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Bursitis

Bursa is a mucous sack, present in several places in the human organism. These mucous sacks are located everywhere in the locomotor system. Their function is to reduce friction between tendons and bone, tendon and tendon, and between bone bulges and skin. They actually look like a balloon filled with fluid and squished between surrounding tissue. All is well until a blow happens, or overstraining, or some other factor causing inflammation, swelling, or enlarging of bursa to the scale where it causes more discomfort than comfort. This is called bursitis (inflammation of the bursa).

These inflammations can be caused by several factors:  

Inflammatory bursitis – caused by friction, chemical agent, or septical agent. Friction occurs with repeated movement of tendons over the bursa itself, which is often combined with occurrence of outside pressure. This happens to people or athletes who often repeat certain movements (tennis players, runners, disc or spear throwers, cleaners, bricklayers, and other professions). Such inflammation  often affects bursae in shoulder, hip, knee, elbow, and around the heel. Mechanical irritation stimulates inflammation which leads to extraction of fluid into bursa itself, leading to swelling and pain. If the case involves bursa which is right under the skin, you can feel warmth and pain by touching it. Chemical bursitis involves biochemical compounds created by surrounding chronic inflammation, especially of tendons. It is vital to discover a real cause of tendonitis and treat it, while bursitis must be treated only as a consequence of it. It is almost always a result of a long-lasting surrounding tissue inflammation. In case of athletes, it occurs if tendonitis isn't treated properly for several years. In other people, it occurs after long-lasting pain with the same cause. Most commonly, this happens in the shoulder.

Septic bursitis is least common, and it involves bacteria entering the bursa through bloodstream or directly through the blow which damages the skin and bursa membrane.  

Blood
bursitis occurs due to bleeding into the bursa, either because of direct blow, or as a result of bleeding into the joint it is connected to. This condition is uncomfortable because lack of treatment can lead to clotting and later calcification with all other side effects.

Treatment of bursitis is rarely simple, and is most successful when it starts as soon as possible. It includes: rest, no physical activities (which were probably the cause of it), ice therapy (to reduce inflammation). Many methods of physical therapy are used, from electrotherapy, magnetic therapy, laser, to ultrasound. Medication is sometimes necessary, especially non-steroid antirheumatics. Punction is a common procedure, when the needle enters the area of swollen bursa, and extracts the fluid. It is advisable to wear an elastic bandage to enhance pressure in swollen area and the resorption of it. Surgical removal of entire bursa is also an option. It is recommended to see a doctor and then physical therapist, if the pain continues, to diagnose the condition and then treat it properly. Home medicine is not a good solution, not with bursitis nor ever.  

Most common types of bursitis:

STUDENT ELBOW – Many years ago, when this term was coined, students used to study leaning with their elbows onto the hard table. These days they use computers, so this disease is more common in other professions. Bursa on the elbow, under the skin and above the bone top, gets inflamed, precisely on the spot where your elbow touches the table. With long-term leaning against the table (studying, or some similar activity) pressure upon the mucous sack is created, resulting in inflammation. The inflammation leads to swelling of bursa which fills with fluid, and all this is followed by creating a painful „pillow“ on the elbow, especially during pressure. inflammation and swelling can be a result of a strong blow – this same bursa fills with blood and swells. This injury is very common in football, handball, volleyball and basketball, where falls happen very often, and players wear no protection. Other than the right diagnosis and quality treatment, it is important that athletes wear protective pads after this injury in order to reduce the blows in the bursa.  

PREPATELLAR BURSITIS – on the very top of the knee is a little bone called patella, and between the bone and the skin we have a so called „prepatellar bursa“. inflammation happens quite often, after long kneeling down, smaller and frequent blows, or stronger blow or a fall. This is almost a professional injury in ceramists and parquetry makers, but also in all sports which include falls and contact with the surface, like volleyball, basketball, handball, football, and martial arts and gymnastics. Treatment is the same as in other types of bursitis, and if left untreated it can result in permanent knee sensitivity to the smallest of blows. Infrapatellar bursa is another mucous sack, a few centimeters below the one we just mentioned, on the bone top of tibia. Causes of its inflammation are same as in prepatellar bursitis, and so is the treatment.

BAKER'S CYST- one of bursae behind the knee is sometimes connected to the knee joint. This way the synovial fluid can fill this mucous sack while the knee moves. This leads to swelling, not necessarily connected to inflammation process, but it can affect movement. It is advisable to wear elastic bandages, especially in longer standing or certain physical activities.  In certain situations, when problems become serious, one should consider surgical removing of the bursa.

SUBACROMIAL BURSITIS- It occurs on the great bursa in the shoulder. In some cases the bursa gets inflamed and grows to the size of a tennis ball. It is caused by falling onto the shoulder, inflammation processes in neighbouring tendons, or frequently repeated movements where the arm extends above the head. So electricians, volleyball, handball, and tennis players are at a greater risk of developing this condition. Treatment is standard and it can take from three weeks to several months, based on whether it started on time and what is the condition of surrounding tissue.  

RETROCALCANEAR BURSITIS- On the vertex of Achilles tendon, and on its front side is a so-called retrocalcanear bursa, which is often inflamed during sports activities. This inflammation process should be differentiated from the inflammation of the vertex because these two conditions require different treatments even though the symptoms are similar. Physical therapy will provide good results, but removal of swelling as well as cortisone injections will reduce treatment time in professional athletes. Adequate sports shoes are important after treatment, as well as special orthopedic pads.   
TROCHANTERIC BURSITIS– On the outer side of the hip there is a part of hip bone called trochanter, and it is easily palpated if you brush your hand over this area. Between this and the system of muscles and ligaments covering it is a bursa which often gets inflamed during hiking, cycling, and activities which involve a lot of running and jumping. A traumatic inflammation is also possible, caused by falling to the hip. Treatment includes rest and anti-inflammatory therapy (ice, physical therapy, drugs, and cortisone injections). Operative treatment is rare and should be done only as the last option available.  

We mentioned just a few of most common types of bursitis. One should know that the human body has around 150 bursae and many are prone to inflammation and injury, so diagnostics and treatment should be left to the specialist.

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