Bursitis Frequently Asked Questions (FAQ)

What Causes Bursitis?

Bursitis is most often caused by repetitive, minor impact on the area, or from a sudden, more serious injury. Stress, overuse, injury, or prolonged pressure on a bone can cause trauma to the soft tissue in a joint including the bursa. Injury to the bursa can result in widening of the blood vessels in the sac. This allows foreign fluids, blood and proteins to enter the bursa. When this occurs, the bursa reacts by swelling and you experience pain in the joint, especially when pressure is applied and during movement. These symptoms will continue until the fluid and/or proteins leave the bursa or they are broken down.

Some high risk activities for bursitis include overuse in areas such as gardening, raking, carpentry, shoveling, painting, scrubbing, tennis, golf, skiing, throwing, and pitching

Bursitis Caused By Acute Trauma

Acute trauma bursitis refers to bursitis caused by a direct blow to or twisting of the joint. For example, something as simple as an awkward fall may cause you to bang your hip or elbow, or you might bang twist your knee or ankle causing the bursa to be pinched. These types of injuries can cause serosanguineous discharge, a fluid composed of serum and blood, to leak into the bursa.

Serosanguineous fluid causes irritation and inflammation in the bursa and surrounding area resulting in pain and swelling.

Symptoms of acute bursitis are redness, tenderness of the joint, swelling & pain. Tenderness and pain will usually increase when you push on the bursa. If the bursitis is recent, redness and tenderness may take a few hours or a few days to appear.

Bursitis Caused By Chronic Trauma

This refers to repeated minor injuries to the bursa that occurs in one spot over time. It can be caused by repetitive motion, prolonged pressure on a joint, or an abnormality in the body that causes excess friction. With repeated injury, the bursa becomes irritated and thickens over time.

Working in a profession or enjoying a hobby that requires repetitive motion puts you at an increased risk of developing bursitis. For example hip bursitis is common in runners, shoulder bursitis in baseball players and painters, and elbow bursitis is often suffered by those who enjoy a frequent game of darts. As you repeat the same motion the bursa becomes over worked, irritated and eventually inflamed.

Wear and tear due to prolonged pressure on a joint can also cause bursitis. For example, resting your elbows on a table can cause olecranon bursitis (also known as student's elbow) or sitting on a hard surface for extended time periods can cause ischial bursitis (also known as weaver's or tailor's bottom). You may experience prepatellar bursitis (also known as housemaid's knee) if you are a carpet or tile layer or a gardener. Similarly, figures skaters or women wearing improper footwear are at risk of developing retrocalcaneal bursitis or Achilles bursitis. This type of bursa trauma usually occurs in athletes who overuse a joint or during middle age as wear and tear over the years begins to take its toll on our joints.

Abnormalities in the body that can cause excess friction can also cause increased irritation in a bursa. An example of this would be a mineral deposit, such as calcium, in a joint that rubs against a tendon or muscle. Other situations that may cause irregular friction in a joint are bone spurs, a loss of cartilage, or an abnormal bone growth such as a hooked acromion in the shoulder. When these obstructions exist, minor traumas within the joint occur over time, the bursa can become inflamed and the first signs of bursitis begin to develop; pain, swelling, and stiffness.

Bursitis Caused By Abnormal Depositis Due to Medical Conditions Such as Arthritis or Diabetes

Medical conditions such as rheumatoid arthritis, osteoarthritis, scleroderma, gout, thyroid disease and diabetes can increase the risk of developing bursitis. These conditions can cause crystal deposits (gout) or calcific loose bodies (rheumatoid arthritis) to form within the joint causing irritation and inflammation in the bursa and surrounding tissue. For example, bursitis is common in people with gout because of their inability to properly break down uric acid which is a natural by-product of metabolism in the body. When it is not broken down properly, the excess acid begins to crystallize and settle in the joints.

Bursitis Caused By Infection

If your bursa becomes infected it is referred to as septic bursitis. Septic bursitis is usually caused by a bacteria know as staphylococcus epidermis (or staphylococcus aureus) that is commonly found on the surface of the skin. Bursae that are located just below the skin are more susceptible to infectious bursitis due to abrasions on the skin covering the bursa (the elbow is . With infectious bursitis the bursa fills with pus instead of blood or fluid and the area surrounding the bursa appears read and is very tender. Some septic bursitis stats: [1]

• Most cases of septic bursitis occur in males approximately 50 years of age
• Most cases of septic bursitis are due to repetitive trauma related to occupational behaviors. Plumbers, carpenters, roofers, clergy, and athletes are commonly affected.
• The staphylococcus aureus bacteria is responsible for 80% to 90% of all cases
• Infection of the bursa happens most often from micro-trauma or direct puncture of the overlying skin causing subsequent infection. In some cases, punctures due to steriod injections (with the intent of providing relief from non-infectious bursitis) have caused infection.
• People that suffer from gout and inflammatory arthritis are at an increased risk of septic bursitis.

In situations where bursitis has developed due to infection (aka "septic bursitis") you MUST see a doctor for prescribed antibiotics and possibly drainage of the bursa.