. Tuesday, September 30, 2008
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With names like miner’s elbow, housemaid’s knee and weaver’s bottom, it sounds more like a wildflower from a seed catalog than an uncomfortable, bumpy inflammation. But once you’ve had sinusitis, you won’t mistake this annoying condition for a bed of roses.

There are approximately 150 fluid-filled bursae distributed throughout your body. Essentially, each bursa is a cushion that helps facilitate movement between adjoining parts of your body. On the back of your hand, for example, bursae help the skin glide freely back and forth. You also have bursae on your elbows, knees and the sides of your body, explains Joseph D. Zuckerman, M.D., vice chairman of the Department of Orthopedic Surgery and chief of the shoulder service at the Hospital for Joint Disease Orthopedic Institute in New York City.

When bursae get injured, whether from injuries,, overuse or even poor posture, they become inflamed and begin to swell. That’s bursitis. Naturally, the bursae that get the most abuse and are nearest the surface––those on the knees, elbows and hips––are the ones most likely to get inflamed. “People who spend a lot of time on their knees–maids, for example, or carpet layers––can have a golfball-size or larger swelling on the front of their knee,” says Dr. Zuckerman.

But those in other professions may also get bursitis, says W. Ben Kibler, M.D., medical director of Lexington Clinic Sports Medicine Center in Lexington, Kentucky. “One of my patients is a judge, and he listens to a lot of cases by resting his elbows on the bench,” Dr. Kibler says. “The right one was swollen a couple of months ago, and now the left one is swollen.”

While unsightly, bursitis isn’t always painful. But an infected bursa can prevent you from moving, walking or doing anything at all, according to Clifton S. Mereday, Ph.D., chairman of the physical therapy program at the State University of New York at Stony Brook. “It can be excruciatingly painful,” he says.

Joint Efforts

It’s not always clear why bursae get inflamed, or why some people get bursitis more often than others. Still, there are things you can do to dump the bumps–before they occur.

Change your game. Since bursitis is often caused by repetitive motions––throwing a baseball, for example, or kneeling in a garden––a change of pace can be a joint-saver. So occasionally swap the baseball for a croquet mallet. Work in the house instead of the garden. Hang up your running shoes and take a long walk instead.

Give your knees a break. People who spend their days laying carpet, fixing plumbing or digging up tulips are particularly prone to bursitis. And because bursae on the knee are so near the surface, they’re easily pricked and sometimes get infected, Dr. Zuckerman says. Try to spend more time on your feet than on your knees. Or if your job requires frequent kneeling, invest in a well-padded cushion or some good knee pads. A little protection today can prevent a lot of pain tomorrow.

Straighten up. People who slump in their seats, slouch at parties or inadvertently look for pennies when they walk put all sorts of pressure on bursae in their backs and shoulders. “By walking more erect, your chances of developing bursitis are reduced,” Dr. Mereday says.

Keep yourself strong. Weak muscles lead to poor posture, and poor posture, as we’ve seen, can cause bursitis. A little exercise––lifting weights, having a swim or just taking regular walks––can prevent both these problems, Dr. Mereday says.

Have a good stretch. Because bursae and tendons are so close together, what affects one can also affect the other. So before you hit the track––or the tennis court or soccer field––take a few minutes to warm up and stretch.

Swell Treatments

You tried to stay off your knees, but the geraniums beckoned you thither––and now you have bursitis. What do you do now?

Try the pharmacy. Over-the-counter drugs such as aspirin and ibuprofen can ease bursitis pain and reduce swelling. In some cases, doctors says, this will be the only medical treatment you’ll need. Take daily, as directed, for two or three weeks until the pain and swelling are gone. If there’s no improvement, see your doctor.

Chill out. While you’re resting, go ahead and put the swollen bursa on ice, says Dr. Mereday. Applying colds help reduce the pain and swelling. Wrap ice packs or cubes in a towel or wash-cloth and place on the injury for 10 minutes, several times a day.

Now get moving. Once the pain subsides––this should happen in a day or two––try to get injured part moving again, Dr. Mereday adds. “Not moving is how you develop frozen shoulder, for instance. It’s not the bursitis that causes it but the adhesions [scar tissue] you get later. So you want to get it moving as soon as possible.”

Big-League Help

Most cases of bursitis can be treated at home. But when the pain gets bad, or you suspect you have an infection, it’s time to see your doctor, Dr Zuckerman says.

When you have red, painful swelling that doesn’t go away, you probably have an infected bursa, Dr. Zuckerman says. For this you need antibiotics, which in most cases will quickly eliminate the infection. To relieve painful swelling, however, your doctor may drain the bursa as well.

In some situations, when the pain of bursitis has not improved with rest, ice and anti-inflammatory medications, asteroid injection can be beneficial. This approach is used very sparingly, and it’s important that there be no infection present, Dr. Zuckerman says.

Occasionally bursitis will be so painful and long-lived that your doctor will recommend surgery to remove the swollen bursa. But this is rare, Dr. Kibler says. Most of the time, self-care––and perhaps drugs––will do the trick.


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