What happens if bursitis is left untreated?
What is bursitis?
A bursa is a fluid-filled, saclike structure found between the clefts of the joints. There are two types of bursa: superficial (near the skin) and deep ones within the body. The superficial bursa acts as a “cushion” between the skin and bone. For instance, the olecranon bursa at the elbow joint or the prepatellar bursa at the knee joint. Whereas deep bursa acts like a “ball bearing” that allows muscles to glide over each other and over the bones. “Bursitis” means inflammation of the bursa, resulting in bursitis symptoms. A person with inflamed superficial bursa would have a rather noticeable swollen, warm, red and tender joint with limited range of motion. If a deeper bursa is affected, the person only experiences pain and limited motion but no noticeable swelling and redness. Bursitis is caused by:
- Trauma and injury (traumatic fall on the joints)
- Prolonged pressure (frequent kneeling or leaning on the elbow)
- Repetition and overused (routines of athletes, carpenters, cleaners)
- Joint diseases (gout and rheumatoid arthritis)
- Infection (septic bursitis)
Fortunately, bursitis is a reversible self-limiting condition, except for septic bursitis. Due to the rich blood supply, bursitis can improve in days or weeks. Hence treatments are often symptomatic relief. Additional treatment is needed if the bursitis is associated with joint diseases. Antibiotics are given for septic bursitis.
Oral nonsteroidal anti-inflammatory drugs (NSAIDs) are usually the prescribed painkillers, such as ibuprofen and naproxen. Topical NSAIDs are also available for superficial bursitis. Prior to taking oral NSAIDs, notify your doctor if you have digestive problems, currently taking anticoagulants or steroids. For deep bursitis, doctors may give an injection containing local anaesthesia and steroid (glucocorticoid) into the deep bursa to reduce the pain and inflammation. It is worth knowing that this steroid injection is not recommended for superficial bursitis as there is evidence of increased risk of infections, tendon injury, skin atrophy and development of sinus tract.
Besides medication, cold therapy is therapeutic for superficial bursitis. Apply an ice pack for no more than 20 minutes. For deep bursitis, heating therapy is more helpful. BE CAREFUL not to use the heating pad more than 20 minutes as it may cause burn to the skin. Never apply a heating pad before sleeping. Rest, cushion and protect the area to help bursitis to heal. If you have bursitis behind the heel, use a thick heel pad to avoid friction. Avoid heavy lifting if you have shoulder bursitis. Avoid positions that put pressure on the area. Avoid kneeling if you have bursitis at the knee and use kneeling pads if your daily activities involve frequent kneeling. For individuals with bursitis at the elbow, fluid aspiration is typically done to decompress the bursal sac, followed by a protective elbow orthosis with soft padding to prevent fluid from reaccumulating. Full straightening of the elbow helps to alleviate the pain too.
So what happens if bursitis is left untreated? Complications of untreated bursitis are:
- Progressive pain
- Muscle atrophy and joint contractures
- Reduced range of motion and limited activity level
- Adhesions to the joints
Due to the fear of pain during movement in untreated bursitis, most individuals resort to inactivity. This is a problem because persistent immobile joints and muscles can lead to muscle atrophy and joint contractures, which could result in a reduced range of motion. Besides, the untreated inflammation can cause a build-up of calcium deposits in the soft tissues, resulting in permanent loss of movement. Imagine being unable to reach for a far object, hold a cup properly or play sports just because your elbow cannot straighten. In addition, adhesions to the joints may develop as a consequence of prolonged immobile joints, such as frozen shoulder (adhesive capsulitis). If a stiff elbow can affect the quality of life, let alone a stiff shoulder.
Progressive pain interrupts sleep, affects mood and reduces productivity. For example, untreated subacromial bursitis at the shoulder can cause severe pain due to the pressure or motion during sleeping. Long term sleep deprivation has shown to cause a range of problems, including poor mood and attention, reduced sex drive and an increased risk of hypertension, heart disease, stroke and diabetes. On the other hand, if septic bursitis is left untreated, it may cause permanent damage to the joints and even life-threatening infection in the blood (sepsis). In short, even though bursitis may resolve on its own, complications may arise without proper treatment. Modern medicine does not just aim to relieve temporary ailments but to also prevent future complications, ensuring the best quality of life you deserved.