Bursitis

Bursitis is a common and often painful condition that affects the bursae—small, fluid-filled sacs that cushion the bones, tendons, and muscles near joints. Whenever these bursae become inflamed, the result is bursitis, which can significantly impair mobility and quality of life if not treated appropriately. This document delves into the causes, symptoms, diagnosis, treatment, and prevention of bursitis, providing a thorough exploration of the condition for medical and general audiences alike.

Understanding Bursae and Bursitis

Bursae are thin, slippery, and strategically located sacs that reduce friction and allow free movement of skin, muscles, and tendons over bony prominences. The human body contains over 150 bursae, each serving as a cushion at key points such as the shoulders, elbows, hips, and knees.

Bursitis occurs when one or more of these bursae become irritated or inflamed, causing pain and restricted movement in the affected area. Bursitis can be acute (short-term) or chronic (long-term), depending on the underlying cause, duration, and frequency of flare-ups.

Causes of Bursitis

Bursitis can arise from a variety of factors, often involving repetitive motions or excessive pressure on a particular joint. Common causes include:

• Repetitive Movement or Overuse: Activities such as gardening, painting, scrubbing, or throwing a ball can lead to repetitive strain on the joint, causing irritation of the bursa.
• Direct Trauma: A sudden blow or fall can injure the bursa, leading to inflammation and pain.
• Prolonged Pressure: Leaning on elbows for extended periods or kneeling for long durations can inflame the bursae in those areas.
• Infection (Septic Bursitis): When bacteria enter the bursa through a cut, scrape, or puncture wound, it may lead to septic bursitis, which requires immediate medical attention.
• Underlying Medical Conditions: Conditions such as rheumatoid arthritis, gout, and diabetes can predispose individuals to bursitis.
• Aging: As people age, the tendons become less elastic and more prone to stress, increasing the risk of bursitis.

Common Sites of Bursitis

While bursitis can occur in any bursa in the body, certain locations are more frequently affected:

• Shoulder (Subacromial Bursitis): Often caused by repetitive overhead activities or trauma.
• Elbow (Olecranon Bursitis): Known as “student’s elbow” or “miner’s elbow,” typically resulting from prolonged leaning or direct trauma.
• Hip (Trochanteric Bursitis): May develop due to injury, arthritis, or uneven leg length.
• Knee (Prepatellar Bursitis): Also called “housemaid’s knee,” usually due to prolonged kneeling.
• Ankle (Retrocalcaneal Bursitis): Often caused by overuse, tight shoes, or excessive running.

Symptoms of Bursitis

The hallmark symptom of bursitis is localized pain near the affected joint. However, the presentation may vary depending on the location and severity of the inflammation. General symptoms include:

• Pain that is sharp, achy, or burning, often worsening with movement or pressure
• Swelling and tenderness around the affected joint
• Redness or warmth over the area, indicating inflammation or possible infection
• Decreased range of motion
• In the case of septic bursitis: fever, chills, and general malaise may occur

It is important to seek medical attention if symptoms persist for more than a week, worsen, or are accompanied by signs of infection.

Diagnosis of Bursitis

Diagnosis is typically based on medical history, physical examination, and, when necessary, imaging studies:

• Medical History: Doctors will inquire about activities, prior injuries, underlying health conditions, and the nature of symptoms.
• Physical Examination: Palpation of the area, checking for swelling, redness, range of motion, and tenderness helps identify bursitis.
• Imaging Tests: X-rays can rule out other bone-related conditions. Ultrasound or MRI may visualize swollen bursae and help in complex cases.
• Aspiration: In suspected cases of septic bursitis, a sample of bursal fluid may be withdrawn (aspiration) with a needle to test for infection or crystals (as in gout).

Treatment and Management of Bursitis

The treatment of bursitis is tailored to its cause and severity. For most cases, conservative, non-surgical management is effective.

1. Rest and Activity Modification

• Avoid activities that worsen symptoms.
• Use cushions or padding during repetitive activities or when pressure is unavoidable.

2. Ice and Heat Therapy

• Apply ice packs to reduce swelling and numb pain, especially in the acute phase.
• Heat therapy may be used later to relax and loosen tissues.

