In a previous article I discussed what bursitis is and why it develops. In this article I’ll talk about some of the more common types of bursitis. Let’s start from the top and work down.
In the shoulder there is a large bursa called the subdeltoid bursa. This sits underneath the deltoid muscle which lies on the side of the upper arm at the shoulder. This is also called the subacromial bursa. Bursitis in this area presents with aching soreness in the shoulder that is aggravated by movement. Pain is present at night also. Overactivity is the usual cause and it’s common for rotator cuff tendonitis to coexist with this type of bursitis.
The olecrenon bursa is located at the tip of the elbow. Bursitis can develop as a a result of excessive pressure (eg., leaning on the elbow on a hard surface) or after significant trauma. One complication of this type of bursitis is that it can be become infected. The usual organism associated with septic bursitis is staph aureus. The treatment for septic bursitis is to drain the affected bursa and treat with antibiotics. Oral antibiotics usually work but intravenous antibiotics are sometimes needed.
The hip is an area where a number of different types of bursitis can occur. Prolonged sitting on a hard surface leads to ischiogluteal bursitis. This is a nagging type of bursitis located in the buttock region.
Iliopectineal bursitis is located in the groin area and is aggravated by walking, running, and going up stairs.
Trochanteric bursitis is located at the outside of the hip. This type of bursitis often occurs in overweight people and is aggravated by walking, going up stairs, and lying on the affected side.
Gluteus medius bursitis looks a lot like trochanteric bursitis. The location is usually a bit posterior to the trochanteric bursa.
Bursitis in the knee can be located either in front of the patella (prepatellar bursitis) or just below the knee along the inside of the upper part of the lower leg bone (tibia). This is called anserine bursitis. Prepatellar bursitis, as is the case with olecrenon bursitis, can become septic.
Bursitis in the ankle can occur at the back of the heel beneath the Achilles tendon. Usually overactivity such as running too much can cause this type of bursitis. Rest, ice, and sometimes anti-inflammatory drugs are useful. Steroid injections should be used with great caution in this area because of the possibility of weakening the Achilles tendon. This situation can lead to rupture of the tendon.
Bursitis occurring at the base of the fifth toe is called a bunionette and bursitis occurring at the side of the large toe is called a bunion. Osteoarthritis is the usual underlying cause of the bursitis. Special padding and injections of glucocorticoids are helpful treatments.
Patients with inflammatory diseases such as gout or rheumatoid arthritis can also develop bursitis. Any patient with recurrent bursitis should be evaluated for an underlying condition that may be predisposing them to getting bursitis.
The diagnosis of bursitis and the treatment is not an easy one. A well-qualified rheumatologist or orthopedist should be consulted. If injection is required, ultrasound needle guidance is recommended.
Nathan Wei, MD FACP FACR is a rheumatologist and Director of the Arthritis and Osteoporosis Center of Maryland. He is a Clinical Assistant Professor of Medicine at the University of Maryland School of Medicine. For more info:
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