the elbow.
The treatment of elbow bursitis usually follows the strategies outlined above, including the use of an elbow pad. People with bursitis of the elbow are also generally advised to avoid putting pressure on the elbow.
There are two areas of the hip that are particularly prone to bursitis. The first is the greater trochanter, a point that sticks out near the top of the femur (the thigh bone). If the large bursa between the greater trochanter and the skin becomes inflamed, the result is trochanteric bursitis.
Another form of bursitis associated with the hip occurs on the inside of the hip near the groin. This form of bursitis is called iliopsoas bursitis because it affects the iliopsoas bursa, the largest bursa in the body. When this bursa becomes inflamed, the nearby tendons generally also become inflamed (a condition called iliopsoas tendinitis), and vice versa.
Women and middle-aged and older men are at an increased risk of developing bursitis of the hip. Bursitis of the hip may develop as a result of an overuse injury, such as from running, stair climbing, or bicycling. It can also be a consequence of lying on one side or standing for long periods of time. As with elbow bursitis, a strong blow to the area, sometimes from a fall, may lead to bursitis of the hip. Certain spine conditions, rheumatoid arthritis, having one leg that is shorter than the other, and bone spurs (bony growths) or calcium deposits inside the tendons that connect to the greater trochanter, and having had surgery near the hip all increase a person’s risk of hip bursitis.
In addition to standard bursitis treatment, your doctor may suggest temporarily using a cane or crutches, especially if your bursitis requires surgery.
There are also two areas in the knee that are common sites of bursitis. Knee tendon bursitis occurs in a bursa that sits between the three tendons of the hamstring muscles and a ligament coming down from the femur, where all four make contact with the tibia (shin bone) on the inside of the knee. This form of bursitis—pes anserine bursitis—is often seen in athletes, especially runners.
Pes anserine bursitis may occur as a result of exercising without prior stretching, abruptly increasing the distance you run, and frequently running on hills. Obesity, osteoarthritis of the knee, damage to the meniscus on the inside of the knee, tight hamstrings, and a knee or lower leg that turns outward may all also increase the risk of developing pes anserine bursitis.
Another common form of bursitis that may affect the knee is called kneecap (or prepatellar) bursitis. In this case, the inflamed bursa sits between the front of the kneecap (the patella) and the skin.
Gout and RA both increase a person’s risk of developing bursitis of the kneecap. Other risk factors include kneeling often as part of your job; having been in a motor vehicle accident; and participating in a sport such as wrestling or football that includes landing on one’s knees or other frequent impacts to the knees.
The usual treatments for bursitis, as outlined above, are commonly effective for treating knee bursitis. If you are prone to bursitis of the knee, it may help to elevate and ice your knees after physical activity, stretch your legs often, and wear kneepads when you kneel or play sports that may involve impact to your knees.
Bursitis of the shoulder is usually related to inflammation in the bursa that lies above the tendons that connect to the top of your arm (the rotator cuff) and below a portion of the shoulder blade called the acromion, which extends forward toward the collarbone.
In shoulder bursitis, both the tendons and the bursa may swell. As they grow larger in the narrow space between the acromion and the humerus (the upper arm bone), the acromion may rub against them. This rubbing is called impingement and may cause pain and further irritation. Shoulder bursitis may lead to adhesive capsulitis, commonly referred to as “frozen shoulder,” in which the movement of the shoulder is severely limited.
As with other kinds of bursitis, shoulder bursitis may arise after a blow to the area. It is also common in people who frequently hold their arms over their shoulders during activities such as painting, swimming, playing tennis or baseball, hanging wallpaper, and doing construction.
Rest and NSAIDs are often prescribed as initial treatment options. Physical therapy can help to restore range of motion in the shoulder. An injection of cortisone may also help to reduce swelling.
Surgery to remove part of the bursa and possibly part of the acromion as well is sometimes recommended. This surgery is often performed arthroscopically, using several small instruments inserted into the shoulder joint through small incisions. During the surgery, the surgeon may also address other problems in the shoulder, such as bone spurs, arthritis, or a partial rotator cuff tear, if there is one. However, surgery for shoulder bursitis is not usually necessary.