Bursitis--Continue

Treatments

The main goal in treating bursitis is to ease pain and swelling until the condition resolves itself. In many cases, the inflammation will clear up with simple steps you can take at home and with painkillers. But if the pain lingers for more than a week or so, or if it recurs, make an appointment with your doctor. You may need prescription anti-inflammatory medications or other therapies.

>What's the difference between arthritis and bursitis symptoms?
Bursitis generally starts more abruptly than arthritis, and usually causes tenderness and swelling in one specific spot rather than all round the affected joint. Bursitis also typically allows much better range of motion than arthritis does. Be aware, though, that sometimes bursitis is a sign that you're developing arthritis.

>I love tennis but have developed bursitis in my elbow. How can I ensure that it doesn't return?
It is essential that you warm up before you play, and also stretch afterwards. Investigate switching to a lighther racquet, and make sure whatever racquet, you use has the right size grip for you. In addition, invest in some tennis lessons or clinics to ensure you're using the proper technique. 

  Lifestyle changes
When bursitis flares up, the following self-help tips can be quite effective in helping you manage it:

• Reset the part of your body that hurts. Stop whatever activity caused the problem until you're pain-free. You can protect the area with an elastic bandage, sling, brace or splint.
• Use ice until the swelling goes down. Apply it for 20 minutes, three  to four times a day, until it's no longer warm to the touch.
• Use heat to reduce joint stiffness once the area isn't warm or red. Try a heat pack or heating pad, sit in a spa or soak in a warm bath. But if swelling reappears, go back to ice.
• Stretch before and after doing anything strenuous. Start any activity slowly, use proper technique and don't push too hard.
• Avoid repetitive movements. If that's not possible, take frequent breaks to rest your joints and stretch your muscles.

Medications

You'll want to relieve pain and swelling as quickly as possible, and your'll probably be able to do that with an NSAID (nonsteroidal anti-inflammatory drug.) The most commonly used are drugs such as aspirin, ibuprofen (Nurofen) and naproxen (Naprogesic), and if the pain is more severe, prescription NSAIDs, such as diclofenac (Volatren), ketoprofen(Orudis) or naproxen (Naprosyn). If you find that these upset your stomach, talk to your doctor about COX-2 inhibtors, such as celecoxib (Celebrex) or rofecoxib (Vioxx).

   If your pain and swelling persist, you may need an injection of  a corticosteroid, such as methylprednisolone (Depo-Medrol) or betamethasone (Celestone). Your doctor will probably also inject a local anaesthetic such as lignocaine directly into the bursa at the same time. The injection decreases inflammation so you can participate-free when you leave your doctor's surgery. For full relief, you may need to repeat the injection, although there's a cumulative limit to what you can have because steroids can weaken nearby cartilage or tendons.

  An infection that develops in a bursa is usually treated with an oral antibiotic such as cephalexin (Keflex, Ibilex) or amoxycillin/ clauvulanate (Augmentin).

PROMISING DEVELOPMENTS

• If you need surgery to relieve your bursitis, there is something new on the horizon which can help you deal with postoperative pain. A recent investigate study looked at the placement of a catheter for direct delivery of the nerve block drug bupivacaine into the joint, following arthroscopic surgery. All patients with the catheter were able to perform range-of-motion exercises virtually pain-free, and as a consequence, 95% of them had near-complete restoration of range of motion without pain once the catheter was removed.

Procedures

Your doctor or physiotherapist may want to try deep heat therapy (called diathermy) or ultrasound, which emits gentle sound-wave vibrations, to warm the tissues and improve blood flow around the area affected by your bursitis. If your bursa is chronically infected, you may need a surgical procedure to incise and drain the bursa. The doctor numbs your skin, opens the bursa, then drains the infected fluid. In the rare case that bursitis doesn't clear up after 6 to 12 months, surgery may be needed to repair damage and relieve pressure in the bursa. This may be either conventional surgery (called open release surgery) or less invasive arthroscopic capsular release surgery.
  Untreated, bursitis (especially in the shoulder) can lead to calcium deposits in the bursa, which can cause a permanent lack of mobility and flexibility in the joint, known as frozen shoulder (see on shortly). In extreme cases, if a bursa has become stiff and hardened with calcification, the calcium deposit may have to be surgically removed. So resist the temptation to 'tough out' the pain of bursitis without treating it.

Natural methods
The traditional Chinese healing technique acupuncture can erase bursitis pain. Acupuncture needles seem to trigger the release of endorphins and monamines, chemicals that block pain signals in the spinal cord and brain. A chiropractor may help too. A spinal adjustment may free restricted movement of bones and release painful muscle tension. There is some disagreement about whether massage on or near a bursitis site is wise. Massage of surrounding muscles by a skilled therapist, however can stimulate circulation to speed healing. Rubbing in liniments such as Metal can encourage blood flow to the area, promoting relaxation and bringing pain relief.