Retired high school superintendent Connor Knobles* doesn’t recall doing anything differently in the weeks before his shoulder pain hit, except that he’d been painting the living room of his condo. But then, “Whack! My shoulder was in constant pain,” he says.
For Clarissa Stewart*, the shoulder pain developed more gradually. “I always carried heavy books, manuscripts and files in a bag slung over my left shoulder,” says the New York-based magazine editor. “Friends and family would call me ‘the Leaning Tower of Pisa.’ But, back then, I didn’t realize that the pain in my right hip was the result of the heavy load on my shoulder.”
A misunderstood ailment
Although Knobles and Stewart initially thought their misery probably was caused by arthritis, their doctors diagnosed them both with bursitis.
While pain and swelling around joints are common to both bursitis and arthritis, they are separate conditions, explains Theodore Fields, MD, a rheumatologist at the Hospital for Special Surgery in New York.
Arthritis is characterized by joint inflammation along with degeneration of connective tissue and bone. Bursitis involves inflammation and swelling of the bursa. Bursae (the plural of bursa) are small, fluid-filled sacs that cushion the joints. Found around most major joints, the 160 or so bursae in your body also promote freedom of movement. “Think of bursae as tiny marshmallows cushioning your joints,” suggests Patrice Winter, MS, PT, an assistant professor in the College of Global and Community Health at George Mason University in Fairfax, VA. “When they are inflamed, they are more like marshmallows that have swelled and burned in the campfire.”
Bursitis can develop as a result of injury, repeated stress to the joint, bacterial infection, or autoimmune conditions such as rheumatoid arthritis (RA) or gout.
Two types of bursitis
Bursitis can be either acute or chronic, and sometimes it seems to come out of the blue. Often, however, its cause is clear. For example, so-called “weekend warriors,” who exercise only sporadically, are good candidates for painful bursitis, according to Jeanne Doperak, MD, a sports medicine specialist at the University of Pittsburgh Medical Center.
Some joints are more prone than others to developing bursitis, notes Dr. Fields. “Shoulder joints tend to be most often affected,” he says. “Left untreated, irritation caused by the bursa may lead to the formation of calcium deposits, which can cause severe stiffness—a condition that’s sometimes called frozen shoulder. Rotator cuff injuries—injuries to muscles and tendons in the shoulder,” he adds, “can also trigger bursitis in the shoulder.”
An ounce of prevention
Of course, the best way to deal with bursitis is to prevent it. Dr. Doperak urges weekend warriors to prepare for exercise instead of jumping right in. “Warm up before and cool down after,” she advises. “Learn how to stretch and strengthen your muscles correctly. Wear protective gear, such as knee and elbow pads, to prevent injury to joints that are at risk.”
Patrice Winter stresses the importance of monitoring your posture and alignment to avoid putting undue stress on any body part. And, if you do a lot of repetitive tasks, such as typing at a computer, take regular breaks. Also, make it a point to change position regularly. Simply keeping your elbow flexed in a single position—leaning on it on an armrest for long periods of time—can irritate the surrounding bursae. “Pay attention to your body and to pain when it occurs,” says Dr. Doperak. “Your body is telling you to stop and reconsider what you are doing.”
Once bursitis develops, treatment is needed. If no infection is present, ice packs, rest, and anti-inflammatory and pain medications often can provide relief. Non-infectious bursitis also can be treated with cortisone injections, which ease pain by quickly reducing inflammation. If gout is present (crystals of monosodium urate are seen) treatment of the acute attack is required.
Infectious (septic) bursitis, which may develop as a result of injury or underlying rheumatic disease, requires additional evaluation and treatment. “Be especially mindful if the affected area is red and hot to the touch,” cautions Dr. Fields. “If that is the case, you need to seek medical attention immediately.”
A physician can draw fluid from the bursae and send it to the lab. If infection is present, the patient should be treated with systemic antibiotics. In rare cases, the bursae may need to be surgically removed.
Easy does it
Clarissa Stewart, who underwent weeks of physical therapy following her bursitis diagnosis, has swapped her heavy briefcase for a padded knapsack. On days when she must carry lots of papers and files, she uses a small, wheeled suitcase. She also wears orthotics, or inserts that correct her alignment, in her sneakers. Her orthopedist discovered that her legs are of unequal length—which was responsible for a great deal of her hip pain.
Connor Knobles’ shoulder pain has not returned, and for that he is grateful. “My doctor injected cortisone into my shoulder,” he says. “It seemed to work. Also, I’ve decided to hire someone else to paint my condo!”
*These names have been changed.
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