What is Bursitis?

A bursa is a tiny fluid-filled sac that functions as a gliding surface to reduce friction between tissues of the body. The plural of bursa is bursae. There are 160 bursae in the body. The major bursae are located adjacent to the tendons near the large joints, such as the shoulders, elbows, hips, and knees.Bursitis is inflammation of a bursa. Injury or inflammation of a bursa around the shoulder joint occurs causes shoulder bursitis.

How does a bursa become inflamed?
A bursa can become inflamed from injury, infection (rare in the shoulder), or an underlying rheumatic condition. Examples include infection of the bursa in front of the knee from a knee scraping on asphalt (septic prepatellar bursitis), inflammation of the elbow bursa from gout crystals (gouty olecranon bursitis), or injury as subtle as lifting a bag of groceries into the car, which could inflame the shoulder bursa (shoulder bursitis).

Bursitis is typically identified by localized pain or swelling, tenderness, and pain with motion of the tissues in the affected area. X-ray testing can sometimes detect calcifications in the bursa when bursitis has been chronic or recurrent. MRI scanning (magnetic resonance imaging) can also define bursitis. Shoulder bursitis is often accompanied by tendinitis of tendons adjacent to the affected bursa in the shoulder. Shoulder bursitis causes focal tenderness of the inflamed tissues. It can also cause a “pinching” pain when the elbow is moved away from the body, referred to as an “impingement” sign.

What is the usual treatment for burstis?
The treatment of any form of bursitis depends on whether or not it involves infection. Infection of a shoulder bursa is uncommon, and bursitis that develops there is usually from injury. Bursitis that is not infected (as from injury or an underlying rheumatic disease) can be treated with ice compresses, rest, and anti-inflammatory and pain medications. Occasionally, it requires aspiration of the bursa fluid. This procedure involves removal of the fluid with a needle and syringe under sterile conditions and can be performed in the doctor’s office. Sometimes the fluid is sent to the laboratory for further analysis. Noninfectious shoulder bursitis can also be treated with an injection of cortisone medication into the swollen bursa. This is sometimes done at the same time as the aspiration procedure. Physical therapy can sometimes be used to aid the recovery from bursitis, especially when it is accompanied by a frozen shoulder.

Infectious (septic) bursitis, again which is uncommon in the shoulder, requires even further evaluation and aggressive treatment. The bursal fluid can be examined in the laboratory to identify the microbes causing the infection. Septic bursitis requires antibiotic therapy, sometimes intravenously. Repeated aspiration of the inflamed fluid may be required. Surgical drainage and removal of the infected bursa sac (bursectomy) may also be necessary. Generally, the adjacent joint functions normally after the surgical wound heals.

What is the prognosis for bursitis?
The outlook is generally excellent for a full recovery with shoulder bursitis. If the bursitis is accompanied by scarring around the shoulder joint (adhesive capsulitis or “frozen shoulder”), it can require long-term physical therapy.

Can shoulder bursitis be prevented?
By avoiding overuse of the shoulder by excessive straining the shoulder and gradual exercise training, shoulder bursitis can be prevented.