Bursitis: Symptoms, Types, Causes and Treatment

Bursitis is a common condition that can cause significant pain and limit daily activities. Understanding this disorder—its symptoms, types, causes, and treatment options—empowers patients and families to better manage and prevent flare-ups. Drawing on the latest research and clinical insights, this article provides a comprehensive guide to bursitis for patients, caregivers, and anyone interested in musculoskeletal health.

Symptoms of Bursitis

Bursitis symptoms can be both subtle and dramatic, often catching people off guard. Recognizing these symptoms early can lead to prompt and effective treatment, reducing discomfort and the risk of complications. While the presentation may vary depending on the affected bursa and whether the inflammation is due to infection (septic) or not (aseptic), there are hallmark features that define this condition.

Symptom	Description	Common Locations	Source(s)
Pain	Aching, sharp, or burning; worsens with movement or pressure	Hip, elbow, knee, heel	1 3 4 5
Swelling	Noticeable puffiness or enlargement	Elbow, knee, hip	4 5 10
Redness	Skin appears red, especially in septic cases	Elbow, knee	4 5 7
Warmth	Area feels warmer than surrounding tissue	Elbow, knee	4 5
Limited Motion	Difficulty using affected joint	Hip, elbow, knee	1 3 4
Systemic Signs	Fever, malaise (mainly in septic bursitis)	Elbow, knee	2 4 7

Table 1: Key Symptoms

Pain and Tenderness

The most universal symptom of bursitis is pain at the affected area. This pain can be sharp, aching, or burning, and is usually aggravated by movement or direct pressure. For example:

• Trochanteric bursitis (hip): Chronic, intermittent aching over the outer hip, often worse when lying on the affected side or during activity 1.
• Olecranon and prepatellar bursitis (elbow and knee): Pain is most noticeable when leaning on the elbow or kneeling, respectively 4 5.

Swelling and Redness

Swelling is particularly prominent in superficial bursae like the olecranon (elbow) and prepatellar (knee) bursae. The skin overlying the area may also appear red, especially in cases of infection (septic bursitis). In some cases, the swelling can be substantial, causing visible distortion of the joint contour 4 5 10.

Warmth and Limited Motion

Inflamed bursae often cause localized warmth due to increased blood flow. Motion of the affected joint can become limited, both because of pain and mechanical restriction from swelling 1 3 4.

Systemic Symptoms

Systemic symptoms such as fever and malaise are most commonly seen in septic bursitis. These features should prompt urgent medical evaluation, as they signal infection that may require antibiotics or other interventions 2 4 7.

Types of Bursitis

Bursitis comes in several flavors, depending on both the anatomical site and the underlying cause. Some types are more common than others, and each has its own unique clinical features and challenges.

Type	Location	Distinguishing Features	Source(s)
Trochanteric	Outer hip	Chronic lateral hip pain, limited function	1 3 9 12
Prepatellar	Front of knee	Swelling over kneecap, often in people who kneel	2 3 5
Olecranon	Tip of elbow	Swelling and pain at back of elbow	2 3 4 5
Retrocalcaneal	Heel (Achilles)	Pain at Achilles tendon insertion	3 5
Septic vs. Aseptic	Any bursa	Infection present (septic); non-infectious (aseptic)	2 4 5 7

Table 2: Bursitis Types

Trochanteric Bursitis

This is the most common cause of lateral hip pain in middle-aged and older adults, especially women. The pain is persistent, worsens with activity, and can limit function. Diagnosis is mainly clinical, and response to corticosteroid injections is usually excellent 1 9 12.

Prepatellar and Olecranon Bursitis

Both are types of superficial bursitis that often affect people whose activities involve repetitive kneeling or leaning on the elbows, such as plumbers or gardeners. These bursae are prone to both traumatic and infectious (septic) inflammation, making prompt diagnostic evaluation essential 2 3 4 5.

Retrocalcaneal Bursitis

Located at the back of the heel, this type often affects runners or people with tight Achilles tendons. It is less commonly injected with steroids, as this may weaken the Achilles tendon 3 5.

Septic vs. Aseptic Bursitis

Each bursa can become inflamed due to infection (septic bursitis) or non-infectious causes (aseptic). Septic bursitis is more likely in superficial bursae, especially in those with skin injuries or immunosuppression. Staphylococcus aureus is the most common culprit, but other bacteria and even rare organisms can be involved 2 4 5 7.

Causes of Bursitis

Understanding what triggers bursitis is key to both prevention and effective management. While some causes are mechanical, others are related to systemic diseases or infections.

