That dull misery in the shoulder, knee or elbow known as bursitis can strike anybody, from the couch potato to the highly trained athlete. Though bursitis may hurt as much as arthritis, it isn?t a
joint disease. Rather, it's an acute or chronic painful inflammation of a bursa. Bursae (from the Greek word for wine-skin and related to the English word purse) are small, closed, fluid-filled sacs
that protect muscles and tendons from irritation produced by contact with bones. If friction becomes too great, from overexercising, hard work, or injury, for instance-the bursae themselves may get
inflamed. Though the shoulder is a common locale for bursitis, any of the bursae in the human body-there are approximately 150-can become irritated. Occupational bursitis is not uncommon and is known
by old, familiar names such as "housemaid's knee," and "policeman's heel." One of the most common foot ailments, the bunion, is a form of bursitis.
Bursitis can develop for several reasons, including repetitively engaging in the same motion, or example, lifting objects above your head for work. Putting a lot of pressure on a bursa for an
extended period of time. Leaning on your elbows or kneeling (for example, to lay carpet) can cause bursitis in the elbows or knees. If you sit for long periods of time, especially on hard surfaces,
you may develop bursitis in your hip. Wearing shoes with a stiff back that rubs against the back of the ankle can cause Achilles tendon bursitis. Trauma. The bursae at the knee and elbow are close to
the surface of the skin, and if you fall directly on your elbow or the knee, you can rupture, injure or puncture a bursa. Infection. Known as septic bursitis, it?s the result of bacteria infecting a
bursa. It can occur from an infection traveling from another site or following an accident that ruptures the bursa. Even scraping the skin on your elbow or getting a mosquito bite that breaks the
skin near the olecranon bursa (near the elbow) can lead to bursitis. Other joint disorders, such as rheumatoid arthritis, osteoarthritis and gout, or health conditions.
Limping. Decreased movement. Your ankles may feel stiff or unable to move as well as they usually do. Pain or tenderness in the back of the ankle. It may be worse at the beginning of exercise, or
when running uphill. You may also have pain when wearing shoes. Redness and warmth. If the bursa is infected, the skin over the heel may be red and warm. You may also have a fever. Swelling on the
back of the heel.
Your doctor will take a history to find out if you have the symptoms of retrocalcaneal bursitis. By examining your ankle, he or she can generally tell the location of the pain. The physician will
look for tenderness and redness in the back of the heel. The pain may be worse when the doctor bends the ankle upward (dorsiflex), as this may tighten the achilles tendon over the inflamed bursa.
Alternatively, the pain may be worse with toe rise, as this puts stress on the attachment of the achilles tendon to the heel bone. Imaging studies such as X-ray and MRI are not usually necessary at
first. If initial treatment fails to improve the symptoms, these studies may be obtained. MRI may show inflammation.
Non Surgical Treatment
All types of bursitis often can be successfully managed non-surgically, and possible treatments include use of ice packs or compressive dressings, activity modification that may reduce stress or
irritation, administration of nonsteroidal anti-inflammatory drugs (NSAIDs) or antibiotics, corticosteroid injections (knee and elbow), stretching exercises, and/or change of footwear (heel). Surgery
may be required in patients whose symptoms remain following these treatments and in certain situations when infection is involved.
Surgery to remove the damaged bursa may be performed in extreme cases. If the bursitis is caused by an infection, then additional treatment is needed. Septic bursitis is caused by the presence of a
pus-forming organism, usually staphylococcus aureus. This is confirmed by examining a sample of the fluid in the bursa and requires treatment with antibiotics taken by mouth, injected into a muscle
or into a vein (intravenously). The bursa will also need to be drained by needle two or three times over the first week of treatment. When a patient has such a serious infection, there may be
underlying causes. There could be undiscovered diabetes, or an inefficient immune system caused by human immunodeficiency virus infection (HIV).