What is bursitis?
For bursitis means an inflammatory process of the serous bursa of a joint. The serous bags are fabric bags filled with synovial fluid which are found in the tendons and joints of the body. There are over 150 bags in the human body, and when these are healthy they create a practically smooth surface deprives of friction, which guarantees it scrolling painless of the tendons and gods muscles that are in contact with you. Bursitis occurs when these bags become inflamed, causing inflammation and synovitis, making movement painful and difficult. Tendons and muscles, contracting in contact with suffering bags, cause microtrauma that can aggravate the problem.
The causes of bursitis they are varied and diverse. They can be related to repeated movements which generate stress that in the long run inflame the bags, especially if these movements involve the lift of heavy objects. They can be related to pressures continue over time, for example in elbow bursitis which can result from prolonged supports on the elbow itself. You can also have bursitis following a trauma even minor, such as a mild one distortion. Bunions may more rarely be related to inflammatory diseases more serious like the gout, L'rheumatoid arthritis or infections (septic bursitis).
The development of bursitis becomes more frequent with aging. Being overweight generates mechanical overload on the lower limbs making the development of knee bursitis and hip bursitis more common. Some sport or even some occupations make it easier for these problems to arise: jobs that require you to stay on your knees for prolonged periods can lead to the development of prepatellar bursitis (a type of knee bursitis), sports that involve throwing objects with your hands can lead to development of shoulder bursitis.
Types of bursitis
The most common types of bursitis are shoulder, elbow and knee bursitis. However you can also have:
- hip bursitis, also called trochanteric bursitis or trochanteritis. It is often the result of trauma, repeated movement, or osteoarthritis. It is more common in women and older people. Trochanteric bursitis does not cause pain in the groin, as typically occurs in hip diseases, but in a lateral bony prominence in the root of the thigh (trochanter).
- iliopsoas bursitis, inflammation of a bursa in a muscle, the psoas, located deep in the abdomen and which descends through the groin to enter the femur. This type of bursitis causes pain in the groin or hip, and is especially aggravated with extension of the lower limb.
- knee bursitis, also called bursitis of the goose leg or anserine bursitis. It is an inflammation of a bursa placed on the inner face of the tibia, between the bone and three tendons that enter it, forming the goose leg (these are the tendons of the semitendinosus, sartorius and gracilis muscles). It is the most common cause of knee pain in young and athletic subjects. Other forms of knee bursitis are infrotellar bursitis or simply patellar bursitis, which can cause abundant accumulation of fluid commonly referred to as "fluid in the knee" or "water in the knee", linked to repeated knee flexion movements such as climbing stairs. and pre-patellar bursitis, typical of people who spend a lot of time on their knees.
- ankle bursitis. You can have one retrocalcaneal bursitis (also called calcaneal bursitis) or one bursitis of the Achilles tendon (bursitis of the heel). In addition to trauma and overload, these types of bursitis they may depend on incorrect support during walking, in relation to foot problems (cavus / flat foot) or the use of unsuitable footwear, for example because they are too rigid, which can excessively compress the bags against the heel during walking . A foot problem not to be confused with bunion is the hallux valgus, linked to an imperfect alignment of the phalanx of the first toe with respect to the first metatarsal, for which please refer to the specific page.
- shoulder bursitis, linked to inflammation of the serous subacromion-deltoid bursa (subacromial bursitis), mainly due to trauma, falls on the shoulder or upper limb, sudden and repeated movements of throwing objects or lifting heavy objects above the head.
- elbow bursitis (or olecranial bursitis), caused by inflammation of the olecranon bursa. It is generated by trauma or by prolonged compression of the bag when you lean for a long time with the elbow on hard surfaces. This issue is also called "student's elbow". It is to be differentiated from tendon problems such as epicondylitis and epithrocleitis, linked to inflammation of the extensor and flexor tendons that are inserted in the elbow.
