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Symptoms and Diagnosis

In bursitis, the area around the bursa is painful and swollen, and the pain is usually more severe when the joint is moved. The skin over the bursa may feel warm and look red. If the symptoms persist, see your doctor. He or she will examine the joint to confirm the diagnosis and may remove fluid from the swelling with a needle or order X-rays to rule out other possible causes.

Bursae in the knee

Bursae (fluid-filled sacs for cushioning joints) in the knee are located between the tendon and the bone.

Treatment

Bursitis usually subsides on its own after a few days. Rest the affected area and use an ice pack to ease the pain and help absorb the excess fluid into your bloodstream. Take a nonsteroidal anti-inflammatory drug such as aspirin to help relieve pain and reduce inflammation.

If your symptoms persist, your doctor may remove the excess fluid through a needle and apply a bandage tightly over the area to prevent fluid from reaccumulating in the area. If the fluid contains pus, the doctor will prescribe antibiotics to help fight a bacterial infection. He or she may also inject a local anesthetic to relieve pain and a corticosteroid drug to reduce inflammation. Surgery to remove a bursa, called a bursectomy, is performed only if bursitis recurs repeatedly or if the bursa is infected and the infection seems to be spreading.

Preventing Bursitis

Bursitis tends to develop in joints that are repeatedly placed under a lot of pressure. You can prevent bursitis by taking steps to protect your joints from prolonged pressure. For example, if you spend much of your working day kneeling, as carpet layers or roofers do, wear knee pads to reduce pressure on the bursae of your kneecaps. To prevent bursitis in your elbow, avoid resting your elbows on the table or desk while working or studying. Wear elbow and knee pads during athletic activities to cushion your elbows and knees from falls that could cause bursitis. Bursitis in the heel can result from wearing shoes that are too tight or that don’t fit properly, or from running long distances. Wearing high heels or shoes that are too tight can irritate bunions and cause bursitis in the joint at the base of the big toe.

Baker’s Cysts

Baker’s cysts are fluid-filled sacs that form behind the knee. The cyst usually develops from inflammation of the knee joint that causes the membrane around the joint to swell backward and, sometimes, down into the calf muscles. Inflammatory conditions such as rheumatoid arthritis (see page 918) and osteoarthritis (see page 996), or overuse of the knee can cause Baker’s cysts to develop.

Symptoms

Baker’s cysts usually produce no symptoms, but movement can cause pain behind the knee or upper calf. If the cysts become inflamed or rupture, however, they can cause persistent discomfort or pain.

Diagnosis

A doctor usually can diagnose Baker’s cysts by their appearance and feel. Because the cysts can cause pain and swelling behind the knee and in the upper calf, a doctor may want to rule out a blood clot (deep vein thrombosis; see page 605), which has the same symptoms. He or she may recommend an ultrasound (see page 111) or MRI (see page 113) of the knee.

Treatment

If the cyst is not causing symptoms, a doctor may recommend monitoring it for a few months to see if it goes away on its own. If it is large or is causing pain or other symptoms, the doctor will probably recommend removing it surgically in an outpatient procedure. If an abnormality in the joint itself caused the cyst, the abnormality may need to be corrected surgically to prevent another cyst from forming.

Frozen Shoulder

Frozen shoulder is a condition in which the joint capsule (the tough, fibrous tissue that encloses a joint) becomes thick, inflamed, and forms scar tissue. Frozen shoulder usually begins with a minor injury or condition such as tendinitis (see page 984) or bursitis (see page 1002) that causes chronic pain and makes it difficult or impossible to move the shoulder. This lack of