Bursitis – General
OtherOverview
Bursitis is inflammation of a bursa, a small fluid-filled sac that reduces friction between bones, tendons, and muscles around joints. It commonly affects the shoulder, elbow, hip, and knee, presenting with localized swelling, tenderness, and restricted movement. The condition is typically self-limiting but can become chronic if underlying biomechanical factors are not addressed.
Pathophysiology
Bursae are synovial structures that normally contain minimal fluid to facilitate smooth tissue gliding. Acute bursitis develops through repetitive microtrauma, direct trauma, or prolonged pressure, causing the bursa lining to become inflamed and produce excess synovial fluid. This inflammatory response leads to swelling, local tissue irritation, and pain with movement. Chronic bursitis may involve fibrosis of the bursa wall and can be complicated by calcification or infection (septic bursitis). Underlying biomechanical dysfunction, muscle imbalances, and postural faults perpetuate the condition.
Patient Education
Bursitis responds well to relative rest, anti-inflammatory measures, and correcting the movement patterns or postural habits that caused it—addressing the root cause prevents recurrence.
Typical Presentation
Site
Localized to bursa location: subacromial (shoulder), olecranon (elbow), greater trochanter (hip), infrapatellar or prepatellar (knee), or lesser trochanter
Quality
Aching, tender, throbbing; may feel warm and swollen; sharp pain with specific movements
Intensity
Mild to moderate; often 4–7/10; typically increases with activity and improves with rest
Aggravating
Repetitive movement in the affected plane, direct pressure on the bursa, prolonged static postures, activities mimicking the causative motion
Relieving
Rest, ice application, NSAIDs, gentle passive movement, elevation, avoiding aggravating activities
Associated
Visible swelling, warmth, erythema (if superficial), restricted active range of motion, muscle weakness or inhibition, postural imbalance, tenderness on palpation
Orthopaedic Tests
Test descriptions are written with AI assistance from standard clinical texts. Where a test lists Sources, its description has been checked against them; those sources are independent and do not endorse OsteoKit. Accuracy figures and grades (A–D) appear only when checked against the published study; tests without one are marked “No accuracy study”.
Further reading: full test procedures are described in standard clinical examination texts, e.g. Magee & Manske, Orthopedic Physical Assessment (7th ed.), and Cook & Hegedus, Orthopedic Physical Examination Tests: An Evidence-Based Approach (2nd ed.).
Ultrasound imaging (where available)
Procedure
Ultrasound of the bursa and surrounding tendons by a sonographer or trained clinician.
Positive Finding
Fluid or thickening in the bursa, and the state of neighbouring tendons.
Interpretation
Fluid in a bursa is common in people without pain, so it must match the clinical picture. Useful to look for tendon tears and to guide aspiration or injection.
Sources
- RelatedFinnoff et al., 2008, AJSM; Jacobson, 2007, Radiology
Palpation of bursa
Procedure
Palpate over the bursa and the neighbouring tendons, comparing sides, noting swelling, warmth and fluctuance.
Positive Finding
Localised tenderness, swelling or a fluid-filled feel over the bursa.
Interpretation
Supports bursitis but overlaps with tendon problems (for example lateral hip pain is usually gluteal tendinopathy). A red, hot, swollen superficial bursa (elbow or kneecap), especially with a wound, fever or diabetes, may be septic: same-day medical assessment.
Active range of motion (AROM) with symptom reproduction
Procedure
Ask the patient to move the joint through its full range, noting where pain occurs.
Positive Finding
Pain in a movement that compresses the bursa, often at a particular part of the range.
Interpretation
Helps locate the painful structure and guides activity modification; not specific to bursitis.
Passive range of motion (PROM) assessment
Procedure
Move the joint passively through its range, comparing with active range and the other side.
Positive Finding
Pain at end range where the bursa is compressed, with range otherwise preserved.
Interpretation
Preserved passive range points away from a joint problem; a capsular pattern of restriction suggests the joint instead.
Resisted isometric muscle testing
Procedure
Test the muscles around the bursa against resistance in mid-range.
Positive Finding
Pain on resisted contraction.
Interpretation
Pain on resisted testing points more to the tendon; bursae and tendons are often involved together, so findings must be read together.
Functional loading tests (position-specific provocation)
Procedure
Reproduce the provoking position or activity: for example single-leg stance or crossing the legs for the lateral hip, kneeling for the front of the knee, leaning on the elbow.
Positive Finding
Reproduction of the familiar pain.
Interpretation
Identifies aggravating positions for activity advice. For lateral hip pain, see the greater trochanteric pain syndrome page for tests with published figures.
⚠ Red Flags
- •Fever, systemic malaise, or signs of systemic infection (septic bursitis)
- •Sudden severe swelling with inability to move the joint
- •History of injections or penetrating trauma suggesting infection risk
- •Signs of vascular compromise or neurological involvement
- •Bursitis persisting beyond 3–4 weeks despite conservative management
- •Progressive neurological deficits or loss of motor control
⚡ Yellow Flags
- •Belief that bursitis is permanent or career-ending
- •Fear-avoidance behavior preventing necessary rehabilitation
- •Multiple joint involvement suggesting systemic or inflammatory condition (rheumatoid arthritis, gout)
- •Poor compliance with activity modification or exercise prescription
- •Psychosocial stress exacerbating pain perception and recovery
- •Secondary gain (work avoidance, compensation seeking)
Osteopathic Techniques
Reference page
This page covers bursitis in general. Septic bursitis, most often from a skin break over the bursa, needs medical care; aspiration helps when infection or crystal disease is in question. For techniques, see the page for the bursa involved.
- Reference bookWilliams et al. · StatPearls 2023
Rehabilitation Exercises
Pendulum circles (shoulder bursitis)
Cross-body shoulder stretch (pectoralis and anterior shoulder)
Hip flexor and piriformis stretch (hip bursitis)
Quadriceps and knee flexor stretch (knee bursitis)
Rotator cuff isometric holds (shoulder bursitis)
Hip abduction resistance band work (hip bursitis)
Quadriceps sets and VMO activation (knee bursitis)
Forearm pronation and supination with light weight (elbow bursitis)
Scapular stabilization and posture awareness (shoulder bursitis)
Single-leg stance (hip and knee bursitis)
Low-impact aerobic activity (walking, swimming, cycling with proper mechanics)
Active-assisted range of motion progression (joint-specific, graded by tolerance)
Referral Criteria
- •Suspected septic bursitis (fever, severe swelling, systemic signs) – refer to general practitioner or emergency department for aspiration and culture
- •Bursitis persisting beyond 4–6 weeks despite conservative management – consider imaging (ultrasound or MRI) and refer to sports medicine physician or orthopedic specialist
- •Recurrent or chronic bursitis affecting function – refer to physiotherapist for comprehensive biomechanical assessment and rehabilitation
- •Signs of infection (increasing warmth, erythema, fluctuance) – urgent referral to general practitioner or hospital
- •Bursitis associated with systemic inflammatory condition (rheumatoid arthritis, gout) – refer to rheumatologist
- •Neurological signs or vascular compromise – urgent referral to appropriate specialist
- •Failure to improve or worsening despite treatment – consider underlying pathology (rotator cuff tear, labral pathology, femoroacetabular impingement) and refer for imaging and specialist review