Bursitis represents a common yet often misunderstood musculoskeletal condition characterized by inflammation of the bursae—small, fluid-filled sacs that act as cushions between bones, muscles, tendons, and ligaments.

These bursae facilitate smooth movement by reducing friction during joint motion.

The Anatomy and Function of Bursa

Bursae are synovium-lined sacs strategically positioned near bony prominences throughout the body, most commonly adjacent to major joints such as shoulders, elbows, hips, and knees. The human body contains over 150 bursae, many of which serve the critical role of cushioning soft tissues from excessive friction and pressure during regular movement.

By creating a gliding surface, bursae allow tendons and muscles to slide smoothly across bones, thus preserving joint integrity and function.

Pathophysiology and Causes of Bursitis

Bursitis develops when one or more bursae become inflamed or swollen, usually due to irritation or injury. The pathogenesis is often multifactorial, with mechanical stress playing a principal role. Prolonged pressure over a bursa—for instance, repetitive kneeling, leaning on elbows, or engaging in repetitive overhead activities—elicits microtrauma that leads to inflammation.

This makes bursitis highly prevalent among individuals engaged in occupations or sports requiring repetitive joint use.

Trauma, both acute and repetitive, is another common trigger. An example is striking the elbow, which may provoke olecranon bursitis. In some cases, injury introduces bacteria to the bursa, leading to septic bursitis, a more severe infection typically caused by Staphylococcus aureus.

Clinical Presentation: Recognizing Bursitis

Symptoms vary according to the affected bursa and underlying cause. Acute bursitis generally presents with localized pain, swelling, warmth, and tenderness. Movement involving the inflamed bursa exacerbates pain, often causing restricted joint mobility. Chronic bursitis may present more subtly, characterized by swelling and persistent joint discomfort but less intense pain.

Different anatomical sites exhibit characteristic manifestations. Shoulder bursitis often presents with shoulder pain worsened by overhead activities. Elbow bursitis, particularly olecranon bursitis, manifests as swelling at the elbow’s tip. Prepatellar bursitis, common among those frequently kneeling, causes swelling and tenderness over the kneecap. Hip bursitis, especially greater trochanteric bursitis, results in outer hip pain that can radiate to the thigh.

Diagnostic Approach: Beyond Clinical Exam

Diagnosis primarily relies on detailed history taking and physical examination. Clinicians assess for localized swelling, tenderness, and pain provoked by joint movement or pressure. Differentiating bursitis from other causes of joint pain such as tendinitis, arthritis, or fractures is essential.

Imaging modalities such as ultrasound and magnetic resonance imaging (MRI) assist in visualizing inflamed bursae and differentiating bursitis from other soft tissue pathology. Ultrasound is particularly valuable for guiding aspiration or injection procedures. Joint fluid aspiration and analysis are crucial when infection is suspected, allowing identification of causative organisms.

Management Strategies: Individualized and Multimodal

Treatment of bursitis aims to relieve symptoms, reduce inflammation, and restore joint function. Initial management involves conservative measures such as rest, activity modification to avoid aggravating movements, ice application, and nonsteroidal anti-inflammatory drugs (NSAIDs) to mitigate pain and inflammation.

Physical therapy plays a pivotal role in strengthening surrounding muscles, improving joint biomechanics, and preventing recurrence. Protective padding or ergonomic adjustments may benefit those exposed to repetitive pressure.

In resistant or severe cases, corticosteroid injections into the bursa provide potent anti-inflammatory effects. For septic bursitis, prompt antibiotic therapy targeting the causative bacteria is mandatory, sometimes coupled with surgical drainage.

"For example, if you have a foot injury, it can change the way you walk," explained Dr. Jeffrey Katz, Professor of Medicine and Orthopedic Surgery. "Maybe you don’t even notice it, but you limp a little. That subtle change can give rise to some inflammation in the bursa."

Prevention and Lifestyle Considerations

Preventive measures focus on minimizing repetitive joint stress and protecting vulnerable areas. Proper ergonomics in occupational and recreational activities, use of cushioning pads, and adequate stretching routines reduce the incidence of bursitis. Maintaining a healthy weight alleviates excessive pressure on weight-bearing joints.

Bursitis is an inflammatory condition of the bursae that significantly impairs joint function and quality of life if left untreated. Understanding its diverse etiology from mechanical overload and trauma to infection and systemic inflammatory diseases—aids in accurate diagnosis and effective treatment.

With proactive preventive measures and early therapeutic intervention, the debilitating consequences of bursitis can often be avoided, allowing individuals to maintain active, pain-free lifestyles.