We usually associate aching joints with arthritis. But did you know a lesser known condition called bursitis may be to blame too? People with bursitis have an inflamed and swollen bursa. The bursa is a fluid-filled sac under your skin that usually forms over your joints and cushions them. Your body contains around 160 bursae and they are lined with cells known as synovial cells. These cells produce a fluid that lubricates and reduces friction between muscles and tendons, and bones and joints.
If you have bursitis, you may experience symptoms like swelling, tenderness, and pain in the area that’s affected. And although any bursa in the body can become inflamed, the bursae in the shoulders, knees, elbows, heels, and hips are the most commonly affected.1
Fortunately, bursitis is commonly not a permanent condition. It may limit a person’s mobility, but does not usually result in any kind of deformity.2
There are 3 primary reasons for bursitis. They are injury, infection, and certain medical conditions.
1. Bursitis Due To Injury
If a bursa is injured, the tissue inside it can become irritated, resulting in inflammation. A bursa usually gets injured when muscles, tendons, and joints associated with it are used excessively and repetitively over a period of time. Activities that have a sudden impact like falling or bumping into something may also cause damage.
Here are some injuries that can lead to different types of bursitis.
Shoulder/Subacromial Bursitis
A fall that injures the shoulder or even hitting the shoulder hard: This could cause the associated bursa to fill up with blood and its lining to become inflamed. Most of the blood does get reabsorbed by the body, but the inflammation in the bursa lining may not subside, resulting in bursitis. This is called traumatic bursitis.
Lifting something overhead or doing work or playing a sport that requires reaching overhead repeatedly: This may cause your shoulder “mini-traumas” every day. Over time, this could develop into shoulder bursitis. Wallpaper hangers, painters, baseball pitchers, swimmers, and tennis players are at high risk for developing this condition.3
Elbow/Olecranon Bursitis
When the olecranon bursa located between the bones of the elbow and the skin gets inflamed, it could lead to elbow bursitis. Activities that could lead to injury include crooking and straightening your elbow repeatedly, falling on it, or even leaning on a hard surface. In fact, bursitis because of resting the elbows on hard surfaces is often referred to as “student’s elbow” and “miner’s elbow.”4
Hip/Trochanteric Bursitis
Bumping your hip, falling hard on your hip, or lying down on one side for long periods may injure your hip, leading to bursitis of the greater trochanteric bursa. Other than injury, hip bursitis can happen because of surgery or spinal abnormalities too. This form of bursitis is seen more frequently in women, although it’s not rare in middle-aged and older men too. It is less common in young men.5 People who frequently run, bike, climb stairs, or stand for long durations are more likely to develop hip bursitis.6
Knee/Pes Anserine And Kneecap/Prepatellar Bursitis
These are the two types of bursitis that can affect the knee area.
Goosefoot bursitis or pes anserine bursitis affects the pes anserine bursa, which is located on the inside of the knee, between the 3 tendons of the hamstring muscles and the shin bone. It is usually caused by tight hamstring muscles, not stretching sufficiently before exercise, or being overweight.
Prepatellar bursitis affects the bursa at the front of the knee. It is also called housemaid’s knee because it often happens because of prolonged and repeated kneeling. It is an occupational hazard in professions such as plumbing and carpet laying.7 8
Heel/Retrocalcaneal And Retroachilles Bursitis
Both these types of bursitis affect the area just above the heel. When either or both of these bursae become inflamed and irritated, it leads to bursitis. A common reason for inflammation is something as simple as hitting the back of the heel against something hard.
The retrocalcaneal bursa is positioned between the Achilles tendon and the heel bone. Running uphill, intensifying exercise routines without sufficient muscle conditioning, excessive walking without suitable footwear, and participating in activities such as athletics or ice skating can injure the ankle, leading to retrocalcaneal bursitis.
