COPING WITH BURSITIS
Bursitis refers to an inflammation of the bursa—the small, fluid-filled sac that allows friction-free motion of muscles and tendons over bones. The bursal sac is lined with a membrane that, much like the synovial lining of the joints, produces a lubricating fluid. Bursitis can be detected through a careful clinical examination by your doctor and through special state of the art imaging tests such as musculoskeltal ultrasound. There are 80 bursae on each side of your body. Each one has its own special protective role. You can develop the swelling and pain of bursitis in your upper or lower extremities, but it usually occurs in the bursae around your elbows, shoulders, hips, knees, and other large joints. Bursitis is a very common ailment, affecting between five and ten percent of people over age 65. Women suffer more frequently than men from bursitis at most ages. Common forms of bursitis include:
Upper Extremities
- Subacromial Bursitis
Shoulder pain is one of the most common musculoskeletal complaints for people over age 40. Your shoulder is a complex ball and socket joint that facilitates arm movement in all directions. Normally, many types of structures, including muscles, bones, ligaments and tendons, effortlessly come together at your shoulder, allowing it to function properly and coordinating pain-free motion. The bursae protect these structures and facilitate frictionless movement.
Several “sister" bursae in your shoulder are potential pain culprits, but the most common type of shoulder bursitis is subacromial bursitis, which is often associated with another condition—rotator cuff tendinitis, also known as impingement syndrome (see page x).
Subacromial bursitis causes pain and aching in the front or side of your shoulder. If it's severe enough, your shoulder may also swell or feel warm. Because it hurts when you lift or rotate your arm, or raise it above your head, your shoulder's range of motion may be limited. Subacromial bursitis is sometimes the result of repetitive shoulder motion, such as overhead lifting. Arthritic conditions can also contribute to this ailment.
- Olecranon Bursitis
Because it often results from chronic and prolonged pressure on your elbow, such as leaning on a table or desk for long periods of time, this ailment is sometimes called "student's elbow." It may also occur after a blow or other sudden injury.
Inflammatory conditions such as gout, pseudo-gout or rheumatoid arthritis may play a role in the development of student's elbow. Less frequently, it may be the result of infection (septic bursitis) or it may develop if you are undergoing dialysis for kidney disease.
Whatever the cause, your elbow reddens, feels warm or becomes tender. You may also develop a fluid-filled sac around the joint.
Lower Extremities
- Prepatellar Bursitis
Also known as "housemaid's knee," this ailment can result from prolonged kneeling on a hard surface. It causes redness, swelling and pain around the front of the lower portion of your kneecap. It is especially painful if you apply pressure to your knee.
- Infrapatellar Bursitis
A relative of prepatellar bursitis, this condition involves the bursa right below your kneecap, between the patellar ligament and the shinbone.
- Pes Anserine Bursitis
Pes anserine bursitis is a common ailment in obese middle-aged or elderly women. If you take your fingers and place them on the medial, or inner, portion of your knee about two inches below the knee cap and press, prepare to yelp! Walking up steps can also be painful.
- Ischial Bursitis
Your ischial bursa is strategically located on top of your “sitting bone," the ischial tuberosity, and below your gluteus maximus, the large muscle in your buttock. Ischial bursitis may be caused by trauma, but it is more often the result of sitting on a hard surface for long periods of time. This accounts for its common name, "Weaver's bottom."
The pain of ischial bursitis can be excruciating. And because this bursa is situated so close to the gluteus maximus, you may also experience “referred” pain (pain not precisely at the site of injury) throughout the back of your buttock and thigh.
In addition to the standard conventional and complementary treatments (see below), you may get relief from sitting on a special gel-filled cushion.
- Trochanteric Bursitis
The trochanter is a large, flat, expansive portion of your thigh bone, or femur. Since it is an anchor for many hip muscles, the trochanter is especially susceptible to injury.
More common in middle-aged and older people and in women, trochanteric bursitis causes aching pain and tenderness in the upper, outer part of your hip and the outer thigh. A good way to confirm this ailment is to apply deep pressure to the trochanteric area (over the side of your hip) and see if it hurts. You may also feel multiple tender points throughout your outer thigh muscle. It typically hurts more when you move your hip outward with your knee flexed at 90 degrees.
Besides traumatic and overuse injuries, rheumatoid arthritis, lumbar spine disease, leg-length discrepancy and scoliosis may cause this problem. Your risk of developing trochanteric bursitis rises if you spend a lot of time on your feet, putting pressure on your hips, or if you are bedridden for long periods because of illness.
- Iliopectineal/Iliopsoas Bursitis
Inflammation in the bursa located between your iliopsoas muscle and the inguinal ligament in your groin may cause tenderness and pain in that area. You may feel it when you bring your hip back (extension). Don't be surprised if you notice that your stride length is shorter; that's because you may be unconsciously taking smaller steps to avoid triggering pain when you extend your hip.
Bursitis of the Feet
- Retrocalcaneal Bursitis
This condition causes pain at the back of your heel, behind your Achilles tendon and in front of your calcaneus, or heel bone. It hurts most when you bring your foot and toes up (dorsiflexion). Common causes include bad shoes, walking too much, and trauma to your foot. In addition, certain diseases such as arthritis, gout, spondylitis and Reiter's syndrome can contribute to its development.
- Achilles Bursitis
Also known as "pump bumps," this condition is all too common in women, thanks to tight, foot-damaging, high heeled-shoes. It occurs in a bursa located next to the lower portion of your Achilles tendon, right above the spot where your tendon attaches to the back of your heel bone. Sometimes, Achilles bursitis is the result of inflammatory diseases like gout, arthritis, and ankylosing spondylitis. (However, ankylosing spondylitis, or AS, is three times less common in women than men).
Causes
In addition to the specific causes I described above, infection, injury, overuse, and prolonged pressure may all lead to inflammation and increased fluid in your bursae. Rheumatic disease or calcium build-up on the tendons connected to your joints may also contribute to the problem.
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