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Bursitis: A painful condition with real solutions

Dr. Conway McLean, Journal columnist

I would like to tell you the story of Sue and her hip pain. She was a moderately over-weight, middle-aged woman, who, over-all, was in decent health.

But Sue had recently developed pain in her right hip, and it was dragging on for too long. She attributed it to the fall she had almost taken months ago, in which she had managed to catch herself, but twisted her leg into a precarious position to prevent the fall. She had minimal pain at the time, but gradually, the hip was becoming more and more of a problem.

Like most sensible people (and I am not referring only to women here, even though many men are too tough to require medical care), she presented to her family doctor. A brief exam provided a diagnosis: bursitis! But wait, wasn’t that a condition from a prior era, along with the mysterious “rheumatism”, and the age of ill humours? (Perhaps you remember some of the treatments for these archaic maladies of a long-ago era, like blood-letting!) To Sue, it seemed a disease from a by-gone time. All she was certain of was that it hurt, and it was getting worse.

Bursitis is a real thing, a frequently-made medical diagnosis. But Sue was curious, and well-versed in research methods. She discovered that a bursa is a fluid-filled sac that lies over a bony prominence. It’s a cushion the body uses to protect the bone from pressure, and trauma.

Like any soft tissue structure, it can become irritated and inflamed, and inflammation generally results in pain. Certain structures are more prone to this condition, with the hip being one of the “favorite” joints. Many sites in the human body have a bursa, but they can also develop abnormally, in areas where they are not normally, as a result of physical stress or chronic inflammation.

Steroids are often used to reduce this, and can provide significant relief. Our protagonist received some steroid medication via an injection. The procedure itself was not much fun, but she had great relief, which unfortunately did not last.

Within a week, her hip was as bad as ever. She had discovered, in her studies, that bursitis is most often caused by repetitive, minor trauma, but that did not fit her clinical picture. She had a sedentary desk job, and didn’t perform any movement repetitively (including exercise).

There are many treatments for a painful bursa, although which is appropriate depends, to some degree, on where, and what type, of bursitis someone has. Everyone has a bursa between the heel bone and the Achilles tendon, but when it gets inflamed, walking, even lying in bed, can be painful.

Chronic inflammation can lead to calcifications, ie bone spurs, which can aggravate the situation. In contrast, below the heel bone, a bursa can develop where none normally exists. This type is termed an adventitious bursa, and often is associated with a bone spur. This site commonly possesses a spur, but it’s generally an incidental finding, and the spur rarely is the cause of pain.

Steroidal medication, whether by mouth or injected, is commonly used, but can cause complications. Orally, they can cause weight gain, and can alter the delicate hormonal balance we all rely on for health.

Soft tissue structures, when injected with cortisone-type drugs, can be weakened, and may rupture, leading to a whole new set of problems. Other medications are available to reduce inflammation, and though not as potent as steroids, don’t have the possible problems associated.

Physical therapy is frequently performed, and may include both stretching, strengthening, as well various modalities such as ultrasound and electric stimulation. These latter two are some of the many devices that have been developed to reduce inflammation and pain.

Various bracing and supportive measures are also available, and can be very beneficial in the healing process (immobilization has been used for centuries) but, predictably, the type will depend on the location of the affected bursa.

Many “natural” treatments have been utilized over the years, but their benefits are unpredictable. Everything from acupuncture, to castor oil compresses, to the application of cold packs, have been attempted to treat bursitis. Other examples include the consumption of ginger (a natural anti-inflammatory) and the application of DMSO (dimethyl sulfoxide) which was first developed as a cleaning solution for motor parts, but was found to have great pain-relieving properties. This substance has also been found to cross the skin barrier well, and so has been used to transport other medicines across the skin.

Musculoskeletal lasers have also been used successfully, although, because this device is so new, extensive, large-scale clinical trials (where thousands of people participate in the study) have yet to be performed. Laser therapy, which is completely painless, appears to reduce levels of inflammatory products inside and around the cells of the affected tissue. In essence, we have gone beyond treating a specific structure, to treating the cells which compose every living tissue that is part of the human body. They aid in the removal of the waste products of inflammation, improve the health of the cells of the bursa, and increase local blood flow. One treatment usually decreases pain substantially, but several treatments are recommended for more lasting relief.

Surgery is not typically recommended for bursitis, unless it is associated with some other problem. Unfortunately for Sue, the subject of our story, she did end up having surgery, but not as a treatment for her bursitis. After a second injection, with even less relief experienced, she obtained a referral to an orthopedist who ordered x-rays, revealing the presence of an arthritic hip. She didn’t actually have bursitis, and the hip replacement surgery resolved her pain.

Can bursitis be successfully treated? Nearly all the time, the answer is yes (if it actually is bursitis). Many options for treatment exist, and sometimes a biomechanical condition is the cause, requiring gait training, or some type of limb orthotic. Getting an accurate diagnosis is essential, and that may mean seeing a specialist. Living with pain tends to reduce one’s activity levels, and that means less exercise, be it walking, running, or a trip to the gym. If you have bursitis, get treatment, so you can get active, and get fit! The term “bursitis” may seem antiquated, but it’s a real condition. Don’t live with it!

Editor’s note: Dr. Conway McLean is a podiatric physician now practicing foot and ankle medicine in the Upper Peninsula, having assumed the practice of Dr. Ken Tabor. McLean has lectured internationally on surgery and wound care, and is board certified in both, with a sub-specialty in foot orthotic therapy. Dr. McLean welcomes questions, comments and suggestions at drcmclean@penmed.com.

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