Bursitis is when the fluid-filled sac (bursa) that cushions a joint becomes swollen and painful; it most often affects the shoulders, hips, elbows and knees [1]. It can usually be treated at home with rest, ice and painkillers and should go away in a few weeks [1]. If the bursa is hot and red or there is a fever, it may be infected (septic bursitis); this needs assessment without delay and antibiotics [1][2][3].
What is bursitis?
Bursae are small, fluid-containing sacs found around the shoulder, elbow, hip, knee and heel; they act as cushions between bones and soft tissues and reduce friction [6]. When a bursa is irritated, excess fluid collects in it and it swells and hurts; this is called bursitis [1][2].
Bursitis is often confused with tendinitis: in bursitis the structure affected is the sac, in tendinitis it is the tendon that attaches muscle to bone [3][6]. The two names are sometimes used for the same complaint: the tendon problem on the outer side of the hip is often also called "trochanteric bursitis" [7]. Tendinitis is covered in a separate article.
What causes bursitis?
In the bursae that lie close to the skin, the most common cause is repeated pressure and friction over the bursa [3]. It is more common in men, particularly those who do manual work such as mechanics, plumbers and gardeners [3]. The main causes:
- Prolonged pressure: working on the knees, or leaning the elbow on a hard surface [2][3]
- A blow: it can make the bursa produce excess fluid or bleed into it [2][3]
- Infection: bacteria can get into the bursa through an injury that breaks the skin, such as an insect bite, a scrape or a puncture wound; it sometimes develops without an obvious wound [2]
- Conditions such as gout and rheumatoid arthritis [2][3]
Where does bursitis occur?
Bursitis most often affects the shoulders, hips, elbows and knees, but it can affect any joint [1]. Of the bursae close to the skin, those at the tip of the elbow and in front of the kneecap are affected most often [3].
In hip bursitis, avoiding the activities that worsen the pain, painkillers and physiotherapy can bring relief for many people; the exercises aim to stretch the band on the outer side of the thigh and to increase the strength and flexibility of the hip [6]. In a study of 204 people with pain on the outer side of the hip, an education and exercise programme gave better results at 8 weeks than a single cortisone injection or a wait-and-see approach [7]. The details are in the hip pain article. The main sites:
- Tip of the elbow: described separately below
- Front of the kneecap: mostly linked to kneeling [3]. A swelling behind the knee (Baker's cyst) is the subject of a separate article
- Shoulder: covered in the shoulder pain and rotator cuff articles
- Outer side of the hip: the pain usually spreads to the outside of the thigh and is worse at night when lying on that side [6]
- Back of the heel: one of the main causes is footwear that does not fit properly [3]
What is elbow bursitis and how is it treated?
Elbow bursitis (olecranon bursitis) is swelling of the thin sac at the bony tip of the elbow [2]. The first sign is often swelling; as the bursa stretches, pain begins, and it gets worse with pressure on the elbow or with bending it [2]. Causes include a blow to the tip of the elbow, leaning the elbow on hard surfaces for long periods, infection, gout and rheumatoid arthritis [2].
If there is no infection, treatment starts with an elbow pad, avoiding activities that put pressure on the elbow and anti-inflammatory painkillers; if the swelling and pain have not settled after 3 to 6 weeks, the doctor may recommend draining the fluid and injecting cortisone into the bursa [2].
When the bursa is infected, the skin becomes red and warm; if the infection is not treated right away it may spread to the arm or into the bloodstream [2]. A hot, red and painful swelling at the elbow, especially with a fever, should therefore be assessed without delay [2][3].
What are the symptoms and how is it diagnosed?
The pain is usually dull and achy; the joint may be tender, swollen or warmer than the surrounding skin, and the pain gets worse on movement or when the area is pressed [1]. The skin may be red; this can be harder to see on brown or black skin [1].
The diagnosis is usually made from the history and examination [3]. An X-ray is requested if there has been an injury or to look for a foreign body or a bone spur [2][3]; ultrasound can help distinguish bursitis from infection of the tissue under the skin [3].
Infected (septic) bursitis is uncommon; up to half of cases occur in people with conditions such as diabetes and chronic kidney disease [3]. A person with bursitis and a fever is considered to have septic bursitis until proven otherwise, while the absence of fever does not rule out infection [3]. If infection is suspected, fluid is taken from the bursa with a needle and examined in the laboratory; this test can also show gout [2][3].
What helps bursitis and how long does it last?
Bursitis can usually be treated at home and should go away in a few weeks [1]. Creams for bursitis are a common question: the sources this article is based on do not list creams, gels, ointments or herbal preparations among the treatments [1][2][3].
To help stop it coming back, it is recommended to use padding when putting joints under pressure, to take regular breaks, to warm up before exercise and to clean any cuts over the joints [1]. What can be done at home:
- Resting the joint and avoiding activities that put pressure on it [1]
- Holding an ice pack wrapped in a towel on the area for around 10 minutes and repeating this every few hours during the day [1]
- Painkillers; a pharmacist or doctor can advise which is suitable [1]
- An elbow pad or knee pad; extra cushions around the joint while sleeping [1][2]
- Raising the swollen area and supporting it with a bandage [3]
Draining the fluid and cortisone injection
A doctor may draw the fluid out of the bursa with a needle to ease symptoms [1]. For bursitis caused by repeated pressure, one review generally does not recommend this because of the risk of introducing infection into the bursa [3]; in a systematic review of elbow bursitis covering 1,278 patients, however, draining did not increase the risk of infection of the bursa in non-infected bursitis [4].
