Bursitis: Causes, Symptoms, and Effective Treatments

Key Takeaways

• Bursitis is inflammation of bursae—small fluid-filled sacs that cushion joints
• Common sites include shoulder, elbow, hip, and knee
• Most bursitis is caused by repetitive motion or pressure, not infection
• Treatment focuses on rest, ice, anti-inflammatory medications, and modifying activities
• Most cases resolve within a few weeks with proper treatment
• Chronic or severe bursitis may require injections or, rarely, surgery

If you’ve ever experienced a sudden, intense pain near a joint that wasn’t quite in the joint itself, you may have had bursitis. This common condition affects millions of people each year and can range from a minor nuisance to a significant source of disability.

Understanding bursitis helps you recognize it early and take appropriate steps for recovery.

What Is Bursitis?

The Anatomy

Bursae (singular: bursa) are small, fluid-filled sacs located throughout your body, particularly near joints. They act as cushions and reduce friction between:

• Bones and tendons
• Bones and muscles
• Skin and bones (where bones are close to the surface)

You have more than 150 bursae in your body, but only certain ones commonly become inflamed.

When Things Go Wrong

Bursitis occurs when a bursa becomes inflamed. The sac swells with excess fluid and becomes painful. This can happen due to:

• Repetitive motion: Same movement over and over
• Prolonged pressure: Leaning on elbows, kneeling on hard surfaces
• Injury: Direct blow or fall onto the area
• Infection: Bacteria entering the bursa (septic bursitis—requires urgent treatment)
• Underlying conditions: Rheumatoid arthritis, gout, diabetes

Common Types of Bursitis

Shoulder Bursitis (Subacromial Bursitis)

Location: Between the rotator cuff and the acromion (bony prominence on top of shoulder)

Causes:

• Repetitive overhead movements (painting, swimming, throwing)
• Sleeping on the same shoulder repeatedly
• Poor posture leading to impingement

Symptoms:

• Pain on the outside of the shoulder
• Worse with overhead reaching
• Pain when lying on the affected side
• Difficulty reaching behind your back

Hip Bursitis (Trochanteric Bursitis)

Location: Over the bony point of the hip (greater trochanter)

Causes:

• Repetitive activities (running, cycling, standing for long periods)
• Lying on one side for extended periods
• Hip injury or surgery
• Spine problems affecting gait
• Leg length discrepancy

Symptoms:

• Pain on the outside of the hip
• Worse when lying on the affected side
• Pain climbing stairs
• Pain after prolonged sitting or standing
• May radiate down the outer thigh

Knee Bursitis

Several bursae around the knee can become inflamed:

Prepatellar bursitis (“housemaid’s knee”):

• Over the kneecap
• Caused by prolonged kneeling
• Common in plumbers, carpet layers, gardeners
• Visible swelling over the kneecap

Pes anserine bursitis:

• Inside of knee, below the joint
• Common in runners, overweight individuals, those with knee arthritis
• Pain worse with stairs and getting up from chairs

Infrapatellar bursitis (“clergyman’s knee”):

• Below the kneecap
• Also from kneeling

Elbow Bursitis (Olecranon Bursitis)

Location: Over the point of the elbow

Causes:

• Leaning on elbows (at a desk, for example)
• Repetitive elbow motion
• Direct trauma
• Can become infected (more common at this site)

Symptoms:

• Swelling at the tip of the elbow (often dramatic)
• Pain with pressure or bending
• May be red and warm if infected

Other Sites

• Ischial bursitis: “Weaver’s bottom”—sitting on hard surfaces
• Retrocalcaneal bursitis: Back of the heel
• Ankle bursitis: Various locations around the ankle

Recognizing Bursitis vs. Other Conditions

Bursitis vs. Arthritis

Bursitis:

• Pain near but not quite in the joint
• Localized swelling
• Related to specific activities or positions
• Often sudden onset

Arthritis:

• Pain within the joint itself
• Stiffness, especially in the morning
• Progressive over time
• May have systemic symptoms (in inflammatory arthritis)

Bursitis vs. Tendinitis

These often occur together and can be difficult to distinguish:

Bursitis:

• Pain more diffuse over the area
• Swelling may be visible
• Pain with pressure on the bursa

Tendinitis:

• Pain along the tendon
• Pain with specific movements that use the tendon
• May feel “crunchy” or hear clicking

When to Suspect Infection (Septic Bursitis)

Seek medical care immediately if you notice:

• Significant redness spreading beyond the swollen area
• Severe warmth
• Fever or chills
• Rapid worsening
• Open wound near the bursa
• Red streaks extending from the area

Infected bursitis requires antibiotics and sometimes drainage. It’s more common in elbow and knee bursitis.

