Bursitis: Painful, Swollen Joints, Home Care and When to Be Seen

What it involves

MedlinePlus describes bursitis as swelling and irritation of a bursa, a fluid-filled sac that cushions the space between muscles, tendons, and bones. It most often follows overuse or a change in activity, and it commonly affects the shoulder, knee, elbow, and hip, as well as the heel and foot.

Who this is for

• Patients with a tender, swollen, warm spot over a joint such as the elbow, knee, hip, or shoulder
• Patients whose joint pain began after a change in work, training, or repetitive activity
• Patients with a red, hot, swollen joint and fever who need infection ruled out promptly
• Patients with gout or rheumatoid arthritis who notice a new area of joint swelling

What to expect

• Questions about the activities that bring on pain, any injury, and any fever or redness
• A physical exam of the joint, including pressing around it and moving it
• A decision about whether labs or imaging are needed, which would be arranged by referral
• A plan for rest, ice, medicine, and exercises, or a referral to a specialist if the problem is not improving

Where it tends to show up

MedlinePlus says bursitis is often an overuse injury, and that being overweight or training hard for something like a marathon can bring it on. Trauma, rheumatoid arthritis, gout, and infection are other causes, and sometimes no cause is found. Different spots have their own names, such as student's elbow and housemaid's knee, and the shoulder pain guide, hip pain guide, knee pain guide, and elbow pain guide describe those areas.

What it feels like

MedlinePlus lists the typical complaints:

• Joint pain and tenderness when you press near the joint
• Stiffness and aching when you move it
• Swelling, warmth, or redness over the joint
• Pain that continues at rest and can spread to nearby areas

What a visit may include

MedlinePlus says a provider takes your history and examines the joint. Possible tests include lab tests for infection, ultrasound, and MRI, and rarely the fluid in the bursa may be drawn out and examined. Imaging would be done by referral to an outside facility. An infected bursa tends to look hot, red, and swollen, which resembles the infection signs in the cellulitis guide.

Home care that is listed

MedlinePlus advises ice for about 15 minutes, 3 to 4 times a day for the first two or three days, with a towel between ice and skin, resting the joint, and not sleeping on the affected side. For a hip, knee, or ankle it suggests avoiding long periods of standing, standing on a cushioned surface with weight even on both legs, and a pillow between the knees when lying on your side. Cushioned flat shoes can help.

Other treatments

MedlinePlus lists anti-inflammatory medicines such as ibuprofen or naproxen, physical therapy, a brace or splint, and home exercises to build strength once pain eases. A provider may also drain fluid and inject a corticosteroid, and in rare cases surgery is done. The practice lists joint injections as a service, described on the joint injections page, and your provider decides whether it applies.

When to come back

MedlinePlus says to contact a provider if symptoms recur, if they do not improve after 3 to 4 weeks of treatment, or if the pain is getting worse. An infected bursa becomes more painful and inflamed and often needs antibiotics or surgery. Cutting down on repetitive motions, watching posture, and strengthening muscles and balance may lower the chance of a repeat.

Sources

• MedlinePlus — Bursitis
• MedlinePlus — Bursitis health topic