Bursitis, or inflammation of a bursa, is caused by trauma, deposition of calcium salts, or infection of a bursa. A bursa is a small sac that contains fluid and usually serves to cushion a bone that lies under the skin, as at the elbow, the kneecap (patella), and the ankle. There are about 400 bursae in the human body, and a new one can form in an area of irritation. Bursitis most commonly occurs around the shoulder joint, the elbow, the sides of the hips, the kneecap, the back of the knee, and the ankle.

Bursitis causes pain, swelling, and increased fluid in the bursa. In the case of trauma, there may be blood or bloody fluid inside the bursa. Inflammation may be caused by a systemic arthritis such as rheumatoid arthritis, gout, and others. Irritation by small, repetitive trauma (microtrauma) can also cause inflammation. Sometimes bacteria enter the bursa and an infection sets in, called infectious bursitis. Deposition of calcium salts inside a bursa (calcification) is usually the result of previous trauma and can cause inflammation. If certain activities intensify the pain, these motions should be avoided for a short time, until pain relief is achieved. Movement should be resumed as soon as possible, especially in the shoulder, in order to avoid restricted mobility at a later date.

Yes, bursitis can certainly be treated without taking pills. The usual nonsteroidal anti-inflammatory drugs (NSAIDs) should not be taken by patients on blood thinners (anticoagulants), which are frequently prescribed after a blood clot. As a matter of fact, oral medicines are not as effective in the treatment of bursitis, which is usually a localized condition, with the exception of certain cases that have systemic causes.

If there are signs of very acute inflammation, such as swelling, redness, heat over the skin, and severe pain, infectious bursitis should be suspected, and I recommend immediate medical attention. For some immediate relief, a cool compress should be applied to the area. This can be a bag of ice cubes wrapped in a towel or a gel pack that has been cooled in the freezer. The physician (rheumatologist or orthopedist) should remove bursa fluid to be tested for bacteria and their antibiotic sensitivity, and for crystals, as in gout. Antibiotic treatment is the way to go with an infected bursa, and sometimes surgical removal is needed.

If the bursitis is not due to bacteria or to a systemic disease, the usual treatment is injection of a long-acting steroid (cortisone-like medicine) into the bursa. These steroids are not like the illegal drugs some athletes take. A successful steroid injection can improve the bursitis for several months, but flare-ups can still occur.

If the bursitis is part of a systemic disease, it may mean that the disease is not controlled adequately and that treatment adjustments may be necessary. In addition, diseases like rheumatoid arthritis and gout can predispose a person to infections of bursae and joints, and that possibility has to be considered and investigated.

Learn more in the Everyday Health Pain Management Center.