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Bursitis (Acute, Chronic)


Bursitis is when your joints become painful, tender and swollen. Bursitis is a painful condition that affects the small, fluid-filled sacs called bursae that cushion the bones, tendons and muscles near your joints. Bursitis occurs when bursae become inflamed. 

Symptoms of bursitis 
If you have bursitis, the affected joint might: 
Feel achy or stiff. 
Hurt more when you move it or press on it. 
Look swollen and red. 

Causes of bursitis 
The most common causes of bursitis are repetitive motions, trauma, infection, and pre-existing rheumatoid conditions. 

Trauma 
Trauma causes inflammatory bursitis from repetitive injury or direct impact. 
Chronic bursitis: The most common cause of chronic bursitis is minor trauma that may occur to the shoulder (subdeltoid) bursa from repetitive motion, for example, throwing a baseball. Another example is prepatellar bursitis (in front of the knee) from prolonged or repetitive kneeling on a hard surface to scrub a floor or lay carpet. 
Acute bursitis: A direct blow (let's say you accidentally bang your knee into a table) can cause blood to leak into the bursa. This causes inflammation with pain as well as swelling. 

Infections 
Bursae close to the surface of the skin are the most likely to get infected with bacteria, a condition that is called septic bursitis. The most common bacteria to cause septic bursitis are Staphylococcus aureus or Staphylococcus epidermis. People with diabetesalcoholism, certain kidney conditions, those with suppressed immune systems such as from cortisone medications (steroid treatments), and those with wounds to the skin over a bursa are at higher risk for septic bursitis. About 85% of septic bursitis occurs in men. 
Rheumatoid conditions 
People with certain rheumatoid diseases such as gout and pseudogout can develop bursitis from crystal deposits. When these crystals form in a bursa, they cause inflammation leading to bursitis. 

Risk factors of bursitis 
Anyone can develop bursitis, but certain factors can increase your risk: 
Age. Bursitis becomes more common with aging. 
Occupations or hobbies. If your work or hobby requires repetitive motion or pressure on particular bursae, your risk of developing bursitis increases. Examples include carpet laying, tile setting, gardening, painting and playing a musical instrument. 
Other medical conditions. Certain systemic diseases and conditions — such as rheumatoid arthritis, gout and diabetes — increase your risk of developing bursitis. Being overweight can increase your risk of developing hip and knee bursitis. 

Prevention of bursitis 
While not all types of bursitis can be prevented, you can reduce your risk and the severity of flare-ups by changing the way you do certain tasks. Examples include: 
Using kneeling pads. Use some type of padding to reduce the pressure on your knees if your job or hobby requires a lot of kneeling. 
Lifting properly. Bend your knees when you lift. Failing to do so puts extra stress on the bursae in your hips. 
Wheeling heavy loads. Carrying heavy loads puts stress on the bursae in your shoulders. Use a dolly or a wheeled cart instead. 
Taking frequent breaks. Alternate repetitive tasks with rest or other activities. 
Maintaining a healthy weight. Being overweight places more stress on your joints. 
Exercising. Strengthening your muscles can help protect your affected joint. 
Warming up and stretching before strenuous activities to protect your joints from injury. 

Diagnosis of bursitis 
Doctors can often diagnose bursitis based on a medical history and physical exam. Testing, if needed, might include: 
History: The doctor will usually take a detailed history about the onset of symptoms and will want to know what movement or activity makes you feel more or less pain. You will need to report other medical problems you may have. 
Fluid removal: The doctor may remove fluid from the bursa with a needle and send it to the lab for analysis. This analysis will help determine if the bursitis is due to an infection or rheumatoid condition or trauma). Bursitis in the knee and elbow are especially prone to infection. Removal of the fluid might alleviate some of the pain. 
X-rays: They are usually not helpful, but the doctor may get them if any other disease is suspected such as a fracture or dislocation. MRI and CT scans are obtained only to exclude other causes. 
Blood testing: The doctor may order blood tests to rule out infection or other conditions such as rheumatoid arthritis. 

Treatment of bursitis 
Medical treatment 
Bursitis generally gets better on its own. Conservative measures, such as rest, ice and taking a pain reliever, can relieve discomfort. If conservative measures don't work, you might require: 
Medication. If the inflammation in your bursa is caused by an infection, your doctor might prescribe an antibiotic. 
Therapy. Physical therapy or exercises can strengthen the muscles in the affected area to ease pain and prevent recurrence. 
Injections. A corticosteroid drug injected into the bursa can relieve pain and inflammation in your shoulder or hip. This treatment generally works quickly and, in many cases, one injection is all you need. 
Assistive device. Temporary use of a walking cane or other device will help relieve pressure on the affected area. 
Surgery. Sometimes an inflamed bursa must be surgically drained, but only rarely is surgical removal of the affected bursa necessary. 

Bursitis home remedies 
The treatment for bursitis can be remembered with the following memory device: P-R-I-C-E-M. 
Protection includes padding especially for bursae close to the surface of the skin on the ankles and knees. 
Relative rest of the affected area if possible may help symptoms. Choose alternate types of exercise activities that eliminate painful motions. Swimming may help rather than hurt. 
Ice is very effective in reducing inflammation and pain. Small ice packs, such as packages of frozen vegetables, applied to the area for 10 minutes at least twice a day may help decrease inflammation. 
Compression is helpful when it is feasible to compress the area. An elastic bandage can be applied ( especially to knees and elbows).   
Elevation of the area above the heart to keep blood from pooling there. 
Medications such as aspirin or ibuprofen can be helpful to reduce inflammation and pain. 

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