Bursitis is an inflammatory condition that occurs in various joints of the body. It is characterized by inflammation of the sacs called bursae, which serve to reduce friction. Repeated movements or prolonged pressure are the main causes of bursitis. In non-infectious bursitis, pain, swelling, and tenderness are observed. Movement restriction and redness around the joint are also common symptoms. Large joints such as the shoulder, elbow, hip, and knee can be affected. It can present in two forms: chronic and acute.
| Medical Name | Bursitis |
| Affected Areas | Bursae (shoulder, elbow, hip, knee, heel, etc.) |
| Causes | Repetitive movements, trauma, infection, overuse of the joint, inflammatory diseases such as arthritis |
| Symptoms | Pain in the joints, swelling, redness, increased heat, movement restriction |
| Diagnostic Methods | Physical examination, ultrasound, MRI, X‑ray (to rule out bone diseases), laboratory tests (if infection is suspected) |
| Treatment Methods | Rest, ice application, anti‑inflammatory medications, physical therapy, corticosteroid injections, radiofrequency, embolization, rarely surgical intervention |
| Possible Complications | Chronic bursitis, calcification around the joint, loss of movement |
| Prevention Methods | Avoiding strenuous joint movements, regular exercise, proper posture and ergonomics, injury prevention |
| Recovery Time | A few weeks in mild cases; months in more severe cases |
Interventional Radiology / Interventional Neuroradiology
Prof. Dr. Özgür KILIÇKESMEZ
What Is Bursitis?
Bursitis is the inflammation of sacs called bursae in the body. These sacs are filled with synovial fluid to prevent friction between bones, muscles, tendons, and ligaments. There are over 150 bursae in the body, acting as cushions during movement. When bursitis develops, the increased fluid in these sacs causes pain. It most often arises from overuse, infection, or trauma. Inflammatory diseases can also contribute to bursitis. Every movement or pressure on the inflamed bursa causes pain. The processes that lead to bursitis determine the treatment methods.
What Are the Causes of Bursitis?
Bursitis is the inflammation of fluid‑filled sacs called bursae in the joints. It can result from various factors and is most commonly associated with:
Prolonged Pressure:
- Students who constantly rest their elbows on desk edges
- Individuals working without adequate knee support
Repetitive Movements: Continuous movements in sports or occupations can irritate the bursa and lead to inflammation.
Trauma: Direct pressure on the bursa can cause trauma. These cases usually present acutely, and the patient may not recall the traumatic event.
Septic Bursitis: Infection can enter the bursa through the skin or invasive procedures.
Most Common Agent:
- Staphylococcus aureus
Chronic Diseases: Autoimmune or systemic inflammatory diseases can trigger bursitis.
Related Conditions:
- Rheumatoid arthritis
- Osteoarthritis
- Systemic lupus erythematosus
- Scleroderma
- Spondyloarthropathy
- Gout
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How Common Is Bursitis?
Bursitis affects a wide range of the population. It occurs equally in both genders, though certain types show gender differences. For example, pes anserine and trochanteric bursitis are more common in women and are also linked to obesity. In men, olecranon bursitis is more frequent among manual laborers. These differences reflect how occupational activities influence bursitis risk.
Common occupational bursitis names:
- “Housemaid’s knee” for prepatellar bursitis
- “Student’s elbow” for olecranon bursitis
- “Clergyman’s knee” for infrapatellar bursitis
- “Weaver’s bottom” for ischial bursitis
Subcutaneous calcaneal bursitis often occurs in dancers and figure skaters due to ill‑fitting or overly tight shoes. While all age groups can be affected, older adults are at higher risk due to chronic conditions like osteoarthritis. Septic bursitis can be more severe in immunocompromised individuals. People with diabetes, rheumatologic conditions, or HIV are at higher risk for this type.
What Happens During Bursitis?
During bursitis, the synovial sacs called bursae become inflamed in the joint areas where they reduce friction. Patients feel pain when these sacs fill with fluid and become irritated. Pain intensifies when the inflamed bursa is compressed against bone, muscle, or tendon. In some cases, especially in subacromial bursitis, levels of inflammatory mediators such as tumor necrosis factor‑alpha, cyclooxygenases, and various interleukins increase. These mediators explain the inflammation in the bursa and the increased joint pain.
What Are the Symptoms of Bursitis?
