Bursitis Diagnosis

  • Diagnosis

    Bursitis is a condition in which fluid-filled sacs near a joint called bursae become inflamed, causing pain and sometimes swelling. Figure 01 Bursae separate bone from overlapping muscles or tendons. Their purpose is to lubricate, cushion, and reduce friction between these tissues so that you can move your joints easily and painlessly.

    Under usual conditions, the bursae are flat and contain very little fluid. When they are injured, however, they become inflamed and swell with fluid, causing pain and pressure on the surrounding tissue. Most people have about 150 bursae in their bodies.

    You are most likely to experience bursitis around your shoulder, elbow, or hip joints, although the condition may also affect your knees, heels, buttocks, and even the base of your big toe. Various common names have been given to bursitis in different areas, often reflecting trades or past-times that lead to overuse of particular joints:

    • Shoulder: bricklayer's shoulder or frozen shoulder
    • Elbow: tennis elbow or miner's elbow
    • Hip: hip bursitis or trochanteric bursitis
    • Knee: housemaid's knee or clergyman's knee
    • Heel: policeman's heel
    • Buttocks: tailor's bottom or weaver's bottom
    • Base of big toe: bunion

    Bursitis can be either acute (lasting only a few days) or chronic (lasting several weeks, with many recurrences). If chronic bursitis is left untreated--especially in the shoulder--calcium deposits can form within the bursae. These deposits can lead to permanent stiffness in the affected joint.

    Sometimes bacteria can invade a bursa, causing an infection. This condition is known as septic bursitis. If untreated, septic bursitis can become life-threatening, because the infection may spread through the blood to other areas of the body.

    Click to enlarge: Bursitis of the shoulder

    Figure 01. Bursitis of the shoulder

    Overusing or injuring a joint is the most common cause of bursitis. As the common names for bursitis indicate, repeated joint movement can inflame nearby bursae. Swinging either a tennis racket or a miner’s pick, for example, can lead to bursitis of the elbow, while kneeling to work in the garden or scrub floors can result in knee bursitis. In addition, if you stand or lie on your side for long periods of time, the pressure on your hip joints may cause hip bursitis, or if you sit on a hard surface and sway back and forth (such as at a loom), you may inflame the bursa over the bone in your buttocks.

    Sometimes it is difficult to identify a specific activity or injury that may have led to the bursitis. In these cases, the inflammation may be the result of gout, rheumatoid arthritis, or an infection (especially a staphylococcal infection) or, more rarely, tuberculosis. Often, however the cause of the bursitis is not identified.

    Bursitis can cause pain, tenderness, or stiffness in the affected area. The pain often gets worse with movement. If the inflamed bursa is close to the skin’s surface, the area may swell and appear to be red. It may also feel warm to the touch.

    A traumatic injury or an infection can cause sudden swelling and soreness. Gradual swelling is usually a sign of chronic or long-lasting bursitis. Chronic bursitis can lead to muscle deterioration, and may permanently limit the range of motion of the affected joint.

    Tendonitis and other conditions cause similar symptoms as bursitis; it may be difficult for a doctor to differentiate among them. There are some differences, however. Generally, bursitis pain is a dull, persistent ache that becomes more intense when the joint is moved. Tendonitis pain, on the other hand, tends to be sharp.

    Sometimes bursitis and tendonitis occur in combination. Your doctor will conduct diagnostic tests to determine the precise cause of your joint pain and stiffness.

    While bursitis can affect anyone, older people, manual laborers, and athletes are especially susceptible to developing the condition.

    Overuse of or injury to a joint can lead to bursitis. If you work in a profession, play a sport, or have a hobby that puts repetitive stress on a joint, you are at greater risk of developing bursitis. Your risk increases even more if you are in poor physical condition or have bad posture.

    Injuries such as twisting your ankle or falling on your arm or hip may damage a bursa, thereby increasing your risk for bursitis. The risk is higher if you are over 40, primarily because tissues near joints weaken as you age, making them more susceptible to injury.

    Having gout, rheumatoid arthritis, or a staphylococcal infection in a bone or joint increases your risk for bursitis because these illnesses can inflame joints and nearby tissues, including the bursae.

    Your doctor will take a medical history and ask questions about your symptoms. You’ll also be asked if you have engaged in any activities that may have stressed or injured the affected joint.

    To rule out other possible causes for your symptoms, your doctor will give you a thorough medical examination. He or she will feel the affected joint to identify the precise area of tenderness. To test for an infection, your doctor may remove fluid from the affected joint with a thin needle. The fluid will then be sent to a laboratory to see if it contains any bacteria.

    Your doctor will probably order an x-ray to rule out other possible causes of the pain. A specialized x-ray procedure known as an arthrogram may be done. This test, which lasts about an hour, involves injecting a dye into a joint space. X-rays are then taken of the joint. If the images show that the dye has leaked into an area where it doesn’t belong, then the joint may be damaged in some way.

    Your doctor may also order either a CT (computed tomography) or MRI (magnetic resonance imaging) scan of the affected joint. A CT scan uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices) of the body. An MRI scan uses a combination of large magnets, radio frequencies, and a computer to produce its images.

    Both CT and MRI technologies deliver more detailed images than standard x-rays.

    Measures that reduce repetitive stress on joints will help to prevent bursitis.

    • Avoid activities that involve repetitive movements. If you must do repetitive tasks, be sure to take frequent breaks so you can rest your joints.
    • Protect your joints by keeping your muscles strong. Ask your doctor for advice on developing a muscular strengthening program.
    • Perform stretching exercises daily. Muscles and joints that remain flexible are less likely to be injured.
    • Maintain a healthy body weight. Extra weight puts added pressure on joints.
    • Wear protective kneepads if you have an occupation (e.g., floor tiling, carpet laying) or a hobby (e.g., gardening) that involves spending extended time on your knees.
    • Wear protective pads on knees and/or elbows if you participate in high-risk sports such as football, basketball, wrestling, or in-line skating.
    • Avoid resting your elbows on hard surfaces.
    • Avoid standing for prolonged periods of time.
    • Make sure your shoes fit properly.
    • Slowly warm up your muscles before exercising or doing strenuous activities, and cool down the muscles with gentle stretching afterwards.
    • Use proper posture when sitting or standing.

  • Prevention and Screening

    Measures that reduce repetitive stress on joints will help to prevent bursitis.

    • Avoid activities that involve repetitive movements. If you must do repetitive tasks, be sure to take frequent breaks so you can rest your joints.
    • Protect your joints by keeping your muscles strong. Ask your doctor for advice on developing a muscular strengthening program.
    • Perform stretching exercises daily. Muscles and joints that remain flexible are less likely to be injured.
    • Maintain a healthy body weight. Extra weight puts added pressure on joints.
    • Wear protective kneepads if you have an occupation (e.g., floor tiling, carpet laying) or a hobby (e.g., gardening) that involves spending extended time on your knees.
    • Wear protective pads on knees and/or elbows if you participate in high-risk sports such as football, basketball, wrestling, or in-line skating.
    • Avoid resting your elbows on hard surfaces.
    • Avoid standing for prolonged periods of time.
    • Make sure your shoes fit properly.
    • Slowly warm up your muscles before exercising or doing strenuous activities, and cool down the muscles with gentle stretching afterwards.
    • Use proper posture when sitting or standing.

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