3. Medications

• Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen can ease pain and reduce inflammation.
• In some cases, corticosteroid injections may be recommended to quickly reduce severe inflammation.
• If infection is present (septic bursitis), antibiotics are necessary.

4. Physical Therapy

• Targeted exercises help strengthen muscles around the joint, restore flexibility, and prevent recurrence.
• Physical therapists can teach safe techniques for work and sports to reduce joint stress.

5. Aspiration

• In cases of significant swelling or infection, removing excess fluid with a needle can relieve symptoms and aid diagnosis.

6. Surgery

• Surgical removal of the affected bursa (bursectomy) is rarely needed and usually reserved for chronic cases unresponsive to other treatments or for persistent infection.

Prevention of Bursitis

Preventing bursitis involves minimizing repetitive strain and protecting joints from injury. Key preventive measures include:

• Warm up before exercise and stretch regularly to maintain joint flexibility.
• Use proper techniques and tools when lifting, kneeling, or performing repetitive tasks.
• Take frequent breaks to avoid continuous pressure or overuse of a single joint.
• Wear protective padding when engaging in activities that involve kneeling or leaning on elbows.
• Manage underlying medical conditions such as gout, diabetes, or arthritis as directed by a healthcare provider.

Living with Bursitis

While bursitis can be uncomfortable, most cases resolve with rest and conservative care. Chronic or recurrent bursitis may require ongoing lifestyle adjustments. Staying active, maintaining a healthy weight, and adhering to medical advice can significantly enhance long-term outcomes.

When to Seek Medical Care

Immediate medical attention is necessary if:

• The joint is hot, red, or excessively swollen, indicating possible infection.
• There is a fever in addition to joint pain.
• Pain is severe or disabling, or if there is sudden inability to move the joint.

Early intervention reduces the risk of complications and speeds recovery.

Nursing Care of Patients with Bursitis

The role of the nurse in managing bursitis extends from providing symptom relief and patient education to supporting recovery and preventing recurrence.

Assessment and Nursing Diagnosis

A comprehensive assessment is vital for effective care:

• History taking: Inquire about onset, duration, location, and nature of pain, as well as triggering activities or events. Ask about occupational and recreational activities, past injuries, and medical history.
• Physical examination: Assess for swelling, warmth, redness, tenderness, and range of motion limitations.
• Diagnostic tests: Assist in preparation for diagnostic imaging, such as X-rays, ultrasound, or MRI. In cases suspected of infection, anticipate laboratory evaluations such as CBC, ESR, CRP, and possibly aspiration of bursal fluid for analysis and culture.

Potential nursing diagnoses may include:

• Acute pain related to inflammation of the bursa
• Impaired physical mobility related to pain and swelling
• Risk for infection (especially in septic bursitis)
• Deficient knowledge regarding condition and self-care

Nursing Interventions

Pain Management

Pain is a principal concern for patients with bursitis. Nurses should:

• Administer prescribed analgesics and nonsteroidal anti-inflammatory drugs (NSAIDs) as ordered.
• Apply cold packs intermittently during the acute phase to reduce swelling and numb pain.
• Use heat therapy after the acute phase, as tolerated, to relax muscles and support healing.
• Encourage the use of protective devices (e.g., splints, pads) to cushion the affected area and minimize friction.
• Facilitate comfortable positioning and provide support with pillows or rolled towels.
• Teach relaxation and distraction techniques such as guided imagery, breathing exercises, and listening to calming music.

Promoting Mobility and Preventing Complications

Movement may be limited due to pain and swelling, but gentle activity is essential:

• Encourage rest of the affected joint during the acute phase to prevent aggravation.
• Guide patients to perform gentle range-of-motion (ROM) exercises as soon as pain subsides, to prevent joint stiffness and muscle atrophy.
• Collaborate with physical therapy for individualized exercise regimens and safe progression of activity.
• Advise on the use of walking aids (e.g., canes, crutches) if lower limb involvement hinders safety.
• Educate on proper body mechanics and ergonomic principles to avoid recurrence.

