Introduction:

Bursitis occurs when the small fluid-filled sac (bursa) found inside joints becomes inflamed. The sac helps to lubricate and cushion the joint, and when it is inflamed movement can be painful. Usually bursitis occurs in larger joints, such as the shoulder, hip, knee, or elbow. Repetitive motion is often the cause. Although bursitis usually goes away in a few weeks with treatment, you can get bursitis 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:

• Aching or stiffness 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
• Warm joint area

What Causes It?:

Usually the bursa becomes irritated or injured after overuse from repetitive motion or strenuous activity. Bursitis 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 doctor will ask you where the joint hurts and feel the joint for swelling or tenderness. Your doctor may order an x-ray or 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:

Often 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. Applying ice or heat may help relieve pain and swelling. Once the joint is no longer painful, you can work to strengthen the muscles around the joint and prevent further flare-ups.

Drug Therapies

• Nonsteroidal anti-inflammatory drugs (NSAIDs) -- to reduce pain and inflammation. Over-the-counter NSAIDs include ibuprofen (Motrin, Advil) and naproxen (Aleve). Prescription NSAIDs include diclofenac (Voltaren), ketoprofen (Orudis), and naproxen. Long-term use of NSAIDs can increase the risk of stomach bleeding and heart attack.
• Corticosteroids -- An injection into the bursa can reduce inflammation. Usually only one injection is needed.

Surgical and Other Procedures

In very 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

Eat whole grains, fruits, vegetables, and fatty fish or help reduce inflammation. Avoid processed foods and foods high in sugar and fat. The following supplements may help.

• Glucosamine sulfate (500 mg two or three times a day) -- Glucosamine is a substance that is found in cartilage, the tissue that covers the ends of bones in a joint. There is mixed evidence that suggests it may help treat the pain of osteoarthritis, and it may also help reduce inflammation in bursitis. Glucosamine is considered safe to take.
• Omega-3 fatty acids (1,000 mg two or three times a day), such as fish oil or flaxseed oil. Although evidence is mixed on whether fish oil helps reduce inflammation, it seems to reduce the amount of inflammatory chemicals your body produces over time.
• Vitamin C with flavonoids (250 - 3,000 mg two times a day), to help repair connective tissue (such as cartilage).
• Bromelain (250 mg twice a day), an enzyme derived from pineapples, reduces inflammation. Bromelain may increase the risk of bleeding, so people who take anticoagulants (blood thinners) should not take bromelain without talking to their doctor first. People with peptic ulcers should avoid bromelain. Turmeric is sometimes combined with bromelain, because it increases the effects of bromelain.

Herbs

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, herbs should be taken with care, under the supervision of a healthcare practitioner.

These herbs may help reduce inflammation:

• Boswellia (Boswellia serrata), 150 mg 3 times per day
• Turmeric (Curcuma longa), 375 mg 3 times per day for 12 weeks. Turmeric is sometimes combined with bromelain, because it increases the effects of bromelain.
• 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 or blood-thinning medications and check with your doctor if you are allergic to aspirin or salicylates before taking white willow. White willow should not be given to children under the age of 18. Turmeric and white willow also can be used to reduce swelling.
• Evening primrose oil (Oenothera biennis), 1,200 mg per day. Evening primrose oil may increase the risk of bleeding, so people who take anticoagulants (blood thinners) should not take evening primrose oil.

Homeopathy

Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for the treatment of bursitis based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.

• 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

Acupuncture

Acupuncture can help reduce swelling and inflammation, and especially relieve pain.

Chiropractic

Although no well-designed scientific studies have looked at whether chiropractic treatment is effective for bursitis, chiropractors often treat people with this condition. They report that some people 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) in treating bursitis.

Movement Therapy

Exercising the muscles around your joints will help reduce pressure on the joint and bursa. 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 strength and reduce the tension caused by repetitive motions.

Massage

You should not use massage if your bursitis is caused by an infection. Otherwise, massage (especially myofascial release therapy) can help you relax and can reduce the discomfort from a sore joint.

Following Up:

Tell your health care provider if your treatment does not relieve your symptoms. Be sure to follow your doctor’s instructions for resting the joint to allow the swelling to go away.

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 (Tylenol), or ibuprofen (Advil, Motrin) for more than a few days unless so directed by your provider.

Be sure to tell your health care provider if you are pregnant.