Bursitis is an inflammation of a bursa, a small structure inside every joint that helps to lubricate and cushion it. Usually bursitis occurs in the larger joints, such as the shoulder, hip, knee, or elbow. It can happen once or can recur over time. Without seeing your health care provider, you usually can't easily tell the difference between bursitis and pain caused by a strain or arthritis.

• Pain in the joint that gets worse when you move the joint (the pain may come all at once or develop gradually over time)
• Swelling
• Redness
• Fever and warm joint area (if an infection is present)

Typically the bursa becomes irritated or injured when the area is overused with repetitive motion or strenuous activity. It may also be caused by a bacterial infection. Certain other medical conditions, such as gout or rheumatoid arthritis, can also cause bursitis.

Your health care provider will ask you to identify exactly where the joint hurts and feel the joint for swelling or particular areas of tenderness. Your health care provider may remove some fluid from the bursa with a small needle to check for signs of infection. You may also be given a blood test to check for other medical conditions.

Sometimes simply resting and elevating the joint can help the area heal. A splint, sling, or other device can support the joint and keep it from moving. Applications of heat or cold may help relieve pain and swelling.

• Corticosteroids—injections into the bursa or taken orally help to reduce inflammation; side effects include blurred vision, frequent urination, and increased thirst; may be given with a local anesthetic to reduce pain
• Antibiotics—for bursitis that is infected
• Acetaminophen, aspirin, and ibuprofen—to reduce pain

In rare instances, the bursa is surgically removed.

Alternative therapies may be useful in reducing the pain and inflammation of bursitis while supporting healthy connective tissue.

Include in your diet anti-inflammatory oils such as those found in cold-water fish, nuts, and seeds. The following supplements may help.

• Glucosamine sulfate (500 mg two or three times a day), for connective tissue support
• Omega-3 oils (1,000 mg two or three times a day), such as flaxseed oil, as an anti-inflammatory agent
• Vitamin C with flavonoids (250 to 500 mg two times a day), for connective tissue repair
• Proteolytic enzymes such as bromelain (250 mg twice a day), to reduce inflammation
• Flavonoids and oral digestive enzymes for inflammation

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, it is important to work with your provider on getting your problem diagnosed before you start any treatment. Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day. Tinctures may be used alone or in combination as noted.

• Herbs that reduce swelling include meadowsweet (Filipendula ulmaria), white willow (Salix alba), Jamaica dogwood (Piscidia piscipula), and turmeric (Curcuma longa). A tincture of one, or a combination of these, may be taken at 15 drops every 15 minutes up to four doses for acute pain relief, or 30 drops four times per day for general pain relief. Turmeric increases the effects of bromelain.
• For bursitis with muscle spasm, add valerian (Valeriana officinalis).
• For chronic bursitis, add hawthorn (Crataegus monogyna).

Some of the most common remedies are listed below. Usually, the dose is 3 to 5 pellets of a 12X to 30C remedy every one to four hours.

• Arnica gel applied topically (to the skin) as directed gives excellent short-term pain relief.
• Arnica for bursitis occuring after an injury to the joint
• Ruta graveolons for rheumatic pains in the joint
• Bellis perennis for injury with a great deal of bruising
• Rhus toxicodendron for pain that gets better with movement
• "Traumeel" injections as an alternative to corticosteroids

Acupuncture can be helpful in reducing swelling and inflammation, and especially in relieving pain.

Although no well-designed trials have evaluated the effectiveness of chiropractic treatment for bursitis, chiropractors commonly treat people with this condition and report that some experience improvements in symptoms, including reduced pain and increased range of motion. Chiropractors are also likely to use other treatments in addition to spine and joint manipulation (such as ice massage and ultrasound therapy) for the treatment of bursitis

You should not use massage if your bursitis is caused by an infection. Otherwise, massage (especially myofascial release therapy) can be used for general relaxation and to reduce discomfort from inflammation and from compensating for a sore joint.

Tell your health care provider if your symptoms are not relieved by your treatment. Be sure to follow your provider's instructions for resting the joint to allow the swelling to subside before returning to your usual routines. You can help prevent bursitis from recurring by avoiding repetitive motions, resting between periods of intense activity, and doing stretching exercises before starting an activity.

Do not take aspirin, acetaminophen, or ibuprofen for more than a few days unless so directed by your provider. Be sure to tell your health care provider if you are pregnant.

Andreoli TE, Bennett JC, Carpenter CCJ. Cecil Essentials of Medicine. 3rd ed. Philadelphia, Pa: WB Saunders Co; 1993.

Barker LR, Burton JR, Zieve PD, eds. Principles of Ambulatory Medicine. 4th ed. Baltimore, Md: Williams & Wilkins; 1995:885-894.

Carr AC, Frei B. Toward a new recommended dietary allowance for vitamin C based on antioxidant and health effects in humans. Am J Clin Nutr. 1999;69(6):1086-1107.

Dambro MR, ed. Griffith's 5 Minute Clinical Consult. Baltimore, Md: Lippincott Williams & Wilkins; 1999.

Gerber JM, Herrin SO. Conservative treatment of calcific trochanteric bursitis. J Manipulative Physiol Ther. 1994;17(4):250-252.

JAMA Patient Page. How much vitamin C do you need? JAMA. 1999;281(15):1460.

Johnston CS. Recommendations for vitamin C intake. JAMA. 1999;282(22):2118-2119.

Levine M, Rumsey SC, Daruwala R, Park JB, Wang Y. Criteria and recommendations for vitamin C intake. JAMA. 1999;281(15):1415-1453.

Murray MT. The Healing Power of Herbs: The Enlightened Person's Guide to the Wonders of Medicinal Plants. 2nd ed. Rocklin, Calif: Prima Publishing; 1998.

Stein JH, ed. Internal Medicine. 4th ed. St. Louis, Mo: Mosby-Year Book; 1994:2400-2404.