A bursa is a fluid-filled pouch formed in soft tissue, usually overlying a bone or joint. Bursitis is the inflammation of one of these sacs and is a common and occasionally painful condition requiring prompt treatment to prevent the inflammation becoming acute or chronic.
Types of Bursitis.
There are two types of bursa. The most common type, known as anatomical bursae, occur on specific sites where tendons cross bones or joints. There are 15 such bursae around the knee joint alone. These usually occurs suddenly without symptoms until they enlarge, and bursitis develops.
The second kind of bursa is one which arises purely as a result of repeated friction or injury to soft tissue overlying a bony surface. These are known as adventitious bursae, and may develop, for example, over the pelvic bone in the buttock from sitting on too hard a seat for several hours a day.
Only when the bursa becomes chronically enlarged or acutely inflamed it will develop bursitis. Housemaid’s knee, anatomically known as the supra patella bursa, is caused by repeated pressure to the knee; any friction or injury causes the bursa to secret fluid, resulting in the swelling.
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Causes of Bursitis.
Not all the causes of bursitis are always clear. It can affect both children and adults. Where friction causes the development of the bursa, the condition may be due to the way certain occupations or activities are carried out.
Bursitis of the elbow, for instance, is common among students leaning on desks, and miners crawling along tunnels. Porters sometimes develop bursitis at the neck from the pressure caused by carrying heavy boxes or baskets.
Weavers, who sit for long periods on hard loom seats, can develop bursitis on the buttocks. Gardeners who work in a kneeling position are more likely to develop bursitis on the knees. However, the rubbing effect is not the complete explanation as some people develop bursitis much more quickly than others.
In rare cases, bursitis can be caused by bacterial inflammation in the bursa or in a connecting joint. Tuberculosis was common cause in the past. In some cases of rheumatoid arthritis, the bursa around a joint become inflamed; some rare cases, gout may develop in bursa.
In bursitis of the elbow, which commonly occurs in older men, signs rarely appears but within a matter of hours swelling is seen.
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In acute bursitis a swelling appears over a joint or bone. The swollen area is painful, tender to touch, and may feel hot and appear red; in severe cases, movement is very painful. The fluid in acute bursitis is produced by the cells that line the wall of the sac.
They produce straw-colored fluid which is often tinged with blood as inflammation causes the small blood vessels to leak. Where there is bacterial infection this fluid becomes filled with bacteria and white blood cells to form pus which may occasionally discharge.
Chronic bursitis is caused by repeated attacks of acute bursitis or repeated injury causing swelling of a bursa.
Bursitis is hardly ever dangerous. Bacterial spread and septicemia (blood poisoning) or spread of tuberculosis are rarely seen in these days of antibiotics.
Untreated gout or rheumatoid arthritis may cause harmful inflammation else-where in the body, and chronic, unattended bursitis will eventually lead to wasting of the surrounding muscles, which in turn may weaken the joint.
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The treatment for acute bursitis should be supervised by a doctor if the cause is bacterial infection, or another rarer cause.
If this is unknown, or if it is due to rubbing or friction or excess use, then resting the affected joint or area, and only passively exercising the surrounding muscles is the cure.
If there is pain, pain killers may be necessary. Anti-inflammatory drugs, such as those which are used in arthritis, may reduce the amount of fluid secreted by the cells lining the bursa.
Antibiotics will only be necessary if there is a bacterial infection. A cold compress, or ice pack, may help reduce the inflammation. Cool a crushed ice-filled polythene bag in the fridge. Mold the cold bag to the skin, checking it is not so cold as to burn the affected area. Then bandage lightly, with an elastic bandage, keeping this on for half an hour before removing.
If this provides relief, repeat the treatment as often as possible, up to every four hours until the condition improves. If the condition does not improve within two or three days, the doctor may drain or aspirate the bursa using a hypodermic needle; this usually gives the patient some relief.