A cortisone (steroid) injection may be given to reduce the swelling; it is not done if the bursitis is caused by an infection [1]. Its benefit is debated: in the same review the injection was associated with more complications and with thinning of the skin, without improving the outcome of non-infected elbow bursitis [4]. In a 2023 review it shortened the duration of symptoms, but infection of the bursa and thinning of the skin were more frequent; the authors recommend reserving the injection for cases that do not respond to other measures [5].
When are antibiotics and surgery needed?
Bursitis caused by infection needs antibiotics, usually taken for at least 7 days [1]. People whose general condition is good can be treated as outpatients with antibiotics by mouth; those with general signs of infection or a suppressed immune system are given antibiotics into a vein in hospital [3].
Surgery is rarely needed [1]. Removing the bursa is considered when infected bursitis does not improve despite antibiotics and draining, and when non-infected bursitis does not respond to non-surgical treatment or keeps coming back [2][3]. After surgery for elbow bursitis the bursa usually grows back over several months as a normally functioning bursa; after 3 to 4 weeks full use of the elbow may be allowed [2].
In the same systematic review, surgical treatment was associated with less resolution and more complications than non-surgical treatment; the level of evidence is low [4].
When not to wait
See a doctor if symptoms have not improved or are getting worse after 1 to 2 weeks despite home measures, if you cannot move the joint or if you have very severe, sharp pain [1]. The following may be signs of infection; seek medical care without waiting [1][2][3]:
- Fever, feeling cold or shivering [1][3]
- Redness and warmth over the swelling [2][3]
- Pus or fluid draining from the swelling [2][3]
- Swelling, redness and pain that develop after a cut, a scrape or an insect bite [2]
- A painful, warm swelling in someone with diabetes, kidney disease or a condition that suppresses the immune system [3]
Frequently asked questions
- How does bursitis go away?
- It can usually be treated at home with rest, ice and painkillers and should go away in a few weeks [1]. See a doctor if symptoms have not improved or are getting worse after 1 to 2 weeks [1].
- Does a cream work for bursitis?
- The sources this article is based on do not list creams, gels or ointments among the treatments for bursitis [1][2][3]. The measures they recommend are rest, ice, padding that reduces pressure and painkillers when needed [1][3].
- What helps elbow bursitis?
- An elbow pad, avoiding activities that put pressure on the elbow and anti-inflammatory painkillers are the first measures; if there is no improvement after 3 to 6 weeks, the doctor may recommend draining the fluid and a cortisone injection [2]. If the elbow is hot and red it may be infected; seek care without waiting [2].
- When is surgery done for elbow bursitis?
- Removing the bursa may be recommended if an infected bursa does not improve despite antibiotics or draining, or, in non-infected bursitis, if non-surgical treatment does not work [2]. In a systematic review based mainly on low-level evidence, non-surgical treatment was found to be more effective and safer than surgical treatment [4].
- What are the exercises for hip bursitis?
- They are exercises to stretch the band on the outer side of the thigh and to increase the strength and flexibility of the hip; a doctor or physiotherapist shows them [6]. In a study of people with pain on the outer side of the hip, an education and exercise programme gave better results at 8 weeks than a single cortisone injection [7]. The details are in the hip pain article.
This article is a general summary; diagnosis and treatment decisions are made by the doctor who examines you.
Sources
- Bursitis. NHS (nhs.uk), 2023. nhs.uk
- Elbow (Olecranon) Bursitis. American Academy of Orthopaedic Surgeons (OrthoInfo), n.d.. orthoinfo.org
- Common Superficial Bursitis. American Family Physician (Khodaee M), 2017. pubmed.ncbi.nlm.nih.gov
- Treatment of olecranon bursitis: a systematic review. Archives of Orthopaedic and Trauma Surgery (Sayegh ET, Strauch RJ), 2014. pubmed.ncbi.nlm.nih.gov
- Non-surgical treatment of aseptic olecranon bursitis: A systematic review. Reumatología Clínica (Kaur IP, et al.), 2023. pubmed.ncbi.nlm.nih.gov
- Hip Bursitis. American Academy of Orthopaedic Surgeons (OrthoInfo), n.d.. orthoinfo.org
- Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial. BMJ (Mellor R, et al.), 2018. pubmed.ncbi.nlm.nih.gov
This article is general information and does not replace an examination or imaging. If you have symptoms, see a doctor.
More in this area
- Broken collarbone (clavicle fracture): sling or surgery?
- Frozen shoulder: how long does it last, and when are injections or surgery considered?
- Shoulder pain and rotator cuff problems: is surgery needed?
- Calcific tendinitis of the shoulder: why it happens and how it is treated
- Dislocated shoulder: what happens after it is put back, and is surgery needed?
- Shoulder pain: what causes it, what helps and who to see
- Tendinitis (tendon inflammation): what causes it and what helps it settle?
- Tennis elbow: what do steroid injections, PRP and surgery add?