BURSITIS: More than Meets the Eye

November 29, 2011

A bursa is a thin sack positioned between two anatomic structures that rub together. Bursae are filled with a slippery fluid which facilitates motion by reducing friction. Typically, bursae are located between a prominent boney eminence (often with a tendon attached to it) and skin, bone or another tendon.

When bursae become inflamed or irritated, they swell and can become painful. This condition is called “bursitis”. Common sites for bursitis include the tip of the elbow (olecranon), the kneecap (pre-patella), the outside hip bone (trochanteric) and the shoulder (rotator cuff).

Treatment should be specifically tailored to discovering what is actually causing the bursa to be inflamed. It could be an infection, gout, rheumatoid arthritis, injury, or a bony prominence that`s rubbing excessively on the bursa. Sometimes the bursa can be an “innocent bystander” becoming inflamed only because of a problem in the underlying tendon it`s trying to protect. This problem is usually a chronic fraying or tearing of that tendon`s attachment to bone and, in the course of the body`s repeated attempts at repair, the overlying bursa becomes secondarily inflamed.

Occasionally, the body, perhaps frustrated in its repair attempts, deposits calcium into the area of tendon degeneration. If that calcium leaks into the overlying bursa, an intense inflammatory response is mounted against the “intruder”. Calcific bursitis results and it can be very painful.

Discovering the exact diagnosis comes from taking a good history and doing a thorough physical exam. X-ray, MRI, and bursal fluid examination are used, when indicated, to assist in making the diagnosis.

In most cases the treatment is conservative, employing rest, medication, physical therapy, and possibly a steroid injection. A small number of cases do come to surgery. This may involve removing the bursa, smoothing out a bone protuberance, or repairing a torn tendon.

In cases in which the problem is a frayed or torn tendon, poor fitness plays a large role in causation. Not only is a weak muscle unable to do its job fully in stabilizing a joint, but its tendon`s attachment to bone is less than perfect. Consequently, treatment is incomplete without a conditioning program. Strengthening the muscle increases its tendon`s grip on bone. With improved holding power, the tendon is less likely to fray under future stresses.

Bursitis is common and its effects range from annoying to downright disabling. As a diagnosis, however, the term bursitis is not complete, for it tells us little about the actual underlying problem. Discovering the underlying condition is critical, for it gives us our best chance at a lasting cure. This search can be a challenge, for, in many instances, bursitis is “more than meets the eye”.