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BURSITIS Bursitis is the painful inflammation of the bursa, a pad like sac found in areas subject to friction.

Bursae cushion the movement between the bones, tendons and muscles near the joints. Bursitis is most often caused by repetitive movement and is known by several common names including weaver's bottom, clergyman's knee, and miner's elbow, depending on the affected individual's occupation and area of injury. Types of bursitis Shoulder Bursitis Information about shoulder bursitis. Many people are told by their doctor they have "shoulder bursitis;" learn about this common diagnosis and available treatments. Olecranon Bursitis Olecranon bursitis is a common cause of swelling and inflammation around the elbow joint. Usually treated easily by draining the swollen bursa, it is important that olecranon bursitis be evaluated by a physician to ensure it does not become infected. Infectious Bursitis Trochanteric (Hip) Bursitis Trochanteric bursitis, also called hip bursitis, is a common problem of pain and inflammation over the outside of the hip and thigh area. Treatment consists of resting and medications. Prepatellar (Kneecap) Bursitis Prepatellar bursitis, or Housemaid's Knee Syndrome, is a condition of swelling and inflammation over the front of the knee. This is commonly seen in patients who kneel for extended periods, such as carpet layers and gardeners. Description There are over 150 bursae in the human body. Usually bursae are present from birth, but they may form in response to repeated pressure. Each sac contains a small amount of synovial fluid, a clear liquid that acts as a lubricant. Inflammation causes pain on movement. The most common site for bursitis to occur is the shoulder (subdeltoid), but it also is seen in the elbows (olecranon), hips (trochanteric), knees, heels (Achilles), and toes. The affected area may be referred to as "frozen," because movement is so limited. In the knee there are four bursae, and all can become inflamed with overuse.

Pathophysiology Inflammation causes synovial cells to multiply and thereby increases collagen formation and fluid production. A more permeable capillary membrane allows entrance of high protein fluid. The bursal lining may be replaced by granulation tissue followed by fibrous tissue. Hemorrhage may occur. One study suggests this process may be mediated by cytokines, metalloproteases, and cyclooxygenases. In septic arthritis, local trauma usually causes inoculation of bacteria into the bursa, which triggers the inflammatory process. Causes *Repetitive movement and extreme pressure have been known to produce bursitis pain in the elbows, knees, hips and shoulders. *Prolonged movements involved in manual labor or assembly line work create the type of repetitive motions that inflame a joint's bursa. *The excessive pressure on knee joints experienced by roofers, carpet layers and gardeners are also occupational triggers of bursitis pain. *The inflammation associated with bursitis can also be caused by an infection of the bursa with bacteria.

Signs and symptoms *Pain and tenderness. *Swelling and redness.

Diagnosis *Physical examination is needed to determine what type of movement is affected and if there is any swelling present. *X-ray testing can sometime detect calcifications in the bursa when bursitis has been chronic or recurrent.

* If infection is suspected, aspiration of the bursa should be performed and the fluid sent to the laboratory for cell count, gram stain and culture.

Treatment/Alternative treatment *Conservative treatment of bursitis is usually effective. The application of heat, rest, and immobilization of the affected joint area is the first step. *Diet changes and vitamin supplements may be helpful. *The use of herbs, homeopathy, aromatherapy, and hydrotherapy can help relieve symptoms. *Ginger is useful in reducing inflammation. *Acupuncture has been proven effective in treating hip and shoulder pain caused by bursitis and other conditions. *Other therapies that deal effectively with musculoskeletal problems (relating to the muscles and skeleton), may also be helpful, such as body work, magnetic field therapy, naturopathic medicine, chiropractic, and applied kinesiology.

Prevention *Aggravating factors should be eliminated to prevent bursitis. *Overexercising or the repetition of a movement that triggers the condition should be avoided. *Doing exercises to strengthen the muscles around the joint will also help. * When doing repetitive tasks, frequent breaks should be taken and the activity should be alternated with others using different parts of the body.

Nursing management

Rest and Protect The Area The first steps of bursitis treatment are to keep pressure off of the affected area, and try to limit your activity of that joint. Some individuals benefit from placing an elastic bandage (Ace wrap) or immobilizing brace around the joint

until the inflammation subsides. Movement and pressure of the inflamed area will only cause exacerbation and prolongation on symptoms. Apply an Ice Pack Icing the area of inflammation is an important aspect of bursitis treatment. The ice will help to control the inflammation and decrease swelling. By minimizing inflammation and swelling, the bursa can return to its usual state and perform its usual function. Take Anti-Inflammatory Medications Nonsteroidal anti-inflammatory medications (NSAIDs) include a long list of possibilities such as Ibuprofen, Motrin, Naprosyn, Celebrex, and many others. Bursitis treatment can be improved by these medications that will decrease pain and swelling. Be sure to talk to your doctor before starting these medications.

Cortisone Injections if the symptoms of bursitis are persistent, an injection of cortisone may be considered. Cortisone is a powerful antiinflammatory medication, but instead of being given by mouth, it is injected directly to the site of inflammation. This can be extremely helpful for situations that are not improved with rest.

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