Your doctor may have told you that you have bursitis, to which you probably asked, “What’s bursitis?”. My guess is that they responded, “Bursitis is inflammation of a fluid filled sac called a bursa.” While that is technically correct, there are many nuances and different types of bursitis which I think are worth explaining.
What is a bursa, and what does it do?
Your body doesn’t like internal friction when it moves. In fact, when you move your arms or legs, the inside surface of your joints (hyaline cartilage) is 10 times slicker than ice sliding on ice! Your body has a similar mechanism to decrease friction when dealing with certain areas of your body that are outside of the joints. Your body creates fluid filled sacs called bursae in order to decrease friction at the tip of your elbow, beneath your shoulder blade, outside of your hip, and in front of your kneecap. There are many many more bursae in the body, but those are the ones that are most frequently irritated.
What happens when you get bursitis?
Most of the time the bursae in your body are very thin, but when you have an increase in friction around a bursa, or trauma to a bursa, it can get inflamed and you get bursitis. Bursitis is often painful, and in some areas such as in front of the knee and at the tip of the elbow, you can actually feel the bursa itself. To get rid of bursitis, you have to know what caused it in the first place:
Greater trochanteric bursitis
This presents as pain on the outside of your hip that is worse when lying on your side, and/or after walking long distances. This happens because a tight band of tissue called the IT band rubs against the outside of the hip bone called the greater trochanter. Stuck in the middle is your greater trochanteric bursa which gets inflamed and give you greater trochanteric bursitis. The rubbing happens because your abductor muscles are weak and they can’t effectively pull the IT band away from the outside of the hip bone (greater trochanter). The main treatment for this is abductor and core strengthening.
Outside of your shoulder joint, but below your shoulder blade is a space called the subacromial space. What you need to know is that there is a bursa that lives in this space and can frequently get irritated causing bursitis. This is very common and presents as pain when you lift your arms up overhead or out to the side (a rotator cuff tear can also present this way), and often causes pain at night. Posterior capsular stretches can greatly help with subacromial bursitis, along with a steroid injection if need be to help calm things down. The shoulder is a complicated joint, so it is worth seeing your orthopedic doctor to arrive at the correct diagnosis.
Prepatellar and olecranon bursitis
These last two types of bursitis occur on the front of your knee and at the tip of your elbow. Most of the time these occur because you banged your knee or elbow on something hard. These can get big and painful. The best treatment for these types of bursitis is ice, compression wraps, anti-inflammatories, and time.
With any type of bursitis it is worth seeing your orthopedic doctor so they can confirm the diagnosis and give you an appropriate personalized treatment plan. A combination of appropriate physical therapy, anti-inflammatories, and steroid injections are often all that is needed to get you better. Occasionally if all else fails then you may need surgery. If you have any questions that I didn’t answer, I encourage you to contact me.
-Written by Dr. Daniel Paull