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Bursitis

• Signs and Symptoms
• What Causes It?
• What to Expect at Your Provider's Office
• Treatment Options
• Following Up
• Special Considerations
• Supporting Research

Bursitis is inflammation of a small fluid-filled sack (bursa) inside every joint. The sack helps to lubricate and cushion the joint. Usually bursitis occurs in larger joints, such as the shoulder, hip, knee, or elbow. Repetitive motion is often the cause, and it can happen once or several times. Without seeing your health care provider, you usually can't easily tell the difference between bursitis and pain caused by a strain or arthritis.

Signs and Symptoms

• Pain in the joint that gets worse when you move the joint (the pain may come all at once or develop gradually over time)
• Swelling
• Redness
• Fever and warm joint area (if an infection is present)

What Causes It?

Typically the bursa becomes irritated or injured after overuse from repetitive motion or strenuous activity. It may also be caused by a bacterial infection. Other health problems, such as gout or rheumatoid arthritis, can also cause bursitis.

What to Expect at Your Provider's Office

Your health care provider will ask you to identify exactly where the joint hurts and feel the joint for swelling or tenderness. Your health care provider may remove some fluid from the bursa with a small needle to check for infection. You may also need a blood test to check for other health problems.

Treatment Options

Sometimes simply resting and elevating the joint can help the area heal. A splint, sling, or other device can support the joint and keep it from moving. Applications of heat or cold may help relieve pain and swelling.

Drug Therapies

• Corticosteroids -- injections into the bursa or oral steroids may reduce inflammation. Side effects include blurred vision, frequent urination, and increased thirst. Steroids may be given with a local anesthetic to reduce pain.
• Antibiotics -- for bursitis that is infected.
• Acetaminophen, aspirin, and ibuprofen -- to reduce pain.

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 while supporting healthy connective tissue.

Nutrition and Supplements

Include in your diet anti-inflammatory oils such as those found in cold-water fish, nuts, and seeds. The following supplements may help.

• Glucosamine sulfate (500 mg two or three times a day), for connective tissue support.
• Omega-3 oils (1,000 mg two or three times a day), such as fish oil or flaxseed oil. While not a direct anti-inflammatory, omega-3 oils, particularly those in fish, can lessen the amount of inflammatory chemicals your body produces over time.
• Vitamin C with flavonoids (250 - 500 mg two times a day), for connective tissue repair.
• Proteolytic enzymes such as bromelain (250 mg twice a day), to reduce inflammation.
• Flavonoids and oral digestive enzymes for inflammation. When used to treat inflammation, digestive enzymes are best taken on an empty stomach.

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your provider to get your problem diagnosed before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.

• Herbs that reduce swelling include meadowsweet (Filipendula ulmaria) and Jamaica dogwood (Piscidia piscipula). You may take a tincture of one, or a combination of these herbs, at 15 drops every 15 minutes up to four doses for relief of severe pain, or 30 drops four times per day for relief of general pain.
• Herbs used for their anti-inflammatory effects include:
  • Boswellia ( Boswellia serrata), 150 mg taken 3 times per day
  • Turmeric (Curcuma longa), 375 mg 3 times per day for 12 weeks
  • White willow (Salix alba), which acts similar to aspirin and 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, and check with your doctor if you are allergic to aspirin or salicylates before taking white willow. Turmeric and white willow also can be used to reduce swelling. Turmeric increases the effects of bromelain.
• Evening primrose oil may also help fight inflammation. The dose is 1,200 mg per day.
• For bursitis with muscle spasm, add valerian (Valeriana officinalis).
• For frequent bursitis, add hawthorn (Crataegus monogyna) .

Homeopathy

Some of the most common remedies are listed below. Usually, the dose is 3 to 5 pellets of a 12X to 30C remedy every 1 -4 hours.

• 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.
• "Traumeel" injections by a trained health care provider as an alternative to corticosteroids.

Acupuncture

Acupuncture can be helpful in reducing swelling and inflammation, and especially in relieving pain.

Chiropractic

Although no well-designed trials have evaluated the effectiveness of chiropractic treatment for bursitis, chiropractors commonly treat people with this condition and report that some experience improvements in symptoms, including reduced pain and increased range of motion. Chiropractors are also likely to use other treatments in addition to spine and joint manipulation (such as ice massage and ultrasound therapy) for the treatment of bursitis.

Movement Therapy

Gentle yoga may help bursitis by increasing flexibility and reducing muscle tension in the area of the bursa. Other movement therapies, such as Pilates and Tai Chi, may also help improve muscle and ligament conditioning and reduce the tension caused by repetitive motions.

Massage

You should not use massage if your bursitis is caused by an infection. Otherwise, you can use massage (especially myofascial release therapy) for general relaxation and to reduce discomfort from inflammation and from compensating for a sore joint.

Following Up

Tell your health care provider if your treatment does not relieve your symptoms. Be sure to follow your provider's instructions for resting the joint to allow the swelling to subside before returning to your usual routines. You can help prevent bursitis from recurring by avoiding repetitive motions, resting between periods of intense activity, and doing stretching exercises before starting an activity.

Special Considerations

Do not take aspirin, acetaminophen, or ibuprofen for more than a few days unless so directed by your provider. Be sure to tell your health care provider if you are pregnant.

Supporting Research

Andreoli TE, Bennett JC, Carpenter CCJ. Cecil Essentials of Medicine. 3rd ed. Philadelphia, Pa: WB Saunders Co; 1993.

Barker LR, Burton JR, Zieve PD, eds. Principles of Ambulatory Medicine. 4th ed. Baltimore, Md: Williams & Wilkins; 1995:885-894.

Carr AC, Frei B. Toward a new recommended dietary allowance for vitamin C based on antioxidant and health effects in humans. Am J Clin Nutr. 1999;69(6):1086-1107.

Foster S. 101 Medicinal Herbs . Loveland, CO: Interweave Press, 1998:200-1.

Gerber JM, Herrin SO. Conservative treatment of calcific trochanteric bursitis. J Manipulative Physiol Ther . 1994;17(4):250-252 .

JAMA Patient Page. How much vitamin C do you need? JAMA. 1999;281(15):1460.

Joe LA, Hart LL. Evening primrose oil in rheumatoid arthritis. Ann Pharmacother . 1993;27:1475-7.

Johnston CS. Recommendations for vitamin C intake. JAMA. 1999;282(22):2118-2119.

Levine M, Rumsey SC, Daruwala R, Park JB, Wang Y. Criteria and recommendations for vitamin C intake. JAMA. 1999;281(15):1415-1453.

Murray MT. The Healing Power of Herbs: The Enlightened Person's Guide to the Wonders of Medicinal Plants. 2nd ed. Rocklin, Calif: Prima Publishing; 1998.

Singh GB, Atal CK. Pharmacology of an extract of salai guggal ex-Boswellia serrata, a new non-steroidal anti-inflammatory agent. Agents Actions. 1986;18:407-12.

Stein JH, ed. Internal Medicine. 4th ed. St. Louis, Mo: Mosby-Year Book; 1994:2400-2404.

• Review Date: 6/15/2006
• Reviewed By: Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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