Bursae are small fluid-filled sacs lined with synovial membrane that are usually located in or close to joints. They function to reduce friction created by the movements of skin, tendons, and muscles over rough bony surfaces. Bursae may become inflamed as a result of excess frictional rubbing (overuse) or direct trauma or prolonged point pressure. Bursitis is an irritation or inflammation of a bursa sac. As a protective mechanism, bursae swell in order to limit movements that increase both friction and subsequent pain. Commonly affected are the bursae in the area surrounding the shoulder, elbow, side of the hip, knee, and heel. The associated inflammation can persist for days to months. If the bursa is not treated properly or is not protected, over time calcium like deposits can occur and subsequent degeneration of the bursa can lead to permanent reduction in function.

Signs and Symptoms: 

• Immediate pain and point tenderness
• Swelling (occasionally spontaneous without pain) which can be very prevalent
• The injured area feels warm to touch
• Range of motion is within normal limits but limited due to pain

On-Site Management:

PROTECT: Primary goal of treatment is to protect are from further trauma. A foam doughnut can be used to take the pressure of bursa in some areas. 

REST: Be sure to rest the body to promote healing. 

ICE: Immediate icing along with anti-inflammatory medication will reduce the inflammation. 

COMPRESSION: important NOT to apply pressure to the area because it will only make it worse.

ELEVATE: if possible, elevate the body part to promote circulation of blood towards heart.

Referral:

If the bursa is chronically inflamed, physician referral is needed as aspiration and infiltration to inject drugs such as corticosteroids, or drain the bursa itself for testing is occasionally required. If the bursa is infected, physicians will take more serious actions such as excision to prevent conditions such as septic arthritis from forming. Physicians may use ultrasound or MRI to confirm bursitis in areas that are not visibly swollen.

Rehabilitation: 

Physiotherapy is often helpful to control inflammation, address decreased flexibility areas of weakness. Pulsed ultrasound and iontophoresis are treatment modalities that have been reported to control inflammation and pain. Biomechanical factors must be addressed to ensure the condition does not become chronic.  Change in apparel and equipment as well as wearing protective devices such as foam doughnuts to relieve pressure and friction on the bursa should be considered. 

Return to Activity:

In some cases, the athlete may return to activity if he/she feel they are not limited in function. Activity should be discouraged, however, to prevent the bursitis from becoming chronic. If the athlete does return to activity, the area must be properly protected.

Prevention:

Since the primary cause of Bursitis includes overtraining and/or direct trauma to the affected area, protection for areas commonly impacted should be devised.

Brukner, P. and Khan, K. Brukner and Khan's Clinical Sports Medicine Brukner, P. and Khan, K. (2007) Brukner and Khan's Clinical Sports Medicine. 4th ed. North Ryde: McGraw-Hill.

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