Bursitis and Cortisone Injections

What is bursitis? Bursitis is inflammation of a bursa. A bursa (the plural form is bursae) is a tiny fluid-filled sac that functions as a gliding surface to reduce friction between tissues of the body. There are 160 bursae in the body. The major bursae are located adjacent to the tendons near the large joints, such as the shoulders, elbows, hips, and knees. Once bursae become irritated or inflamed, recovery is a surprisingly long process requiring a change in activity over a half a year or more to allow the bursa to heal. It can be next to impossible at times to keep from re-injuring the bursa because it's just not possible to stop everything and rest the injury properly. Everyone has demands that make them keep going and in the process a bursitis injury can be prevented from healing. What ends up happening is we continually swell the bursa due to daily activities. On rare occasions, the hip bursa can become infected with bacteria. This condition is called septic bursitis. Although uncommon, the hip bursa can become inflamed by crystals that deposit there from gout.

What is hip bursitis, and what symptoms does it cause? There are two major bursae of the hip, inflammation of which can both be associated with stiffness and pain around the hip joint. The trochanteric bursa is located on the side of the hip. It is separated significantly from the actual hip joint by tissue and bone. Trochanteric bursitis frequently causes tenderness of the outer hip, making it difficult for patients to lie on the involved side, frequently making sleep difficult. It also causes a dull, burning pain on the outer hip that is often made worse with excessive walking or stair climbing. The ischial bursa is located in the upper buttock area. Ischial bursitis can cause dull pain in this area that is most noticeable when climbing uphill. The pain sometimes occurs after prolonged sitting on hard surfaces, hence the names "weaver's bottom" and "tailor's bottom." Bursitis of the hip is the most common cause of hip pain.

How is hip bursitis treated? The treatment of any bursitis depends on whether or not it involves infection. Noninfectious or aseptic hip bursitis can be treated with ice compresses, rest, and antiinflammatory and pain medications. Occasionally, it requires aspiration of the bursa fluid. This procedure involves removal of the fluid with a needle and syringe under sterile conditions. It can be performed in the doctor's office. Sometimes the fluid is sent to the laboratory for further analysis. Frequently, there is inadequate fluid accumulation for aspiration. Noninfectious hip bursitis can be treated with an injection of Cortisone medication, often with an anesthetic, into the swollen bursa. This is sometimes done at the same time as the aspiration procedure.

Septic bursitis (again, uncommon in the hip) requires even further evaluation by a doctor. This is unusual in the hip bursa but does occur. The bursal fluid can be examined in the laboratory for the microbes causing the infection. Septic bursitis requires antibiotic therapy, often intravenously. Repeated aspiration of the infected fluid may be required. Surgical drainage and removal of the infected bursa sac (bursectomy) may also be necessary.

An application of ice can also minimize the inflammation that can occur after an injection procedure. This inflammation can be caused by the leakage of blood by injury to the tiny capillaries from the needle and by the cortisone medication itself. It can, therefore, be very helpful to apply a cold pack to the area for 20 minutes after a cortisone injection.

What about Drugs?

BRAND NAME: Celebrex; Generic Name: Celecoxib: Celecoxib is a nonsteroidal anti-inflammatory drug (NSAID) that is used to treat arthritis, pain, menstrual cramps, and colonic polyps. Prostaglandins are chemicals that are important contributors to the inflammation of arthritis that causes the pain, fever, swelling and tenderness. Celecoxib blocks the enzyme that makes prostaglandins (cyclooxygenase 2), resulting in lower concentrations of prostaglandins. As a consequence, inflammation and its accompanying pain, fever, swelling and tenderness are reduced. Celecoxib differs from other NSAIDs in that it causes less inflammation and ulceration of the stomach and intestine (at least with short-term treatment) and does not interfere with the clotting of blood. NSAIDs have been found to prevent the formation and reduce the size of polyps in patients with the genetic disease, familial adenomatous polyposis (FAP). In FAP, patients develop large numbers of polyps in their colons, and the polyps invariably become malignant. The only cure of FAP requires removal of the entire colon. Celecoxib is approved as an adjunctive (secondary) treatment among patients with FAP. The cramping and pain during menstrual periods is due to prostaglandins, and blocking the production of prostaglandins with celecoxib reduces the cramps and pain.

BRAND NAME: Advil, Motrin, Nuprin; Generic Name: Ibuprofen: Ibuprofen belongs to a class of drugs called Non-Steroidal Anti-Inflammatory Drugs (NSAIDs). Other members of this class include aspirin, (Aleve), (Indocin), (Relafen) and several others. These drugs are used for the management of mild to moderate pain, fever, and inflammation. Pain, fever, and inflammation are promoted by the release in the body of chemicals called prostaglandins. Ibuprofen blocks the enzyme that makes prostaglandins (cyclooxygenase), resulting in lower levels of prostaglandins. As a consequence, inflammation, pain and fever are reduced. The FDA approved ibuprofen in 1974.

What are Corticosteroids? Corticosteroids are a class of medications that are related to cortisone. Medications of this class reduce inflammation powerfully. They are used to reduce inflammation caused by a variety of diseases. Cortisone is one type of corticosteroid. For the purpose of this discussion, "cortisone" is used interchangeably with "corticosteroid." Corticosteroids can be taken by mouth, inhaled, applied to the skin, given intravenously (into a vein), or injected into the tissues of the body. Examples of corticosteroids include prednisone and prednisolone (given by mouth), Solu-Medrol (given intravenously), as well as triamcinolone, kenalog, celestone, Deop-Medrol, and others (given by injection into body tissues).

Is a cortisone injection merely a pain reliever or temporary remedy? Corticosteroids are not pain relievers. They reduce inflammation. When corticosteroids relieve pain, it is because they have reduced inflammation. While the inflammation for which corticosteroids are given can recur, corticosteroid injections can provide months to years of relief when used properly. These injections also can cure diseases (permanently resolve them) when the problem is tissue inflammation localized to a small area, such as bursitis and tendonitis.

For what conditions are cortisone injections used? Cortisone injections can be used to treat the inflammation of small areas of the body (local injections), or they can be used to treat inflammation that is widespread throughout the body (systemic injections). Examples of conditions for which local cortisone injections are used include inflammation of a bursa (bursitis), a tendon (tendonitis), and a joint arthritis. Systemic corticosteroid injections are generally used for rheumatoid arthritis affecting many joints.

Good article on Rheumatoid Arthritis

Master Post Date 09/01/2008; 7:23am