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bursitis.jpg
07/Dec/2022

If you’ve ever had bursitis, you know how painful it can be. I had the displeasure of experiencing it several years ago when I slipped in the bathroom and fell heavily. Unfortunately, my shoulder took the full brunt of the fall 😫. I honestly thought I’d broken a bone; it was so painful! But after seeing my doctor, it turns out I had bursitis. And so began several weeks of ice packs, rest and gentle exercise. The good news is that my shoulder recovered completely. But I realised that although I’d heard of bursitis, I didn’t know what this common, painful condition was.

So let’s look at bursitis – what it is, what causes it (apart from falls 😉) and what are the treatment options.

What is bursitis?

Simply put, bursitis is the inflammation of a bursa. A bursa (plural bursae) is a small fluid-filled sac that cushions your bones and soft tissues (muscles, tendons and skin) in and around your joint.

They reduce friction between moving parts (e.g. between a bone and a tendon), enabling them to move smoothly over each other.

When a bursa becomes irritated or inflamed, it fills up with excess fluid. This causes pain and restricts movement.

What causes bursitis?

Bursitis can develop quickly (acute bursitis) or more slowly (chronic bursitis). Common causes include:

  • injury, e.g. having a fall and landing hard on your shoulder or hip
  • overusing a joint, especially if the movements are repetitive, e.g. typing, playing tennis
  • prolonged pressure, e.g. kneeling for long periods while laying carpet or scrubbing floors
  • joint stress, e.g. from being overweight or having an uneven walk (gait)
  • other health conditions, e.g. rheumatoid arthritis, gout, diabetes
  • infection, e.g. if a joint is injured and bacteria enter the bursa.

What are the symptoms of bursitis?

The signs and symptoms of bursitis include:

  • pain, especially when moving the joint
  • joint stiffness and swelling
  • restricted movement of the joint
  • warmth and reddening of the skin in the affected area.

The joints most commonly affected are the shoulder, elbow, hip, knee and heel.

How is it diagnosed?

If you have a painful, swollen joint or you’re finding it difficult to move a joint, it’s important that you discuss your symptoms with your doctor. Getting a diagnosis as soon as possible means that treatment can begin immediately.

To diagnose your condition, your doctor will:

  • Take your medical history and ask about your symptoms, recent injuries, the work you do, and other health issues.
  • Do a physical examination and look for redness and swelling in and around the joint, and test your joint’s range of movement.

If your doctor thinks your bursa is infected, they may remove a sample of fluid from your bursa. This will be examined under a microscope for signs of infection.

Scans such as x-rays and ultrasounds are usually unnecessary; however, your doctor may send you for a scan to rule out the possibility of another condition.

How is bursitis treated?

Some people can manage the pain, inflammation and stiffness of bursitis with self-care, such as cold packs, rest and gentle exercise. However, other people will require medical treatment to manage.

In this case, your doctor may recommend using over-the-counter non-steroidal anti-inflammatories (NSAIDs). They can be taken as a tablet (orally) or applied directly to the skin (topically) as a cream or gel. In cases of severe pain, your doctor may prescribe stronger anti-inflammatory medicines or inject a corticosteroid into the bursa.

You may also see a physiotherapist or exercise physiologist who can recommend exercises to help your joints move more easily and prevent bursitis from occurring again.

If your bursitis is caused by an infection, your doctor will prescribe antibiotics to treat the infection. In some cases, a needle is inserted into the bursa to remove the infected fluid. This may happen several times until the infection has cleared.

If the bursitis was triggered by a particular form of overuse, it‘s important to avoid that activity or modify how you perform it. An occupational therapist or physiotherapist can help you find solutions to this problem.

What can I do to control my symptoms?

You can do many things to relieve your pain and inflammation.

  • Protect and rest the joint to help the bursa recover. Your doctor or physiotherapist will advise you on how to rest the joint and for how long. This could include using cushions or pads when sitting or kneeling for long periods, using a sling or walking stick, modifying your activities etc.
  • Ice packs can help soothe red, inflamed joints, and heat packs and rubs can relax tense, painful muscles.
  • Maintain a healthy weight to reduce the pressure and stress on weight-bearing joints such as hips and knees.
  • Continue to stay active as much as you can while following any instructions provided by your healthcare team to protect your bursa.
  • Your doctor, physiotherapist and/or occupational therapist can offer other suggestions and strategies to reduce your risk of developing bursitis again.

