What is Bursitis ?

To know about bursitis first of all it is important to know about bursa. Bursa is present in everyone where it is scattered through out the body. The main function of bursa is to reduce the friction between two surfaces that are moving in different directions. It can be imagined to a bag, which is locked with little amount of oil in it and no air at all. Bursa is a sac filled with the body’s own natural lubricating oil. Ultimately. In simple words it acts as a smooth slippery surface between two moving objects. It is usually found at points where muscles and tendons rub against each other.

The inflammation of one or more bursae leads to bursitis. It is caused by repetition of movement or excessive pressure. The bursa loses its smoothness and provides a slippery surface that has lost all its friction. It gets more irritated and painful when it moves. When such condition occurs he bursa becomes inflamed and gets swollen up. The commonly affected areas are generally the elbows and knees because they are repeatedly used and rested upon more compared to other parts of the body.

Causes
• Bursitis can be caused due to excessive pressure and repetitive movements. For example people who rest on their elbows for a long period or who frequently bend their elbows can develop elbow bursitis.
• Injuries such as car accidents or fall.
• Other conditions such as rheumatoid arthritis, scoliosis etc.

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Signs and symptoms • Inflamed bursa. • Stiffness in the joints. • Paining or burning sensation around the inflamed bursa. Types Following are the various types of bursitis: Elbow bursitis. Shoulder bursitis. Kneecap bursitis or prepatellar bursitis.
Elbow bursitis: Bursitis is caused due to the inflammation of bursa. When bursa gets inflamed the sac fills with the fluid, which causes pain and swelling behind the elbow. The swelling or inflammation can cause more infection within the bursa at later stages resulting in a condition known as infected elbow bursitis. Elbow bursitis is also known as olecranon bursitis. It can be caused due to traumatic accident or a fall or may be because of excess pressure. The symptoms of elbow bursitis includes: • Swelling at the joint or at the tip of the elbow. • Severe pain at the backside of the elbow. • Movements of the elbow reduce gradually due to the pain. Elbow bursitis is diagnosed by an x-ray examination to check if the elbow joint is normal. The symptoms of infected elbow bursitis includes the following: • The skin appears to look reddish at the back of the elbow. • Fevers. • Cuts on the skin around the swollen part of the elbow. • Sweating. Shoulder bursitis: The inflammation that occurs between the arm bone (humerus) and the tip of the shoulder (acromion) leads to Shoulder bursitis. Shoulder bursitis is similar to Shoulder tendonitis in fact they have common syndromes, which is referred to as “impingement syndrome”. Though they have the same syndromes they are diagnosed with different treatments. It is differentiated by the strength of the rotator cuff muscles. The syndrome occurs when the rotator cuff tendons and bursa that surrounds these tendons get inflammated. This inflammation leads to thickening of the tendons and bursa and loss of space in that location. Due to the loss of space the tendons and bursa will not have enough space for accommodation and the patient gets irritated or feels painful whenever these structures move between the bones. The symptoms of shoulder bursitis includes the following: • Pain that starts during night times while sleeping. • Overhead activities with pain. • Pain over the surface of upper arm or shoulder.
Kneecap bursitis or prepatellar bursitis: Kneecap bursitis is also called as “Housemaid’s knee”. It is characterized by the swelling and pain of the kneecap. This disease is common in people who tend to work hard like gardeners or whose work involves kneeling for extended periods of time. Hence the name housemaid’s knee. The symptoms of this type involves: • Swelling of the kneecap. • Movement of the knee joint is reduced. The symptoms increase when the patient kneels and reduces or comes down when relaxing. Treatment for this may be the removal of bursa itself. Treatments Bursitis is treated with the following: Anti-Inflammatory medications. Cortisone Injection. Ice An Injury.

Anti-Inflammatory medications: The most common anti-inflammatory medicines for bursitis referred are Nonsteroidal anti-inflammatory pain medications (NSAIDs). For example: Ibuprofen, Aleve, Celebrex, and Relafen etc. Anti-Inflammatory medicines come under two different categories that are:
NSAIDs
Steroids
NSAIDs: NSAIDs are given to block cyclooxygenase. Cyclooxygenase is an enzyme that is important in the production of prostaglandins, which are responsible for swelling and pain in conditions such as bursitis. So NSAIDs are given to indirectly stop the production of prostaglandins. But there are certain complications involved while reducing the production of prostaglandins because these are responsible for other functions of the body. Among the prostaglandins, one particular type is responsible for lining the stomach with a protective fluid. So when these are diminished then people have chances of getting stomach ulcers. To compromise this there are new NSAIDs, which have come to market these days, known as COX-2 inhibitors. COX-1 and COX-2 are two types of cyclooxygenase enzymes that function in our body. The new NSAIDs work on COX-2 and let COX-1 to function normally that prevents stomach ulcers. There are certain side effects associated with NSAIDs that include burning sensation or irritation in the stomach. It is advised not to use for patients who are pregnant, breastfeeding mothers and people with stomach ulcers. It can be used for people having heart, kidney, liver and asthma problems provided they are under supervision under physician.

Steroids: These medications are drug delivery systems given either orally or through injections. It is derived from a natural hormone produced by the body.

Cortisone Injection: Cortisone is produced naturally by adrenal gland present in our body. There are cortisones, which are produced synthetically having trade names such as kenalog, celestone, etc. The difference between the two is that synthetic cortisone is injected to the particular area of infection instead of directly injecting it into the blood stream. The effects from these are quick and last for long. It does not act as pain reliever but just works as anti-inflammatory medicine. Medicines such as Licocaine or Marcaine are given along with Cortisone to induce numbness of the inflammated part and to bear while injecting. The common side effects of these are:

• The part of the skin where the injection is given may turn white in colour.
• The injected cortisone may crystallize and cause more pain than before that lasts for about two days.
• Diabetes patients may face increase levels of blood sugar.

Ice an Injury: As we have already read that bursitis can be caused due to injury, icing becomes more effective if done immediately after the injury. Ice should be applied directly over the injured part by moving it constantly and not letting it remain in the same spot. The swelling can be reduced further by placing the injured part above the heart. The procedure of icing should be done for maximum of 20 minutes because excess icing may damage the tissues. When icing is done repeatedly, there should be a gap of 45 minutes between each session for the body to get back to the normal temperature.

Article Contributed By: Shilpa V


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