Bursitis

What is Bursitis?

Bursitis is swelling or inflammation of a bursa, a thin, fluid-filled sac found near bony prominences and between bones, muscles, tendons and skin. The body has more than 150 bursae, and they cushion tissues that move against one another.^[1] When a bursa swells, movement or direct pressure on it causes pain.^[1]

Common symptoms

The main symptoms are pain that is worse with movement or pressure, swelling over the bursa, tenderness and limited motion of the nearby joint.^[1] The location varies:

• Shoulder (subacromial bursitis), often with pain when lifting the arm^[2]
• Outer hip (trochanteric bursitis), with pain on the side of the thigh that is worse when sitting for long periods or climbing stairs^[3]
• Elbow (olecranon) and knee (prepatellar, sometimes called "housemaid's knee"), the two most commonly affected bursae^[4]

Redness, warmth or fever can point to infection and need prompt medical attention.^[5]

Causes and risk factors

Common causes include overuse, repetitive stress, injury, infection and inflammatory or crystal-related joint conditions such as rheumatoid arthritis and gout.^{[1, 5]} Kneeling for long periods is a typical trigger for knee bursitis.^[4] The name "bursitis" is sometimes a misnomer, because not every swollen bursa is mainly inflammatory.^[1]

In the hip, lateral hip pain once labeled trochanteric bursitis is now often called greater trochanteric pain syndrome, which also includes tendon problems of the gluteal muscles.^[3]

How it is diagnosed and treated conventionally

Diagnosis is mostly clinical, based on your history and examination, with imaging used to rule out other causes.^[3] If infection is possible, fluid may be drawn from the bursa and tested, because infected and non-infected bursitis can look alike.^{[5, 6]}

Non-infected bursitis often settles with conservative care: rest, ice, compression, a brace or pad and anti-inflammatory medicines.^[7] Physical therapy and stretching are standard for hip and shoulder bursitis, and surgery is kept for cases that do not respond.^[3] A review of olecranon bursitis noted that steroid injections and surgery have more adverse effects than simple measures when used first.^[7] Infected bursae need antibiotics, and sometimes drainage or surgery.^[6]

Why Bursitis calls for a whole-person approach

A swollen bursa is usually a sign of something nearby: repeated stress on a joint, a tight or irritated tendon, or a medical condition affecting the joints. Treating only the sore spot may not address why it keeps returning.^{[1, 3]}

Care that looks at movement, muscle tension and general health is therefore a reasonable complement to medical treatment.

Overuse and movement patterns

Overuse, repetitive stress and direct pressure are leading causes.^[1] Structured exercise is the treatment with the best evidence for improving function in greater trochanteric pain syndrome, and exercise-based treatments performed well in a network meta-analysis of shoulder impingement.^{[8, 9]}

Tendon and muscle involvement

Bursitis rarely occurs in isolation. In the hip, bursitis often coexists with tendon problems of the gluteal muscles, and in the shoulder the subacromial bursa lies directly beside the rotator cuff tendon.^{[2, 3]}

Underlying joint and inflammatory conditions

Rheumatoid arthritis, gout and other inflammatory conditions can cause bursitis, so recurring or unexplained bursitis deserves a medical review.^{[1, 5]}

Persistent pain

When bursitis pain lasts, it is often treated as part of wider musculoskeletal pain. Acupuncture has been studied for chronic musculoskeletal and shoulder pain as a group, which is why our care aims at pain and function and not only the bursa.^[10]

Acupuncture for Bursitis

What the research shows

We found no systematic reviews or trials of acupuncture for bursitis itself. The evidence comes from related conditions, and it is mixed.

An individual-patient meta-analysis of 39 high-quality trials (20,827 patients) in chronic musculoskeletal, osteoarthritis, headache and shoulder pain found acupuncture was better than no acupuncture and also better than sham, though the difference from sham was smaller. Its effects mostly persisted over a year.^[10] This covers chronic pain in general, not bursitis.

For shoulder pain from impingement, where the bursa is often involved, results differ. A sham-controlled trial of 68 adults found real acupuncture reduced pain more than sham acupuncture, with no adverse effects reported.^[11] The trial was small, so it needs confirming. A larger trial of 227 people with subacromial pain syndrome found that adding acupuncture or electroacupuncture to group exercise gave no significant extra benefit at 6 months.^[12] A network meta-analysis listed acupuncture among exercise-based therapies suitable for early-stage shoulder impingement.^[9]

In greater trochanteric pain syndrome, a network meta-analysis of 13 trials found that dry needling did not outperform no treatment for pain, while shockwave and platelet-rich plasma gave short-term relief and exercise improved function.^[8] Dry needling is a related technique and is not the same as acupuncture.

