Bursitis

Also called Housemaid's knee, Student's elbow, Trochanteric pain

Inflammation of a cushioning sac at a joint. Usually settles with rest from the aggravating activity, and the hot painful ones need ruling out first.

What it is

Inflammation of a bursa, one of the small fluid-filled sacs that cushion where tendons and skin pass over bone. The common sites are the shoulder, elbow, hip, knee and heel.

Most cases come from repeated pressure or overuse: kneeling, leaning on elbows, running, or a job that repeats one movement. Some follow a direct blow, and some occur with rheumatoid arthritis or gout.

Greater trochanteric pain syndrome, pain on the outside of the hip, was long called trochanteric bursitis and is now understood to be mostly a tendon problem rather than a bursa problem. It matters because the treatment is graded loading rather than rest and injections. See tendinopathy.

The one thing that must not be missed is **septic bursitis**, infection within the bursa. A hot, very tender, red bursa, particularly at the elbow or knee, with fever or spreading redness, needs same-day assessment and antibiotics, and sometimes drainage. Steroid injection into an infected bursa causes serious harm.

Most non-infected bursitis settles over weeks with relative rest, ice and simple analgesia.

Signs you might notice

A swelling over a joint, often soft and fluid-filled, that may be visible and obvious at the elbow or kneecap.

Pain and tenderness, worse with pressure or with the movement that caused it.

Stiffness, and pain on kneeling, leaning or lying on the affected side.

At the hip: pain on the outer side, worse lying on that side at night, and on climbing stairs.

Same-day assessment: heat, marked redness, severe tenderness, fever, feeling unwell, or spreading redness. That is septic bursitis or cellulitis.

Also urgent: a hot swollen joint itself, as opposed to the bursa over it, which may be septic arthritis and is an emergency.

How it can affect day-to-day life

The cause is usually visible in daily life: kneeling on hard floors, leaning on a desk, a new exercise routine, or a change of shoes.

Kneeling occupations, flooring, cleaning, gardening, plumbing, are the classic cause of knee bursitis, and knee pads solve it more reliably than any treatment.

Hip pain that stops somebody sleeping on their side is exhausting and often under-treated. A pillow between the knees, side-lying position changes and a proper loading programme change it.

Steroid injections give short-term relief in many bursitis sites, and repeated injections weaken tissue, so they are a bridge to rehabilitation rather than a solution.

Recurrence is common if the cause is not changed, which is why the practical question is what the person does with that joint all day.

Supporting someone well

Work out what is pressing or repeating, and change it. Knee pads, a different chair, a foam mat, elbow padding.

Relative rest from the aggravating activity, not total rest.

Ice for 10 to 15 minutes several times a day in the acute phase.

Simple pain relief, and a short course of anti-inflammatory tablets or gel if suitable.

For hip pain, ask for physiotherapy and a loading programme rather than rest and injection.

Get any hot, red, very tender swelling seen the same day, especially with fever.

Do not accept repeated steroid injections as the plan without rehabilitation alongside.

Return to activity gradually rather than all at once when it settles.

Where to get help

A pharmacist for pain relief; a GP practice or self-referral to physiotherapy.

Same-day GP or urgent care for a hot, red, painful bursa with fever.

A and E for a hot, swollen, very painful joint.

Arthritis UK and the Chartered Society of Physiotherapy publish exercise guidance.