A Complete Guide to Bursitis and Common Joints Affected

Bursitis is the inflammation of a fluid-filled sac (bursa) around a joint. The bursa helps tendons slide smoothly over and around bones. An inflamed bursa can cause pain, swelling, and stiffness in the affected joint. Bursitis can be painful, even when a joint is at rest. There are many causes of bursitis, including chronic overuse or pressure, but sometimes the cause is unknown. Likewise, joint pain can have several causes, and bursitis is just one of them. Conservative treatments are the mainstay of treatment, regardless of the cause.

This article reviews bursitis, including the types, symptoms, causes, and treatments. 

Bursae are fluid-filled sacs around the joints. They act as cushions that separate bones from soft tissues, such as tendons, muscles, and skin. Bursae allow tissues to slide smoothly over and around bones, reducing friction and stress.

Bursitis occurs when a bursa swells. An inflamed bursa can cause pain, swelling, and stiffness in the affected joint.

Bursitis can develop acutely, or it can become a chronic condition that comes and goes over a long period of time. It can occur as a result of:

• trauma to a joint
• overuse of a joint
• medical conditions, such as arthritis or gout

Bursitis is most common in middle-aged individuals. Although it is usually not a serious condition, it can severely impair mobility in the affected joint.

Talk with your doctor if you have new joint pain or swelling. If you already have been diagnosed with bursitis, contact your doctor when experiencing recurrent or persistent joint symptoms.

The human body has more than 150 bursae throughout its myriad of joints. Any of them can develop bursitis. However, some are more vulnerable than others to the inflammation of bursitis.

Bursitis commonly occurs in the following joints:

• buttocks (weaver’s bottom)
• elbows, the most common type of bursitis
• hips
• knees
• shoulders, especially in people with rotator cuff problems

Other potentially affected joints include the ankles and great toe.

Symptoms of bursitis include pain and swelling around a joint, as well as limited motion. Symptoms can be severe, and they may come and go with physical activity or for no apparent reason.

Common bursitis symptoms can include:

• a dull ache or feeling of stiffness in the joint
• joint pain, especially with motion
• redness around the joint
• reduced mobility and range of motion of the joint
• inflammation around the joint
• visible deformity of the affected joint

With chronic bursitis, the condition may no longer be acutely painful. Instead, over time, the swelling and thickening of the bursa may only limit motion or cause a dull ache.

Anything that inflames the fluid-filled bursa can cause bursitis. The most common cause of bursitis is chronic overuse or pressure, while trauma is the second most common cause. 

Other causes can include:

• autoimmune conditions, such as scleroderma and systemic lupus erythematosus
• gout 
• infections (septic bursitis)
• osteoarthritis
• psoriatic arthritis
• rheumatoid arthritis 
• spondylitis and spondyloarthropathies

For cases when doctors cannot identify a cause, the term used is idiopathic bursitis.

Bursitis can affect any person. However, some types of bursitis tend to affect certain groups more. For example, females are more prone to hip bursitis due to the structure of their hips. Males tend to get elbow bursitis, which could relate to labor trades.

Risk factors for bursitis include:

• chronic medical conditions, such as arthritis, gout, or diabetes
• immunosuppression
• obesity
• older age
• prolonged joint pressure
• repetitive joint motion

Not all people with risk factors will get bursitis. 

Bursitis has relatively few complications, but it can limit your mobility. Therefore, treatment is important to maintain joint movement and activity.

Bursitis most often heals on its own. Anti-inflammatory medications and rest can support the process. However, symptoms may recur at a later time after successful treatment.

For most bursitis cases, common and simple treatments include:

• taking antibiotics, which can treat infectious bursitis
• icing the joint to help reduce swelling and relieve some of the pain
• using nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin) to reduce pain and decrease swelling
• starting physical therapy to stretch, strengthen, and increase flexibility around a joint, which can also help prevent bursitis from recurring
• prioritizing rest, as the bursa can heal only if it is free from additional movement that could further inflame it
• using supportive devices, such as braces, splints, or canes, to relieve pressure from the bursa

When conservative treatments do not work, doctors may recommend the following treatments:

• corticosteroid injections to reduce inflammation in the bursa, which doctors often combine with drainage of excess fluid from the bursa
• drainage of excess fluid in the bursa by needle, which may eliminate the pain and help the bursa to heal more quickly
• surgery, which may be necessary if symptoms do not improve with other treatments

Bursitis does not usually result in serious complications. The most common complication of bursitis is subsequent recurrence. This can occur without proper treatment or if you continue the triggering activity.

You can help prevent bursitis recurrence by:

• avoiding activities that aggravate the bursa
• practicing daily stretches and range-of-motion exercises
• maintaining a target body weight
• wearing joint pads, such as elbow or knee pads, to protect them

Here are some questions people commonly ask about bursitis.

Shoulder bursitis usually involves the subacromial or subdeltoid bursae. The subacromial bursa sits deep in the shoulder under the collarbone. The subdeltoid bursa sits underneath the deltoid muscle and over the top of the arm bone. Shoulder bursitis is common in people with rotator cuff problems. Physical therapy is very important to prevent frozen shoulder.

Several things can trigger bursitis, including an infection. However, the most common triggers are chronic overuse, prolonged pressure, and trauma.

Most cases of bursitis resolve on their own. However, it is possible for bursitis to become chronic or to recur.

If you do not have any other medical conditions, untreated bursitis may heal on its own. However, treating it will improve your comfort and can speed up the healing process.

When underlying medical conditions are present, symptoms may continue to worsen or may resolve and recur. Infectious bursitis can also worsen without treatment and cause serious complications, such as sepsis.

Bursitis is a common joint problem that most often affects the shoulders, elbow, hips, and knees. An inflamed bursa in these areas can cause swelling, redness, and limited motion.

Most cases of bursitis respond well to conservative treatments. This includes resting the joint, icing it, and taking NSAIDs. Infectious bursitis requires antibiotic treatment.