Contact our free national Help Line

Call our nurses if you have questions about managing your painmusculoskeletal condition, treatment options, mental health issuestelehealth, or accessing services. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

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10/Aug/2022

Although it sounds like it, a Baker’s cyst isn’t named after an occupation like housemaid’s knee (prepatellar bursitis), policeman’s heel (plantar calcaneal bursitis) or writer’s cramp (hand dystonia). It has nothing to do with the act of making delicious, delicious bread 🍞 or other baked goods 😋.

Baker’s cysts are named after Dr W.M Baker, the 19th-century surgeon who first described cysts that form on the back of the knee. Their clinical name is popliteal cyst. Often people don’t know they have a Baker’s cyst, especially if it’s not causing pain. However, sometimes they can cause problems.

Your knee – a complex joint

To understand how a Baker’s cyst affects your knee, it’s helpful to know a little about your knee joint.

Your knee is a large and complex joint where three bones meet: your thighbone (femur), shinbone (tibia) and kneecap (patella). Covering the ends of your bones is a thin layer of tissue called cartilage. It provides a slippery cushion that absorbs shocks, helps your joints move smoothly and prevents bones from rubbing against each other.

Surrounding the joint is a tough capsule filled with a lubricating fluid (synovial fluid). This fluid allows your knee to move freely.

A Baker’s cyst can form when an injury or arthritis causes your knee to produce too much synovial fluid. This excess fluid bulges from the joint capsule behind the knee as a protruding sac (see image).

Cysts can vary in size and cause symptoms such as pain or stiffness in the knee joint.

Baker’s cysts may not require treatment, but if they do, they can be treated effectively with self-care and medical treatment.

Causes

Some of the common causes of Baker’s cyst include:

Symptoms

Often, there are no symptoms, and you may not even know you have a cyst. If symptoms do occur, they can include:

  • a lump or swelling behind the knee
  • knee pain
  • stiffness or tightness of the knee
  • limited range of knee movement (if the cyst is large).

Diagnosis

Many people don’t know they have a Baker’s cyst as it may be small and painless.

However, you should see your doctor if you notice a painful lump in the space behind your knee.

Your doctor will ask about your symptoms and medical history and examine your knee. They’re usually able to diagnose a Baker’s cyst based on this.

Sometimes a doctor may organise scans of the joint, usually an ultrasound, or if the diagnosis is uncertain, possibly an MRI (magnetic resonance imaging). This is to rule out other rare causes of the lump, such as a popliteal aneurysm, blood clot or tumour.

Complications

The symptoms of a Baker’s cyst are usually mild; however, in rare cases, the cyst may burst, leaking fluid into the calf region. This can cause increased pain in the knee and swelling or redness in the calf.

If you experience swelling or warmth in your calf, you should seek medical advice quickly.

It can be difficult to tell the difference between the complications of Baker’s cyst and more serious but less common problems such as a blood clot in a vein in your leg. So it’s better to be safe and get it checked out.

Treatment

You probably won’t need treatment if you have no symptoms or only mild pain.

However, if it is causing you pain, your doctor will develop a treatment plan that may include:

  • Self-care. You can reduce the pain and swelling by using an ice pack on your knee for short periods. Make sure to wrap it in a cloth so the pack doesn’t come into direct contact with your skin. You should also protect and rest the joint. Elevate your knee while resting it, and avoid activities that strain your knee (e.g. jogging). You may also find it helpful to use a cane or crutches for a short period or wear a knee support.
  • Medicines such as paracetamol or non-steroidal anti-inflammatory medicines (e.g. ibuprofen) may provide temporary pain relief. These medicines are available over-the-counter or with a prescription, depending on their dosage and other ingredients.
    A corticosteroid (steroid) injection may be helpful for people who haven’t found relief from other treatments or if they have severe pain.
  • Treating the underlying condition (e.g. arthritis) is also important, so your doctor may discuss other medicines and treatment options.
  • Seeing a physiotherapist or exercise physiologist for gentle strengthening and range of movement exercises to reduce symptoms and maintain knee function.
  • Draining the cyst by inserting a needle into it (needle aspiration) and removing the fluid. This may be done under ultrasound.
  • Surgery is rarely needed to treat a Baker’s cyst. However, it may be an option in some cases to treat the cause of the cyst (e.g. an injury) or to remove the cyst if all other treatments haven’t provided relief.

Contact our free national Help Line

Call our nurses if you have questions about managing your painmusculoskeletal condition, treatment options, mental health issues, COVID-19, telehealth, or accessing services. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

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Musculoskeletal Australia (or MSK) is the consumer organisation working with, and advocating on behalf of, people with arthritis, osteoporosis, back pain, gout and over 150 other musculoskeletal conditions.

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