Doctor’s Senior Exercise & Health Newsletter

Bursitis is an acute or chronic inflammation of a bursa. They facilitate the movement of tendons over boney prominences. Bursae are found in many locations of the body, wherever tendons glide over boney areas. The most common form of bursitis is found in the shoulder and is called sub-acromial bursitis, supraspinatus tendonitis, and bicipital tendonitis. Other than the shoulder, there are other areas that are prone to bursa problems. These are usually joint areas that receive a great deal of active use, such as the elbow, knee and hip. When the elbow is affected it is called olecranon bursitis, commonly known as miner’s elbow. When the knee is affected it is called pre- or suprapatella bursitis, or housemaid’s knee.

 Pain in the gluteal and upper thigh area, when caused by a bursa is usually due to iliopectineal (iliopsoas), ischial, more commonly known as the tailor’s or weaver’s bottom. Other areas are also affected such as the Achilles tendon and great toe areas. The etiolgy (causes) of bursitis is unknown. However it is generally thought to have inflammatory origins, such as a trauma that is caused by overuse, such as excessive exercise, repetitive motions such as occupational, or an inflammation due to arthritis, rheumatoid arthritis or gout.

 In acute bursitis, there is extreme pain and usually inflammation. There is limited movement involved, and moving the joint causes a sharp increase of pain. If there are repeated episodes of acute bursitis attacks, the condition may become chronic. When this occurs, the bursa becomes thickened and adhesions can readily develop. At this stage there will be limited range of motion. Muscles can become atrophied and weakened. If the condition persists for any length of time, as in the case of the shoulder, the individual could sustain a frozen shoulder because of the limited range of motion.

 Preventing shoulder pain from becoming chronic, whether it is caused by bursitis, rotator cuff injuries, tendinitis, or other causes, “RIMS”, should be used by the individual. What this means is as follows:

 R: Rest is key for the first 24 to 48 hours. A note of caution, do not keep arm in a sling. When walking, you can hook your thumb in a shirt or on a belt to keep the arm from dangling and putting pressure on the shoulder joint.

I:  Ice-cold applications to reduce inflammation and swelling 3-4 times daily for the next 24 to 48 hours.

M: Mobility. Increase gentle movement of the injured joint to prevent it from becoming frozen.

S: Strengthen. Exercise (slowly at first), to strengthen muscles and ligaments to restore normal range of motion.

 When bursitis of the elbow occurs, the bursa at the tip of the elbow fills with fluid and it appears as a golf ball size protuberance. Very often there is pain at the site, especially when there is pressure placed on it, increasing the irritation and at times some inflammation and redness can be present. Quite often the fluid will be absorbed, but if this does not occur, your healthcare provider can drain the fluid. Applying cold compresses can prove to be helpful. There are other causes of elbow pain, and the most common is, tennis elbow. This affects the outer tip of the elbow (lateral epicondyle) and the outer portion of the upper forearm. Treatment here is best applied by “RICE”. It is easy to remember and applied as follows:

 R: Rest for the injured area is a must. Here too, the arm should not be left dangling when walking, but can be supported as mentioned above, or cup your other hand under the elbow to support the painful arm.

I:  Ice the injured painful area 3-4 times daily for the next 24 to 48 hours.

C: Use a compression bandage around the upper arm, just below the elbow.

E: Elevate and support the arm by placing a pillow under it while sitting or lying down.

 Injuries to the hip can cause a variety of problems. One such problem is bursitis. It is always important to have your healthcare provider check when you have pain of any kind. Getting a definitive diagnosis can dictate the type of treatment you will need. Should the problem prove to be bursitis, the treatment will basically be similar to the above conditions. With bursitis of the hip, it may be wise to use a cane for short period of time, in order to keep pressure off the area. Use the RIMS and RICE as mentioned above.

 Bursitis of the knee is also quite common, and here too, the treatment will be mimicked as above, using a combination of RIMS and RICE. In severe cases use of the cane may be a useful adjunct, and compression in the form of a bandage or knee brace may be needed.

 In addition to the treatments mentioned above, the use of a good analgesic gel can prove to be very helpful. Such a gel as BIOFREEZE® is an excellent analgesic gel to use. It will help alleviate the pain and reduce inflammation of the painful area. Knowing your condition and treating it promptly and correctly, can reduce your pain and time of immobility.