- ischial bursitis, caused by inflammation of a bursa between the gluteus maximus muscle and the ischial tuberosity. It is usually caused by prolonged sitting on a hard surface.
- foot bursitis or bursitis of the wrist, rare and to be differentiated with other problems of hands and feet.
Regardless of the district in which it occurs, i symptoms of the bursitis are the same to be paid by anyone articulation. Yes it has inflammation with pain, buildup of liquid in the bursa with joint effusion e swelling which is more evident the more severe the bursitis, heat which can be felt by touching the pain site and redness of the skin. These four symptoms are not always present all together, depending on the severity the redness, heat and swelling may not be evident. However, an inflamed bursa is always painful, especially during or after activity. Pain can also lead to difficulty in moving the affected joint, with the appearance of joint stiffness.
There diagnosis of bursitis is placed by the doctor on the basis of symptoms. It is also useful to know the patient's working and sporting habits, which is good for the patient to communicate. Bursitis must be differentiated from other possible ones joint problems, such as tendinitis, arthritis or arthrosis. For this reason, in the most doubtful cases, the doctor can make use of various types of tests, first of all ultrasound is radiography. Ultrasound is able to determine whether the inflammation is caused by the serous bags or tendon structures, allowing them to be precisely identified. Radiography is useful if there are no problems with the ultrasound, and arthrosis is suspected. An orthopedic specialist visit may also be useful for both diagnosis and therapy. It is not usually necessary to perform an MRI scan for the diagnosis of bursitis, it is good to reserve this examination for more serious problems.
What to do in case of bursitis? How to cure bursitis? There care of the bursitis it may also require preventive interventions, such as trying to avoid certain activities that can cause trauma or overloads at the level of the joints involved. In case of hip bursitis, it is good to avoid strenuous physical activities such as running and resting. In case of bursitis to the Achilles tendon or bursitis in the heel it may be necessary to change shoes using softer footwear, and some specific physiotherapy exercises may be useful. If you have prepatellar bursitis, you should avoid staying on your knees for long, or if you need to work on your knees you can prevent the problem by using knee pads.
In case of various bursitis remedies can be used for the treatment. Pain can be fought with non-steroidal anti-inflammatory drugs (NSAIDs), also available in the form of local ointment. Before taking any drug, you must contact your doctor to set up the therapy. Maintaining the joint may also be helpful rest, to apply ice intermittently and use guardians or compression bandage. Other types of physical therapies have been used mainly in joint diseases other than bursitis, such as tendinopathies and calcifications (especially of the elbow and shoulder): for example TECAR or the ultrasound therapy. These treatments can be used to try to reduce inflammation and facilitate healing.
Sometimes, especially in knee bursitis or shoulder bursitis, there is such a liquid effusion that it becomes necessary to remove some of the fluid from the joint. In this case we speak of arthrocentesis, aspiration of the liquid that must be performed by a specialist, also using an ultrasound-guided method with the help of ultrasound.
In untreated trochanteric bursitis, cycles of infiltration local with anti-inflammatory or anesthetics. This is also done in trochanteric bursitis not responsive to anti-inflammatory drugs and to appropriate physiotherapy. In this and some other types of bursitis, if there is no response to medical therapy, a surgical approach can be considered in severe cases.
Interventions of bursectomy, under local or general anesthesia, also with minimally invasive arthroscopic methods. It is usually necessary to use crutches for a few weeks after surgery. After surgery, good physiotherapy is essential to regain range of motion and limit stiffness. There are reports of treatment of trochanteric bursitis and bursitis of the elbow with surgery, but large studies have never been performed.
- Williams BS, Cohen SP (2009). "Greater Trochanteric Pain Syndrome: A Review of Anatomy, Diagnosis and Treatment". Anesthesia & Analgesia. 108 (5): 1662–1670.
- Vigorita V, Ghelman B, Mintz D (2008). Orthopedic Pathology (Second ed.).