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Bursitis is inflammation of the small fluid-filled sacs (bursae) that act as cushions over the joints, and under the muscles and tendons. There are approximately 160 bursae throughout the body. These small fluid-filled sacs lie over many of the joints to protect them from the friction of all the moving parts. The elbows, shoulders, and hips are the most common locations of bursitis.

Bursitis is generally identified by pain present over the involved joint, which can be accompanied by swelling, redness, or tenderness in the area. If bursitis has been chronic, or recurrent, x-ray imaging may occasionally detect calcifications in these areas.

Hip Bursitis: There are two main bursae in the hip region: the greater trochanteric bursa (at the outer bony point of the hipbone) and the iliopsaos bursa (inside the hip near the groin). Hip bursitis most frequently tends to involve the greater trochanter. The primary symptom of hip bursitis is pain at the site of the hip, which may extend into the thigh. The pain is usually sharp and intense, and may progress to a dull achiness over time. Risk factors for hip bursitis are numerous. They include repetitive stress on the joint (such as that associated with running and climbing), direct trauma to the hip, lower spine disease, leg-length discrepancy, rheumatoid arthritis, and bone spurs or calcium deposits. Repetitively sleeping on the same side every night is also associated with a higher incidence of developing hip bursitis.

Shoulder Bursitis: Typically, a repetitive overuse type of injury causes shoulder bursitis. Activities that could lead to bursitis include repetitive overhead lifting and throwing. Sleeping on the same shoulder every night is also a common cause of shoulder bursitis. Bursitis of the shoulder is often accompanied by tendonitis of the rotator cuff muscle/tendon units, and can cause pain and tenderness in those inflamed tissues. There may also be a pinching type pain when the arm is raised overhead and to the side, away from the body. This is referred to as an “impingement sign.”

Elbow Bursitis: The elbow bursa is located between the loose skin and the pointy bone (olecranon) at the back of the elbow. Generally, the bursa is flat, but it will swell and fill with fluid if it becomes irritated or inflamed. Causes of elbow bursitis include acute injury or trauma, prolonged pressure (leaning on a hard surface for long periods), a medical condition, such as rheumatoid arthritis and gout, or even an infection within the bursa. Symptoms of elbow bursitis include swelling at the site, excessively loose skin at the back of the elbow, and finally pain.

Treatment: The treatment of bursitis in most cases is conservatively managed with the use of icing, anti-inflammatory medications and modifying or eliminating the causative agent that triggered the bursitis, such as avoiding overhead activities involving the shoulder or not sleeping on the affected hip, or shoulder until the inflammation subsides. In those instances where this regiment is not sufficient, the use of injectable steroids into the inflamed bursa may be necessary.

Dr. Nicholas Alexander is the Founder of Mahwah Valley Orthopedic Associates and a Board Certified Orthopedic Surgeon specializing in both the surgical and non-surgical treatment of hip and knee conditions.  Dr. Alexander completed his Fellowship in Adult Reconstruction and Reconstructive Surgery of the Hip and Knee at the Johns Hopkins School of Medicine and has over two decades of experience. He also serves as the Chairman of the Valley Hospital Total Joint Center. Dr. Alexander has offices in Mahwah and Clifton, NJ.  If you, or someone you love, is considering treatment for a hip or knee injury, contact us today for a consultation.

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