Diagnosis

Medical Evaluation

Your doctor will:

• Ask about your symptoms and activities
• Examine the affected area
• Check for signs of infection
• Assess range of motion
• Compare to the opposite side

Tests (If Needed)

X-rays:

• Usually normal in bursitis
• May show calcium deposits
• Rules out fractures or arthritis

Ultrasound:

• Shows fluid in the bursa
• Guides aspiration if needed

MRI:

• For complex cases
• Differentiates from other conditions

Aspiration:

• Removing fluid from the bursa
• Analyzes for infection or gout crystals
• May be therapeutic (reduces swelling)

Treatment

Initial Self-Care (First 48-72 Hours)

Rest:

• Avoid the activity that caused the problem
• But don’t immobilize completely—gentle movement helps

Ice:

• 15-20 minutes several times daily
• Reduces inflammation and pain
• Wrap ice in a cloth to protect skin

Compression:

• Elastic bandage for accessible areas (knee, elbow)
• Reduces swelling

Elevation:

• When possible, raise the affected area

Over-the-counter medications:

• NSAIDs (ibuprofen, naproxen) reduce inflammation
• Acetaminophen for pain relief

Protecting the Area

Avoid aggravating activities:

• Don’t kneel on a bursitis-prone knee
• Don’t lean on an affected elbow
• Modify exercise temporarily

Padding:

• Knee pads for prepatellar bursitis
• Elbow pads if you lean on your elbows
• Cushioned mats for kneeling

Medical Treatment

Prescription NSAIDs:

• Higher doses than over-the-counter
• Topical NSAIDs for localized treatment

Physical therapy:

• Stretching and strengthening exercises
• Addresses underlying biomechanical issues
• Prevents recurrence

Corticosteroid injections:

• Highly effective for persistent bursitis
• Injection directly into the bursa
• Relief often within days
• May be combined with aspiration
• Limited to a few injections to avoid complications

Antibiotics:

• For septic (infected) bursitis
• May require aspiration or drainage

Surgery (Rare)

Surgery is rarely needed but may be considered for:

• Chronic bursitis not responding to other treatments
• Infected bursitis requiring drainage
• Calcium deposits causing persistent problems

Surgical removal of the bursa (bursectomy) allows a new, healthy bursa to form.

Prevention

Modify Repetitive Activities

• Take regular breaks
• Vary your tasks throughout the day
• Use proper technique (especially for overhead work)

Use Protective Equipment

• Knee pads when kneeling
• Cushioned gloves for repetitive hand work
• Proper footwear with adequate cushioning

Strengthen and Stretch

• Strong muscles reduce stress on bursae
• Flexible muscles and tendons move more smoothly
• Target areas prone to your type of bursitis

Maintain Healthy Weight

• Excess weight increases stress on hip and knee bursae
• Weight loss reduces recurrence risk

Watch Your Posture

• Poor posture contributes to shoulder bursitis
• Ergonomic workstation setup helps
• Take breaks from prolonged positions

Recovery Timeline

Acute Bursitis

• Days 1-3: Worst pain and swelling
• Week 1-2: Gradual improvement with rest and treatment
• Weeks 2-4: Most cases resolve
• 4-6 weeks: Full recovery, gradual return to activities

Factors Affecting Recovery

Faster recovery:

• Early treatment
• Avoiding aggravating activities
• Following treatment recommendations
• No underlying inflammatory conditions

Slower recovery:

• Continuing aggravating activities
• Delayed treatment
• Underlying conditions (RA, gout)
• Previous bursitis episodes

Returning to Activities

• Gradual return, not sudden
• Start at lower intensity
• Stop if pain returns
• Continue preventive measures

Frequently Asked Questions

Can bursitis become chronic?

Yes. Without proper treatment or with continued aggravation, bursitis can become a chronic problem. The bursa wall may thicken, making it harder to treat. This is why early, appropriate treatment matters.

Should I use heat or ice?

Ice is better for acute bursitis (first few days to weeks) when there’s active inflammation. Heat may be helpful for chronic bursitis or muscle tension around the area. Many people alternate between the two.

Will bursitis go away on its own?

Mild bursitis may resolve on its own with rest and activity modification. However, treatment speeds recovery and prevents complications. Don’t ignore bursitis that isn’t improving.

Can I exercise with bursitis?

Yes, but modify your activities. Avoid movements that aggravate the bursitis. Low-impact activities (swimming, cycling for hip bursitis) are often tolerable. A physical therapist can help you maintain fitness while recovering.

Is bursitis the same as arthritis?

No. Bursitis is inflammation of the bursae (cushioning sacs near joints), while arthritis is inflammation or degeneration within the joint itself. However, people with arthritis may be more prone to bursitis, and the two can occur together.

How do I know if I need a cortisone shot?

Consider an injection if:

• Conservative treatment hasn’t helped after 2-4 weeks
• Pain is significantly affecting your function
• You’ve ruled out infection
• Your doctor recommends it

Most people improve with conservative treatment alone.

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Dealing with joint pain? Learn about related conditions in our guides on tendinitis vs. arthritis or explore our conditions hub.

Last medically reviewed: February 2025

Medical Disclaimer: This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. If you have symptoms of bursitis, especially with signs of infection, please consult a healthcare provider.