Bursitis is a painful condition in the joints, and symptoms vary depending on the bursa’s location. Patients typically present with significant pain and tenderness around the joint. Inflammation limits joint movements, causing difficulty in daily activities. Swelling, redness, and warmth in the affected area are typical signs. In acute bursitis, these symptoms can be more severe due to infection.
- Intense, localized pain in the joint area, worsened by movement or pressure.
- Extreme tenderness when touching the affected bursa.
- Swelling due to fluid accumulation in the inflamed bursa.
- Redness and increased warmth at the inflammation site.
In chronic bursitis, symptoms may last longer but are generally less intense. The bursa gradually fills with fluid and remains permanently swollen. However, chronic cases may not be as painful as acute ones. Persistent movement restriction in the affected area is a constant discomfort. Clinical evaluation of bursitis requires careful assessment of the joint and surrounding structures. Skin examination is also important to gauge inflammation severity; erythema and warmth are key diagnostic clues. Temperature differences between affected and unaffected areas can aid diagnosis.
How Is Bursitis Diagnosed?
Diagnosis of bursitis begins with patient complaints and physical examination findings. While clinical signs may suffice in some cases, imaging methods usually support the diagnosis. Advanced tests are crucial when diagnostic uncertainty exists.
- Plain X‑ray: Used when trauma, foreign body, or fracture is suspected; it reveals structural changes in the joint.
- MRI: Examines deep bursa structures, providing detailed images of the affected area.
- Ultrasound: Real‑time imaging of the joint and bursa surroundings; it visualizes fat pad changes around the bursa to differentiate infection from other conditions.
- Color Doppler: Evaluates blood flow in the bursa and surrounding tissues to detect hyperemia, a sign of inflammation.
To confirm the diagnosis, fluid aspiration from the inflamed bursa may be performed. Aspiration is valuable in suspected septic bursitis or crystal diseases. The aspirated fluid is sent for laboratory tests:
- Cell count
- Gram stain
- Culture
- Glucose analysis
- Crystal analysis
If the white blood cell count is below 500/mm³, it generally indicates non‑infectious bursitis.
How Is Bursitis Treated?
Treatment of bursitis varies according to the location of the inflamed bursa, with the main goal of reducing pain and inflammation. Corticosteroid injections are commonly used for this purpose. These injections, administered directly into the inflamed bursa, rapidly reduce inflammation and provide short‑ to medium‑term pain relief. Ultrasound guidance is preferred to ensure accurate delivery of the medication and minimize side effects.
- Corticosteroid Injections: Effective for shoulders, hips, and elbows.
- Aspiration: Often used in septic bursitis to remove excess fluid and reduce swelling.
- Ultrasound‑Guided Interventions: Ensure precise targeting and treatment of the pain source.
- Shock Wave Therapy: A non‑invasive method to reduce pain and inflammation in chronic bursitis.
- Embolization: An effective day‑procedure for refractory bursitis unresponsive to other treatments; it reduces blood supply to the problematic tissue, preventing inflammation.
What Other Conditions Should Be Considered?
Bursitis is only one of many causes of joint pain. Other common causes include osteoarthritis, rheumatoid arthritis, and gout, which can present with similar symptoms. A comprehensive evaluation is necessary to accurately identify the source of pain.
For shoulder pain, differential diagnoses include:
- Rotator cuff tears
- Labral tears
- Shoulder impingement
These conditions can cause shoulder pain and may coexist with bursitis. Gout can mimic bursitis in locations such as the olecranon, prepatellar, and infrapatellar bursae, presenting with tophi or pseudogout pain. Ischial bursitis is often mistaken for sciatica, but increased pain when sitting helps distinguish it. Differentiating trochanteric bursitis from iliotibial band syndrome is important, as their tenderness points differ. Iliopsoas bursitis can present similarly to various pathologies, requiring careful assessment.
Frequently Asked Questions
Prof. Dr. Özgür Kılıçkesmez graduated from Cerrahpaşa Medical Faculty in 1997. He completed his specialization at Istanbul Education and Research Hospital. He received training in interventional radiology and oncology in London. He founded the interventional radiology department at Istanbul Çam and Sakura City Hospital and became a professor in 2020. He holds many international awards and certificates, has over 150 scientific publications, and has been cited more than 1500 times. He is currently working at Medicana Ataköy Hospital.
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