Bursitis

A bursa is a thin, fluid-filled sac that lets skin, tendon and bone glide smoothly over one another. Bursitis develops when a bursa becomes irritated and inflamed, so it produces extra fluid and swells. The usual trigger is repeated pressure, friction or overuse, for example prolonged kneeling, leaning on the elbows, or activities that load the shoulder or hip. A single knock or fall can set it off too.

Some bursitis reflects an underlying problem rather than simple wear. It can accompany tendinopathy or rotator cuff problems, and inflammatory conditions such as gout or rheumatoid arthritis can be involved. Occasionally a bursa becomes infected. It is more common with certain jobs, hobbies and increasing age.

Bursitis tends to cause fairly localised symptoms. These may include:

• Pain and tenderness over a specific point near a joint
• Swelling, which can sometimes be seen or felt
• Pain that is worse with pressure on the area or with particular movements
• Stiffness or discomfort in the nearby joint

Bursitis can often be recognised from the history and examination, and it is worth confirming the cause, as the symptoms can overlap with other problems around the joint.

Ultrasound is especially useful here. It can confirm an inflamed or swollen bursa, show any fluid, and help distinguish bursitis from other causes of the pain. Dr Borukhson uses point-of-care ultrasound during the consultation, so the area can often be assessed in the same visit. You can read more on the ultrasound clinic page.

Treatment usually starts with simple measures such as rest, reducing the activity or pressure that triggered it, and pain relief. Where symptoms persist, an ultrasound-guided injection can settle the inflammation, and ultrasound guidance allows it to be placed accurately and any fluid to be drained where helpful. The plan is agreed with you.

A few simple measures help most bursitis settle and reduce the chance of it returning.

• Ease off the trigger. Cut back the activity, kneeling or leaning that brought it on, rather than stopping all movement.
• Protect the area. Use padding or a cushion over a pressure point such as the knee or elbow, and adjust how you sit or work.
• Cooling and pain relief. A cold pack and simple painkillers can ease a flare; a pharmacist can advise.
• Keep the joint moving gently within comfort, returning to fuller activity as the pain settles.

Most cases improve over a few weeks. Some are more stubborn or tend to recur, particularly when the original pressure continues, so addressing the cause matters as much as treating the flare.

Most bursitis is not dangerous, but a few features mean it should be looked at promptly rather than left.

Seek urgent medical advice, the same day, if the area becomes hot, red and increasingly painful, if the skin is broken over it, or if you feel feverish or generally unwell. These can point to an infected bursa, which needs assessment and sometimes antibiotics or drainage.

Arrange a routine review if localised pain and swelling near a joint is not settling after a few weeks, keeps coming back, follows a significant injury, or limits your usual activities. It is also worth checking if you are unsure of the diagnosis, or if you have an inflammatory condition such as gout, so the cause can be confirmed and treated correctly.

Most bursitis improves with the right approach, and assessment confirms the diagnosis, identifies what is driving it, and rules out other causes. If you have localised pain and swelling near a joint that is not settling, a specialist review, with ultrasound where helpful, can clarify it.

How is bursitis diagnosed?

Bursitis can often be recognised from your history and an examination of the affected area. Because the symptoms can overlap with other problems around the joint, it is worth confirming the cause, and ultrasound is especially helpful here. It can show an inflamed or swollen bursa and any fluid, and tell bursitis apart from other causes of the pain. Dr Borukhson uses point-of-care ultrasound during the consultation, so the area can usually be assessed in the same visit.

Will bursitis go away on its own?

Most bursitis settles with the right approach, often starting with simple measures such as rest, easing off the activity or pressure that triggered it, and pain relief. Many cases improve over a few weeks, though some are more stubborn and benefit from treatment. If localised pain and swelling near a joint is not settling, it is sensible to have it assessed rather than wait indefinitely.

Do I need surgery for bursitis?

Surgery is rarely needed for bursitis, and most people improve with simpler measures. Where symptoms persist, an ultrasound-guided injection can settle the inflammation, and ultrasound guidance allows it to be placed accurately and any fluid to be drained where that helps. The plan is always agreed with you, starting with the least invasive option that fits your situation.

Is bursitis serious, and should I see a specialist?

Bursitis is usually a treatable cause of localised pain and swelling rather than a serious condition, and most cases respond well. A specialist review is worthwhile when the symptoms are not settling, when the diagnosis is unclear, or when it is helpful to rule out other causes around the joint. An assessment, with ultrasound where useful, can confirm what is going on and guide the right treatment for you.