Cause	Description	Typical Cases/Populations	Source(s)
Mechanical Stress	Repetitive motion, pressure	Athletes, manual laborers	1 3 5 8
Acute Trauma	Direct blow, fall	All ages, especially active	5 8
Infection	Bacteria, rarely fungi/mycobacteria	Immunocompromised, skin lesions	2 4 5 6 7
Systemic Disease	Gout, rheumatoid arthritis	Middle-aged, elderly	5
Idiopathic	No identifiable cause	Variable	1 3

Table 3: Common Causes

Mechanical Stress and Microtrauma

The most common cause of bursitis is chronic microtrauma—small, repeated injuries due to overuse or pressure. Occupations or hobbies that involve frequent kneeling (e.g., carpet layers) or leaning on elbows (e.g., mechanics) are particularly at risk 1 3 5. Overuse of the hip muscles is a well-known contributor to trochanteric bursitis 1 9.

Acute Trauma

A single blow or fall can cause acute bursitis, resulting in rapid swelling and pain. This is especially true for superficial bursae, which are more exposed to direct trauma 5 8.

Infection (Septic Bursitis)

Bursae near the skin are vulnerable to infection, particularly when there is a skin lesion, recent trauma, or underlying medical conditions such as diabetes or immunosuppression. Staphylococcus aureus accounts for more than 80% of septic bursitis cases, but rare organisms, including Mycobacterium species, can also be responsible 2 4 5 6 7. Septic bursitis may spread to deeper tissues, making early diagnosis and treatment crucial.

Systemic Diseases

Inflammatory conditions like gout and rheumatoid arthritis can lead to bursitis as part of their overall manifestations. In these cases, managing the underlying disease is essential for long-term control 5.

Idiopathic

Sometimes, the cause of bursitis remains unclear. Even without a clear trigger, proper management can greatly improve outcomes 1 3.

Treatment of Bursitis

Fortunately, most cases of bursitis respond well to conservative treatments. However, the approach varies depending on the type, severity, and whether infection is present.

Treatment Option	Indication	Effectiveness/Notes	Source(s)
Rest & Activity Modification	All types	First-line, reduces irritation	1 3 5 9
Ice & Elevation	Acute cases, swelling	Reduces pain and swelling	3 5
NSAIDs	Pain and inflammation	Widely used, effective	3 5 10
Aspiration	Severe swelling, suspected infection	Diagnostic and therapeutic	2 5 7
Corticosteroid Injection	Persistent non-septic bursitis	Rapid relief, especially for hip/elbow	1 3 10 12
Antibiotics	Septic bursitis	Tailored to organism; IV for severe cases	2 4 5 7
Surgery	Refractory, recurrent, severe septic	Reserved for failure of other measures	2 3 4 9
Physical Therapy	Chronic or functional limitation	Supports recovery and prevention	1 9

Table 4: Bursitis Treatment Options

Conservative Measures

• Rest and activity modification: Avoiding activities that aggravate symptoms is crucial. Ice and elevation help reduce acute swelling and pain 1 3 5.
• NSAIDs: Nonsteroidal anti-inflammatory drugs are effective for pain and swelling 3 5 10.
• Physical therapy: Especially important for trochanteric bursitis, therapy can improve function and reduce recurrence 1 9.

Aspiration

For significant swelling or suspected infection, aspiration of the bursa can provide relief and diagnostic information (e.g., cell count, Gram stain, culture) 2 5 7.

Corticosteroid Injections

Local corticosteroid injections are highly effective for persistent, non-septic bursitis, particularly in the hip and elbow. They provide rapid relief, though repeat injections may be needed in chronic cases 1 10 12. Steroid injection into the retrocalcaneal bursa is generally avoided to prevent Achilles tendon weakening 3 5.

Antibiotics

Septic bursitis requires prompt antibiotic therapy, usually targeting Staphylococcus aureus. Outpatient oral antibiotics are suitable for mild cases, but intravenous antibiotics and hospital admission are recommended for severe or systemic infections 2 4 5 7. Surgery is reserved for cases that do not resolve or develop complications 2 3 4.

Surgery

Surgical intervention (incision, drainage, bursectomy) is rarely needed but may be necessary for refractory, recurrent, or severe septic bursitis 2 3 4 9.

Conclusion

Bursitis is a common and treatable source of musculoskeletal pain. With a wide range of symptoms, types, causes, and treatment options, individualized management is essential. By understanding the warning signs and risk factors, patients and clinicians can work together to reduce the burden of this often-overlooked condition.

Key Takeaways:

• Bursitis causes pain, swelling, and limited function, especially at the hip, knee, elbow, and heel.
• The most common types are trochanteric (hip), prepatellar (knee), olecranon (elbow), and retrocalcaneal (heel) bursitis.
• Causes include repetitive microtrauma, direct injury, infection, and systemic diseases like gout.
• Most cases respond to rest, NSAIDs, and activity modification; persistent cases may require steroid injections.
• Septic bursitis demands prompt diagnosis and targeted antibiotic therapy, with surgery reserved for severe or unresponsive cases.
• Early recognition and tailored treatment can restore function and prevent complications.

Understanding bursitis empowers you to take charge of joint health, minimize downtime, and get back to doing what you love.