How Bursae Work

Bursae are lined with a thin layer of synovial tissue that produces fluid to lubricate and reduce friction between moving parts of the joint. Under normal conditions they are flat and contain only a small amount of fluid. When irritated or injured, the synovial lining produces excess fluid, causing the bursa to swell and press on nearby tissues — resulting in pain and restricted movement.

Common Locations

• Shoulder (subacromial bursitis) – the most common site; pain with overhead arm movements
• Elbow (olecranon bursitis) – swelling at the tip of the elbow, often called “student’s elbow”
• Hip (trochanteric bursitis) – pain on the outer hip, especially when lying on the affected side
• Knee (prepatellar or infrapatellar bursitis) – swelling in front of or below the kneecap; common in people who kneel frequently (“housemaid’s knee”)
• Heel (retrocalcaneal bursitis) – pain at the back of the heel near the Achilles tendon
• Hip flexor / iliopsoas bursitis – pain in the groin or front of the hip

Causes and Risk Factors

Bursitis is most often caused by repetitive motion or prolonged pressure, but can also result from:

• Repetitive movements or overuse of a joint (sports, manual labor, musical instruments)
• Prolonged pressure on a joint (kneeling, leaning on elbows)
• Sudden injury or trauma to a joint
• Inflammatory conditions such as rheumatoid arthritis or gout
• Bacterial infection of a bursa (septic bursitis)
• Age — bursae become less resilient with age
• Poor posture or biomechanics
• Being overweight (increases stress on hip and knee bursae)

Symptoms

• Dull aching or sharp pain around the affected joint
• Swelling or a visible lump at the site of inflammation
• Tenderness when pressing on the area
• Stiffness or reduced range of motion
• Warmth or redness over the joint (especially in septic or gouty bursitis)
• Pain that worsens with movement and may improve with rest

Diagnosis

A physician will perform a physical examination and review your medical history and activity level. Imaging may be used to confirm the diagnosis and rule out other conditions — ultrasound is particularly useful for visualizing bursa swelling, while MRI can assess surrounding soft tissue. If infection is suspected, the physician may aspirate (draw fluid from) the bursa to test for bacteria.

Treatment Options

Most cases of bursitis respond well to conservative treatment:

• Rest – avoiding the activity that caused irritation
• Ice – applying cold packs for 15–20 minutes several times a day to reduce swelling
• Anti-inflammatory medications (NSAIDs) – ibuprofen or naproxen to reduce pain and swelling
• Physical therapy – exercises to strengthen surrounding muscles and restore range of motion
• Corticosteroid injections – powerful anti-inflammatory injected directly into the bursa for faster relief
• Aspiration – draining excess fluid from the bursa to relieve pressure
• Antibiotics – required for septic (infected) bursitis
• Surgery – rarely needed; considered when bursitis is chronic and unresponsive to other treatments

Prevention

Steps to reduce the risk of bursitis include warming up before exercise, using proper technique and ergonomics, taking regular breaks from repetitive tasks, using protective padding when kneeling, maintaining a healthy weight, and strengthening the muscles around commonly affected joints.

Outlook

Acute bursitis typically improves within a few weeks with proper treatment and rest. Chronic bursitis — often caused by repeated episodes — may take longer and require more aggressive management. Identifying and modifying the underlying cause is key to preventing recurrence.

Consult your health care provider for specific medical advice.