Ask the Doctors

Dear Doctors: What's the best way to treat bursitis? My son has it in his knee. I have it in my right shoulder. It's extremely painful for each of us.

Dear Reader: Bursitis is the inflammation of the bursae, which are the slender, fluid-filled sacs that act as cushions between potential points of friction in our joints. Some of the 150 or so bursae in the human body lie just beneath the surface of the skin. Others are tucked away below muscles, tendons and other soft tissue. Without the smooth and slippery surface of these bursae between the hard surfaces within your joints, friction would render movement quite painful.

If you'll bear with us for a slightly deeper anatomical dive, the following details will help you understand exactly what's going on and what steps you can take to address the pain.

The bursae themselves are made up of something known as the synovial membrane, which is also referred to as the synovium. Each sac contains synovial fluid, a viscous liquid that brings to mind the look and texture of raw egg whites. The synovial membrane is semipermeable, which means that fluid can flow in and out.

When you have bursitis, the synovial membrane becomes inflamed. This causes the membrane to thicken, and excess synovial fluid is produced. The once-thin bursa swells, and the same structure that was once preventing pain is now causing it. In addition to tenderness and pain, bursitis symptoms can include localized swelling, skin redness and warmth.

Most often, bursitis results from repetitive motion, injury or an underlying condition, such as rheumatoid arthritis. Less frequently, bursae may become infected, which leads to a condition known as septic bursitis.

You and your son have bursitis in two of the most common sites –- the shoulder and the knee. In our practices we also see bursitis of the hip, elbow, wrist and ankle. People who do a lot of heavy lifting, who bowl, play golf, baseball or other sports, and the occasional athletes who get up from the couch to suddenly ask their bodies to perform, are all susceptible to bursitis.

By helping you to understand the cause, we're hoping to get you on board with the treatment. Resting the affected area is key. It's also a part of treatment that patients tend to underestimate. The other goal is to alleviate swelling. This can be done with the use of non-steroidal anti-inflammatories (NSAIDs) such as Aleve or ibuprofen, by using an ice pack on the affected joint, keeping the joint elevated, and wrapping with an elastic bandage.

More rarely, and when the bursa is quite swollen, treatment may involve draining excess fluid with a needle, a process known as aspiration. Some patients with bursitis of the shoulder find relief with injections of corticosteroids. If yours is a case of septic bursitis, which is caused by infection, it's important to receive treatment with antibiotics.

Often, the most challenging part of treatment is accepting that recovery takes time. We'll echo what we bet your own doctor is saying –- be patient, be diligent and don't try to return to normal activities too soon.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

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