How acupuncture may work

How acupuncture might ease bursitis pain is not known, and no mechanism has been shown specifically for bursitis. The large chronic pain meta-analysis concluded that pain relief after acupuncture cannot be explained by placebo effects alone, and that factors beyond needling at the correct point locations also contribute.^[10]

What treatment involves

Treatment uses fine, sterile, single-use needles placed at points near the affected joint and elsewhere on the body, usually left in place for about 20 to 40 minutes. We reassess after a short course of visits. In the sham-controlled shoulder trial, patients had one session a week for 4 weeks.^[11]

Serious problems are rare. In prospective studies, about 9 in 100 patients had a minor reaction such as bleeding, soreness or redness at a needle site, and serious events occurred in about 1 in 10,000 patients.^[13] Tell the practitioner first if you have a bleeding disorder, take blood thinners, are pregnant, or have a pacemaker (relevant to electroacupuncture). We do not needle through red, hot or infected skin over a bursa.

Ayurvedic medicine for Bursitis

The Ayurvedic view

Ayurveda has no single classical name that matches bursitis. Practitioners may describe joint pain and swelling with stiffness as a disturbance of Vata, the principle said to govern movement, sometimes with Kapha for swelling. In this traditional framework, these are categories for choosing treatment, not biomedical diagnoses.

Therapies that may be used

Care is chosen for the individual and traditionally combines:

• Diet and daily routine meant to calm Vata, such as warm, regular meals and steady sleep
• Gentle warm oil massage around, but not directly over, an inflamed bursa
• Herbs prescribed individually by a qualified practitioner, such as turmeric or Boswellia, which are traditionally used for joint discomfort
• Panchakarma only where traditionally and medically appropriate

Panchakarma is not appropriate during pregnancy, acute illness or frailty. Warm oil and heat are not used over a swollen bursa that is red, hot or possibly infected.

What the research shows

We found no clinical trials or systematic reviews of Ayurvedic treatment for bursitis, so we cannot say whether it helps. Anything described here rests on tradition and on general practice, not on studies of this condition. For turmeric and Boswellia, the broader pain evidence is described under herbal medicine below.^{[14, 15]}

Quality matters with Ayurvedic products. About one fifth of Ayurvedic medicines bought online in one study contained detectable lead, mercury or arsenic, so we ask that any product come from a tested source.^[16]

Herbal medicine for Bursitis

Herbs and formulas that have been studied

We found no trials of herbs or Chinese formulas in bursitis. Turmeric (curcumin) and Boswellia are the herbs most often studied for muscle and joint pain in general.^{[14, 15]}

What the research shows

The evidence is for musculoskeletal pain broadly, not for bursitis. A meta-analysis of 21 trials concluded that turmeric extract and curcumin supplements may be useful adjuncts for musculoskeletal health with few adverse events, but the studies used very different products and doses and were highly inconsistent.^[14] A systematic review of dietary ingredients for chronic musculoskeletal pain made no recommendation for Boswellia or ginger because the evidence was low quality.^[15]

Safety and herb-drug interactions

Herbs are active substances and can interact with medicines. Case reports describe bleeding when warfarin was combined with herbs including dang gui, dan shen, ginger, ginseng and Boswellia.^[17] This matters for people with bursitis who also take blood thinners or anti-inflammatory medicines.

In one study, about one fifth of Ayurvedic products bought online contained detectable lead, mercury or arsenic.^[16] Herbs should come from tested sources and be prescribed individually. Tell us if you are pregnant or breastfeeding, have liver or kidney disease, or have surgery planned.

Translating traditional medicine into modern biological language

The links drawn here are interpretation, not equivalence. Chinese medicine describes joint pain with swelling as blocked flow of qi and blood, often with dampness. Researchers working with acupuncture for shoulder and chronic musculoskeletal pain measure pain and function, which loosely parallels this picture.^[10]

Ayurveda's aggravated Vata describes pain that limits movement. No study has shown that a dosha or a TCM pattern corresponds to a specific biological process in bursitis.

How this care fits with your medical care

Integrative care for bursitis is complementary. Keep your physician, physical therapist or orthopedic specialist, and do not stop or change prescribed medicines or planned injections without your prescriber. We do not diagnose bursitis or the cause of joint swelling, so new or worsening swelling should be medically evaluated first. Exercise and activity changes remain central to recovery.^[8]

Please bring your diagnosis, any imaging reports, a full list of medicines and supplements, and details of any injections or surgery, planned or past. Tell us about any inflammatory joint disease such as gout or rheumatoid arthritis.

When to seek urgent medical care

An infected bursa can spread and needs prompt treatment.^{[5, 6]}

• A swollen joint area that is red, hot and increasingly painful, especially with fever or chills
• Redness spreading along the skin, or pus or drainage from a skin wound near the bursa
• Swelling after a recent cut, scrape or puncture over a bursa
• Sudden inability to move the arm or leg, or severe pain after a fall or injury
• Pain with numbness or weakness in the limb, or a swollen, painful calf

If any of these occur, call 911 or go to the nearest emergency department.