Bursitis

Bursae are small sacks of fluid that serve the purpose of buffering regions around joints where there is a lot of rubbing or sliding of tissues such as tendons and fascia against each other or bony prominences. Bursae have a protective role of sorts, as without them other tissue within joints would be subject to frequent friction and irritation. Unfortunately, the bursae themselves, can become irritated and inflamed when subjected to longstanding friction or mechanical irritation. When this occurs, the condition is referred to as a bursitis. A bursitis is the term used to describe an inflamed bursa.

Although it is often dispensed as a specific diagnosis, I think it is probably rare that a set of symptoms is driven solely, or even predominantly by an inflamed bursa. More common, I would argue, would be the scenario where there is a combination of elevated nerve ending sensitivity in and around a particular joint, which most often would be secondary to an acute trauma/injury or an accumulative irritation of joint structures from occupational or sporting activities. Swimmers for example, can often end up with a bursitis in their shoulder, but the irritation of the bursa itself is probably very often a product of a rotator cuff tendinopathy.

The reason I point this out is that treatment of “bursitis” should not focus solely on a specific effort to treat the bursa itself. The initial goal is to desensitize the joint in question so that it (the joint) is more tolerant of movement. We achieve this through activity modification, joint mobilisation, massage and occasionally a referral out for a cortisone injection. Once the joint is, let’s say “calmer”, the concentration of inflammatory mediators in and around the joint is likely to reduce and symptoms should track towards resolution. As movement becomes easier and less symptomatic, we can shift attention towards graded strengthening and conditioning.

Below you will find information about the more common joints that are associated with bursitis. Although there do exist some joint specific considerations, the management of bursitis, regardless of which joint it is associated with follows similar treatment principles.

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