Wednesday, September 1


As more and more people exercise to benefit their physical health, "overuse" or "chronic" injuries are becoming more and more common. One of these, bursitis, can afflict anyone who incurs repetitive stress to a joint, particularly the knee, elbow and shoulder. Join Dr. Andrew Turtel, a medical director for the Women's World Cup and a member of the Association of Professional Team Physicians (PTP) as he discusses bursitis -- its causes, treatments and how best to prevent it from happening to you.

What is bursitis?

Dr. Turtel: There are bursa all over the body - in the shoulder, the knee, the elbow, anywhere there is a major prominence in the bone. Basically, bursa sacs allow the skin to slide over the bony prominence. For instance, the skin on the hand is pretty close to the bone; if it weren't you couldn't get a firm grip on things. You can think of the bursa as an empty balloon with a drop of oil in it - one side of the balloon is attached to the bony surface and the other to the underside of the surface of the skin and it slides.

If you have a lot of trauma to the area -- for instance, if you are a plumber and you spend a lot of time on your knees -- the bursa sac, specifically the cells that line the bursa sac, can become inflamed, secreting fluid that fills the sac.

In athletes, injuries to the bursa sacs are usually caused by repetitive stress to the bursa sac either through overuse or consistent contact with a hard surface. So, in short, bursitis is an inflammation of the bursa sac where it becomes irritated causing pain in the joint.

Who can get bursitis?

Dr. Turtel: Anybody, really. Secretaries get bursitis in their elbows, plumbers get it in their knees. The older diagnosis of shoulder bursitis, which I think of now as more of a rotator cuff tendinitis than bursitis in the strict definition, can afflict javelin throwers, pitchers or even electricians doing work over their head.

What are the symptoms?

Dr. Turtel: Mostly pain and discomfort with possible swelling. Most tissues of the body will respond to stretching with the symptom of pain. When you have gas in the stomach, it's the stretching of the wall of the stomach that's very painful. In the bursa, it's the stretching of the sac as it fills with fluid that causes the pain in the joint.

Q: I recently separated my shoulder . There is also some streching of the surrounding ligaments. I'm wondering if three months of therapy and nine months in time should have healed this problem by now? I don't experience pain during everyday activities anymore. I'm still throwing softballs and play volleyball as well. There is quite a bit of pain the following morning and I was told that the injury shouldn't get worse. What are your thoughts?
-- Douglas Lee, Quincy, Mass.

A: From Dr. Brent S.E. Rich, team physician for the Arizona Diamondbacks:
"It is true that after three months of physical therapy and nine months of time that 'most' second-degree shoulder separations are totally resolved. Given the fact that you have no daily pain or interference with daily activities and are able to play volleyball and softball says that you are doing pretty well. I would recommend icing after activity and possibly taking some Advil or Aleve to see if that lessens the post-exercise discomfort. If it persists, follow up with your physician for re-evaluation."

Do you have a question for a team physician? Click here to ask. And check out more "Ask the Pro Doc" answers to users' questions.

How is bursitis treated?

Dr. Turtel: RICE - rest, ice, compression and elevation is the first mode of treatment to combat the swelling. Anti-inflammatories can help as well. If there is an underlying problem, perhaps a muscle weakness in the shoulder, then you would have to address that with strengthening exercises. But the first few days that the pain exists, we really try to curtail the inflammation.

If there is a collection of fluid in a chronic situation, usually with the elbow, sometimes the fluid won't go away -- it becomes thick and you have to go in and remove it because it's bothersome or for cosmetic reasons. In the shoulder, the bursa is very deep underneath the skin, so that's rarely the case.

Can bursitis be prevented?

Dr. Turtel: As in any case of direct trauma, the best prevention is protection. So if you're a plumber, kneepads can help. You could have a hundred people doing an activity and only two or three will get bursitis and it's usually because they haven't taken the necessary precautions.

What is the prognosis?

Dr. Turtel: The prognosis is uniformly good. The one problem with the bursa, since it is right under the skin a lot of times the bursa can get infected although technically it's not bursitis anymore it's an infected bursa. But other than something that's chronic or infected, generally the RICE modality can alleviate the condition.

Dr. Andrew Turtel, a member of the Association of Professional Team Physicians (PTP), was a medical director for the Women's World Cup soccer team. Dr. Turtel received his undergraduate degree from Duke University in Durham, N.C. and and his M.D. from SUNY Upstate Medical Center in Syracuse, N.Y. He completed a residency in orthopedic surgery at the Long Island Jewish Medical Center in New Hyde Park, N.Y., and was also awarded a fellowship in sports medicine at the Steadman-Hawkins Clinic in Vail, Colo.

The information, including opinions and recommendations, contained in this website is for educational purposes only. Such information is not intended to be a substitute for professional medical advice, diagnosis or treatment. No one should act upon any information provided in this website without first seeking medical advice from a qualified medical physician.

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