A friend recently recounted how the arthritis in her hip had become really uncomfortable, but there wasn't much she could do about it, other than surgery. So you can imagine her happy surprise when she had bursitis, not arthritis, and it could indeed be treated and healed. As people become increasingly frustrated with the medical system, how many others are self-diagnosing their painful joints as arthritis, and so believe nothing can be done to resolve the problem? On behalf of all the do-it-yourselfers out there, I called orthopaedic surgeon James V. Luck, Jr., MD, medical director of Orthopaedic Hospital in Los Angeles for information about how to distinguish bursitis from arthritis. It's not unusual for people to confuse these two, Dr. Luck told me, since both appear as pain in the joints and occur more frequently with age.
WHERE DOES BURSITIS
COME FROM?
A bursa is a fluid-filled sac. These bursae or sacs are located throughout the body, wherever tendons or ligaments move across joints, to protect the bones, tendons and muscles surrounding joints from friction during movement. Sometimes, repeated pressure, overuse, acute physical stress or just age can cause bursae to become inflamed and secrete excess fluid, which pools inside. The affected area becomes painful and there may be swelling, heat or redness. While the body has more than 150 bursae, "bursitis" is most apt to develop in the elbows, hips, shoulders, knees, heels and toes.
WAYS TO IDENTIFY BURSITIS
Starting with bursitis of the hip (trochanteric bursitis), Dr. Luck says the easiest way to distinguish it from arthritis is usually by the location of the discomfort. Arthritic pain typically starts in the hip joint, which is found near the groin, at the midpoint on the crease between the thigh and the pelvic area. It may then move into the leg and sometimes even the knee, leading many patients to think the problem is there, says Dr. Luck. With hip bursitis, on the other hand, the pain is usually felt in the large protrusion, sometimes referred to as the "hip bone," more accurately called the greater trochanter. This is where the uppermost part of the thighbone juts out, along with muscles, tendons and, of course, bursae. Hip bursitis is most often triggered by long periods of sitting, standing or frequent bending from the hips. Most physicians feel physical deconditioning (loss of physical fitness) contributes to trochanteric bursitis as well.
Bursitis of the elbow (olecranon bursitis) develops in the back side of the elbow, where one often leans on things. Inflammation of that bursal sac is tender to the touch, and creates a great deal of excess fluid and usually considerable swelling that feels like a balloon sitting under the skin. Infection occurs easily with elbow bursitis, says Dr. Luck. The inflammation is so near the surface of the skin that even a small cut can allow bacteria to enter and infect -- making it very important to seek medical care for this bursitis. People most at risk are students (especially older ones) and those who bend their arm back and forth in work or for sports such as tennis and golf.
Heavy use of the shoulder, for sports or work, puts people at risk for bursitis located there. This can be more complex, though, because it frequently appears in tandem with inflammation of the tendons -- a combination referred to as impingement syndrome. The resulting pain radiates through the shoulder and is difficult to differentiate from arthritis, says Dr. Luck. One way to tell if pain is caused by bursitis is by raising the affected arm from the sides... if that causes pain, it is likely bursitis. (The converse is also true -- pain moving the arm forward and back indicates the problem is more likely arthritis.) Complicating the picture further, there is often a concomitant rotator cuff tear (a tear in the shoulder's tendon and muscle group) since such tears, which are more common as people age, are often the trigger for bursitis. In contrast, arthritis of the shoulder would cause pain over a larger area and range of movement.
Bursitis in the knee can flare in two different locations. Prepatellar bursitis is when the bursa overlying the kneecap can fill, feeling extremely swollen and spongy, says Dr. Luck. A bursa in the back of the knee (called a Baker's Cyst) can also fill with fluid, but in this case the fluid may be coming from the knee as well as the bursa itself. With this type of bursitis an MRI is needed to determine whether the knee is the real underlying source of the problem, in which case a different treatment plan will be followed.
TREATMENT FOR BURSITIS
Assuming there is no other injury that calls for medical attention (as may be the case in the shoulder or knee) most bursitis can be treated in the short term at home with R-I-C-E -- that's Rest, Ice, Compression and Elevation. Consult your physician as to how to best use these strategies. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) can help reduce both inflammation and pain, though, as always, you want to take the lowest dose possible and be alert to side effects.
For best healing, once the diagnosis of bursitis is confirmed, it is also crucial to build muscle strength with exercising. However, Dr. Luck advises patients to seek out a physical therapist or ask their physician about the correct exercises and ergonomic adjustments, since the wrong ones can do more harm than good. If these efforts fail to resolve the discomfort, your doctor may advise a corticosteroid shot to suppress the inflammation. If this doesn't work, the bursa can be aspirated with a syringe to draw out excess fluid, which usually provides short-term relief, and helps it heal. In extremely persistent cases, the inflamed bursa can be removed surgically, a short, relatively routine procedure, allowing the body to better heal the inflamed area.
PREVENTION IS THE BEST MEDICINE
Fortunately, there are things you can do to prevent getting bursitis at all. Keep your body strong with regular, low-impact aerobic exercise, but be careful -- both at work and playing sports -- to avoid overusing any joints. Stretching exercises are also important. Cushion joints that you lean or sit on, i.e., the elbows and buttocks, not only for comfort but to prevent irritation surrounding the bursae. In the event that you develop bursitis anyway, identify the activity that is the likely culprit and figure out what changes you can make to stay bursitis-free in the future. As always, make sure you are as healthy as you can be by eating a healthful diet, which goes far toward keeping your body healthy and pain-free.
Source(s):
James V. Luck, Jr., MD, president, CEO and medical director, Orthopaedic Hospital, Los Angeles.
