By Boyd W. Haynes III, MD
As an orthopaedic physician, I see people who come into my office and tell me that they have developed arthritis in their joints and that it hurts like the dickens! Then they point to their hip or their shoulder and show me where it hurts. I usually ask them a few simple questions and ask them to move for me and demonstrate what causes the pain. Sometimes, I confirm their suspicions and tell them that they do, indeed, have arthritis and show them their arthritis on x-ray. However, the pain is often caused by Bursitis, a lesser-known, but very painful condition, in which symptoms can closely mirror those of arthritis. In this article, I will examine this condition, talk about how I diagnose and treat bursitis and tell you how you can help to prevent it from happening to you.
Bursa or Bursae are tiny, fluid-filled sacs that provide cushioning between muscles, tendons and joints. They can be found through-out the body, but the ones that are the most troublesome seem to be in the hip, elbow, shoulder and knee. These little sacs can become inflamed for a number of reasons, which include:
• Repetitive use or pressure
• Trauma or injury
• Overuse or underuse
• Lack of stretching before and after exercise
• Being overweight
• Having gout or rheumatoid arthritis
• An infection
• Un-determined cause
• Females have a greater tendency for bursitis of the hip (due to the shape of the female pelvis)
What are the Symptoms of Bursitis?
Most commonly, the main symptom of bursitis is pain, either with movement or without movement. The area around the joint can ache, burn, throb or become hot and swollen. Stiffness and soreness, when trying to move the affected part of the body, are commonly seen. There may also be significant tenderness when pressing around the joint in the affected area. Stiffness is usually worse in the morning or after a period of inactivity.
When you come to see me to have your symptoms evaluated, I will order x-rays to be taken of the painful area to rule out other potential causes of the pain, such as arthritis or a bone spur. You may have arthritis and bursitis concurrently, but it may be only the bursitis that is causing the pain. I will get you to specifically point to the area that hurts and ask you to describe the pain (burning, throbbing, aching), ask you when you have it and if it is worse at certain times of day. I will ask you show me the movements that seem to cause the most pain. I want to know when your symptoms started and if you have attempted any treatments at home. I will also ask you if you have consulted your Primary Care Physician and if you have been prescribed any medication for the pain or inflammation. If you have been prescribed medication, it would be very helpful for me to know the name of the drug and how many milligrams/how many times/day you were/are taking the drug.
How is Bursitis Treated?
Once I confirm a diagnosis of bursitis, how I treat it will depend on how long you have been experiencing symptoms and what at-home treatments you have tried. For example, if you just started having symptoms and had not attempted much in the way of at-home treatment, I would probably recommend the following:
• A therapeutic dose of Aleve or Ibuprofen for a week (or longer)
• Icing of the affected area 3-4 times a day for 15 minutes at the time for 2-3 days. Alternatively, sometimes heat can be helpful for this condition. You need to try both to see what provides you with relief.
• Rest of the affected area (no repetitive motion)
• Activity modification
• Elevation of the affected area
If those treatments did/do not work for you at home, we would then proceed to more intensive therapies, such as:
• A prescription for a stronger anti-inflammatory medication
• Physical Therapy
• A specific and targeted regimen of at-home exercises
• Activity and behavior modification
• Prescription oral steroids
For severe cases of bursitis, where we don’t seem to make much progress with conservative treatments, we can proceed to using the following:
• Injections of cortisone into the bursa
• Draining of the excess fluid of the bursa by needle aspiration
• Prescription pain medication
• Losing weight for overweight patients
• Use of Pain Management to help control chronic pain
For extreme cases of bursitis, that do not respond to any other treatments and which cause severe pain, there is a surgical alternative called bursectomy, which involves removing the affected bursa. This surgery is usually done endoscopically, (through small incisions, using a camera and specially-designed instruments) which reduces blood loss, trauma and tissue damage and speeds recovery. The bursa will grow back, but without causing the pain and inflammatory response they did before surgery. This surgery is rarely necessary.
Happily, most cases of bursitis respond well to more conservative treatment and many patients start to feel better when we find the anti-inflammatory medication that seems to work best for them and a gentle, overall exercise program for fitness and to prevent the return of the pain. Women commonly get bursitis in the hips, which often can be prevented by a good stretching program. Yoga is an especially good activity for bursitis patients, as are swimming and water aerobics.
Prevention
There are things that you can do to lessen your risk of developing bursitis. They are as follows:
• Stretch problem areas, multiple times, daily
• Exercise at least 3 times a week for 30 minutes
• Don’t sit or work in any one position for too long, get up and move around or shift positions frequently
• Maintain a healthy weight
• When working areas of the body known to have bursitis, use accommodative devices whenever possible, i.e., using kneeling pads for gardening or using dollies or hand trucks for moving heavier, weighted items
Bursitis can be painful and hard to eliminate, but with persistence and the correct treatment, it can be overcome. You can say goodbye to bursitis once and for all!
Boyd W. Haynes III, MD is a fellowship-trained, board- certified Orthopaedic Specialist with Orthopaedic and Spine Center in Newport News, Virginia. Voted a “Top Doc” for 2012, 2013, and 2014 in a physician survey conducted by Hampton Roads Magazine, Dr. Haynes specializes in Sports Medicine, Total and Partial Joint Replacement, and Outpatient Total Joint Replacement. For more information about Dr. Haynes or OSC, please call 757-596-1900 for a consultation.