The retroachilles bursa is positioned between the Achilles tendon and the skin at the back of the heel. This form of bursitis is almost always because of shoes that dig into the back of the heel.9
2. Bursitis Due To Infection
Bursae that are present near your skin’s surface, such as those close to your elbow, may get infected if germs get in through grazes or cuts and make their way into a bursa. This is known as septic bursitis and causes additional symptoms like shivering and fever. You’re also likely to notice a break in your skin near the inflamed area if you have this kind of bursitis.10
Unlike the other types of bursitis, septic bursitis is a serious medical condition that needs prompt medical attention. Statistically, almost 20 percent of people with bursitis have septic bursitis.11
Normally, your immune system is able to prevent this kind of infection, so septic bursitis is usually seen in people whose immune system has been compromised – for instance, people undergoing chemotherapy, those taking corticosteroids, people with chronic obstructive pulmonary disease (COPD), lupus, or HIV. Some kidney disorders, diabetes, and alcoholism can also increase your risk for septic bursitis.12
3. Bursitis Due To Medical Conditions
Certain medical conditions may cause inflammation in your bursae.
Gout
Gout is a kind of arthritis where small crystals develop in and around your joints, causing swelling and attacks of intense pain. It’s caused when uric acid builds up and forms small but sharp crystals that inflame your joints. Uric acid may accumulate either because you’re producing excessive amounts of it, or because your kidneys are not filtering it out properly. High blood pressure, obesity, diabetes, and kidney problems can increase your risk of getting gout. As can having offal, red meat, seafood, beer or spirits, all of which cause a build up of uric acid. Your chances of getting this condition also go up if a close family member has it.13
Elbow and kneecap bursitis are the two types of bursitis most commonly caused by gout.14 Hip bursitis can also be triggered by gout, which causes urate crystals to build up in the synovial joints.15
Rheumatoid Arthritis (RA)
Rheumatoid arthritis is characterized by swelling, pain, and stiffness in your joints. This condition typically affects the feet, wrists, and hands. A problem with your immune system causes it to attack healthy cells that line your joints. This can, over time, cause damage to the joints as well as cartilage and bone nearby. Your chances of getting rheumatoid arthritis are higher if you have a family history of this condition or you smoke. Also, women are more vulnerable to this condition than men.16
Rheumatoid arthritis can lead to hip, knee, and elbow bursitis. It affects the synovial membrane that covers joints, leading to inflammation in the associated bursae.17
Scleroderma
Scleroderma is a rare condition characterized by thickened, hard skin. Sometimes, blood vessels and internal organs too can be affected by this disease. There are many kinds of scleroderma and they can range in seriousness from being mild to life threatening. This condition is caused by your immune system mistakenly attacking connective tissue present under your skin and around blood vessels and internal organs. This results in scarring and thickening of tissue. Though we don’t know why this happens, experts believe that your genes may play a part.18
Ankylosing Spondylitis
Ankylosing spondylitis is a kind of chronic arthritis that affects parts of your spine and other areas resulting in stiffness and pain in your back and fatigue. You may also experience swelling and pain in other parts of your body if your joints or an area such as a bursa where a bone joins a tendon becomes inflamed. We don’t yet know what causes this condition but your genes may play a part. Men are thrice as likely as women to get it.19
Systemic Lupus Erythematosus
Systemic lupus erythematosus is a condition that can affect many organs and tissues in your body. It may cause symptoms like rashes on your hands, wrists, or face, swelling and pain in your joints, and fatigue. This is an autoimmune condition and both the environment and your genes may play a part in triggering it.20
4. Other Causes Of Bursitis
Calcium Deposits Or Bone Spurs
Osteophytes are bone spurs that can irritate the shoulder’s bursae and other soft tissue. Calcium deposits, which begin as soft and small deposits but slowly become big and hard over time, can also irritate the shoulder’s bursae, leading to shoulder bursitis.21
Being Overweight
Being overweight may also lead to bursitis, especially bursitis in the knee area. This is because of the extra pressure on the bursae in the knee area.22 A body mass index (BMI) of 25 to 29.9 is considered to be overweight for adults.23
Bad Posture
Bad posture is another cause of bursitis. For instance, if you don’t walk normally, your knees and hips experience increased pressure, which may lead to knee or hip bursitis. An altered gait or bad posture may sometimes be due to a medical issue like a difference between the length of your legs.24
Shoulder bursitis may affect people who sit or walk with hunched shoulders. The posture squeezes and subsequently irritates the soft tissue between the shoulder joints, making shoulder bursitis a possibility.25
Age
Although shoulder bursitis could affect people at any age, advanced age heightens the risk.26
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