Preventing Infection

For patients with septic bursitis, infection control is paramount:

• Monitor vital signs and observe for systemic signs of infection (e.g., fever, chills, malaise).
• Adhere to strict aseptic techniques during wound care and bursal aspiration.
• Administer antibiotics as prescribed and monitor for therapeutic response and side effects.
• Educate patients and families about the importance of completing antibiotic therapy.
• Report any signs of worsening infection or failure to improve to the healthcare provider immediately.

Patient Education and Support

Empowering patients with knowledge significantly aids recovery and prevention:

• Explain the nature of bursitis, its causes, and expected course of recovery.
• Instruct on self-management strategies, including the appropriate use of cold or heat, medication adherence, and safe activity modification.
• Advise on avoiding repetitive movements or prolonged pressure on the affected joint.
• Encourage weight management and regular physical activity for overall joint health.
• Discuss the importance of early intervention at the first sign of recurrence.
• Provide written materials or reputable online resources for further education.

Psychosocial Considerations

Chronic or severe bursitis can lead to frustration, decreased independence, and social withdrawal:

• Offer emotional support and active listening; encourage patients to express feelings of pain or limitation.
• Facilitate involvement of family and support networks to assist with daily living activities as needed.
• Refer to counseling or support groups if persistent mood changes or anxiety are observed.

Collaborative and Multidisciplinary Care

Effective bursitis management often requires collaboration:

• Work closely with physicians for medication management, aspiration, or corticosteroid injections as indicated.
• Liaise with physiotherapists and occupational therapists for rehabilitation and adaptive equipment training.
• Engage nutritionists if weight loss or dietary modification is recommended.
• Refer to social workers or case managers for assistance with work accommodations or home care needs.

Evaluation and Outcomes

Regular evaluation ensures care effectiveness and patient progress:

• Assess pain using standardized scales and monitor response to interventions.
• Observe for reductions in swelling, improved joint mobility, and restoration of function.
• Monitor for complications such as chronic pain, reduced mobility, or recurrent infections.
• Evaluate patient understanding of self-care practices and ability to implement preventive measures.

Prevention Strategies

Prevention is an essential part of nursing care, particularly for patients at risk of recurrent bursitis:

• Educate on the importance of warm-up exercises and stretching before physical activity.
• Encourage regular breaks during repetitive tasks and use of ergonomic equipment.
• Promote the use of padding or cushioning for knees or elbows during activities that exert pressure on joints.
• Support lifestyle modification, such as weight reduction and tobacco cessation, to enhance musculoskeletal health.

Discharge Planning and Follow-up

Comprehensive discharge planning ensures continuity of care:

• Provide a clear plan for home care, including medication schedule and activity recommendations.
• Instruct on signs and symptoms warranting prompt medical attention, such as increased pain, redness, fever, or drainage from the affected area.
• Arrange for follow-up appointments with healthcare providers and allied health professionals.
• Supply contact information for community resources and support groups.

REFERENCES

1. American College of Rheumatology. Tendinitis (Bursitis). https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Tendinitis-Bursitis.
2. Christopher H. Williams; Zohaib Jamal; Britni T. Sternard. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. 2023 July 24.
3. Arthritis Foundation. Bursitis. https://www.arthritis.org/diseases/bursitis.
4. Charret L, Bart G, Hoppe E, Dernis E, Cormier G, Boutoille D, et al. Clinical characteristics and management of olecranon and prepatellar septic bursitis in a multicentre study. J Antimicrob Chemother. 2021 Oct 11. 76 (11):3029-3032.
5. Firestein, Gary S., et al. Kelley’s Textbook of Rheumatology, Ninth Edition. China: Elsevier Health, 2012.
6. Viradia NK, Berger AA, Dahners LE. Relationship between width of greater trochanters and width of iliac wings in tronchanteric bursitis. Am J Orthop (Belle Mead NJ). 2011 Sep. 40(9):E159-62.
7. American Academy of Family Physicians. Bursitis of the Hip. https://familydoctor.org/condition/bursitis-of-the-hip/.
8. Merck Manual, Professional Version. Bursitis. https://www.merckmanuals.com/professional/musculoskeletal-and-connective-tissue-disorders/bursa,-muscle,-and-tendon-disorders/bursitis. .
9. U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Bursitis. https://www.niams.nih.gov/health-topics/bursitis.

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