First, a little local anesthetic is applied and then the needle is inserted deep into the bursa and some of the fluid is then sent to a hospital laboratory, to check for bacteria.
It is often found to contain tiny clumps of fibrin (protein), known as ‘melon seeds’ because of their size and colour. These have no significance. The doctor might also inject hydrocortisone, a steroid drug which has an anti-inflammatory effect, into the bursa. Once drained, the bursa is bandaged firmly.
This treatment may have to be repeated a number of times. When a chronic bursa is removed surgically one of the interesting characteristic findings is the presence of the clumps of clotted protein about the size of seeds and known to doctors as melon seeds because of their size and colour.
These have no significance. The surgeon clears these out and cuts away as much of the fluid forming sac as much possible. This surgical removal of the bursa is usually successful although in a small minority of cases the bursa will form again in a few weeks.
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Pain and difficulty on movement is to be expected in acute bursitis and with treatment this condition usually clears completely within a week or 10 days. If the cause is bacterial inflammation the likelihood of recurrence is very rare indeed.
With chronic bursitis the condition usually only recurs if the stimulus of rubbing or friction is repeated. For this reason taking preventive measures is very important. Thick clothing or padding of areas exposed to pressure is essential.
Adequate cushioning on seating helps prevent buttock bursae and to prevent the most common, ‘housemaid’s knee’, knee pads for all jobs such as floor laying or gardening are absolutely essential. Anyone who develops inflammation in the Achilles tendon of the ankle—achillobursitis—should take care to avoid violent exercise.
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How To Avoid Bursitis?
- Avoid kneeling for long time when dang housework. This is not necessary nowadays, as there are plenty of mops and electric polishers on the market.
- Never shuffle on your knees when you are doing any work that must be done in this position.
- Apply a crepe bandage to knees after kneeling for any length of time, if they feel sore afterwards. Use rubber kneeling pads for domestic work or gardening: this spreads out the pressure over a larger area and is softer on the knees.
- Pad any area that is going to be subjected to pressure, for example from a baby carrier, rucksack, rubbish bin, heavy basket. Plastic foam is useful for this purpose.
- Avoid tight, badly-fitting shoes, especially if you have bunions.
- Wear thick clothing if carrying heavy objects or, if leaning on one elbow is absolutely unavoidable, make a habit of using elbow pads.
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Frequently Asked Questions.
1. My husband, who is a sanitation worker, has a sore shoulder that the doctor says is bursitis. If he continues in his job, will it just get worse?
The pressure and weight of a carrying trash cans over his shoulder has formed a bursa, which has become inflamed and swollen. Either your husband should change or vary his technique for carrying heavy boxes, or he should wear a special pad underneath his coat, which will prevent all the weight being taken by one spot. Without these changes, working will make the situation worse, as the area will become even more painful and swollen.
2. I only have to do weeding for 10 or 20 minutes and both my knees swell up. Is this gardener’s knee?
Yes. For some unknown reason your knees are unduly sensitive, and you get bursitis easily. The only answer is to try various knee pads, or to avoid this type of gardening altogether.
3. My eight year old son has a swelling behind his knee. Could this be bursitis?
Yes, this type of bursitis which appears in children is called semimembranosus bursitis. The cause is unknown; it is not likely that he could have brought it on in any way. Usually the condition disappears without treatment in a couple of weeks, and during that time strenuous or prolonged exercise specially knee exercise is best to avoided. It is not harmful or a sign of illness, so there is no need to worry.
4. Does a bursa ever burst?
The bursitis bursts when the cause is a bacterial infection; this is rare. Bursitis is not an abscess where cell linings are destroyed until pus is discharged. In acute bursitis the cells lining in the bursa are inflamed and overactive, so fluid is formed under pressure. The pain and tension are easily removed by a doctor aspirating the fluid with a needle.
More commonly known as ‘housemaid’s knee’ , this condition tends to afflict people in specific trades or activities. It is especially easy to treat in the early stages.