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Bursitis Nursing Guide

Content created/revised by Cassandra B. Shine, BSN, RN

Bursitis Overview

This course is intended as a Quick Reference for Bursitis and will cover an overview and nursing considerations utilizing the nursing process.

Bursitis Etiology and Epidemiology

Bursitis is painful inflammation of a small, fluid-filled sac called a bursa. Inflammation of the synovial fluid–lined sacs (bursae) occurs between the moving parts of joints that cushions bones and tendons. Inflammation causes synovial cells to increase in size and thickness, which in turn allows the entrance of protein and collagen fluid. Hemorrhage in the bursa can occur from bacterial infection such as in septic bursitis, repetitive use, systemic inflammatory diseases, or trauma to the bursae. There are approximately 150 bursae in the body.

The most affected sites are:

  • Calcaneal (heel or ball of the foot)
  • Ischial (buttock: e.g. weaver’s bottom)
  • Olecranial (sometimes called miner’s or barfly’s elbow)
  • Prepatellar (knee: e.g. housemaid’s knee)
  • Subacromial (shoulders)
  • Subdeltoid (deltoids) 
  • Trochanteric or iliopectineal (hips)

Bursitis is a common diagnosis in physically active people especially between the ages of 15 to 50. It is more common in males than females and can often be misdiagnosed as arthritis. Jobs or hobbies that involve repetitive tasks that can lead to bursitis include:

  • Carpentry
  • Gardening and yard work
  • Lifting, especially improperly
  • Painting
  • Poor posture or a poorly positioned joint or bone, bone spurs, or arthritis in a joint
  • Household activities such as scrubbing floors
  • Shoveling
  • Sports like tennis, golf, and baseball

The risk factors for bursitis include:

  • Repetitive activities (e.g., running, kneeling)
  • Gait abnormalities (e.g., due to leg-length discrepancy or sacroiliac joint disorders)
  • Osteoarthritis (e.g., in medial compartment of knee for anserine bursitis)
  • Autoimmune musculoskeletal disease (e.g., rheumatoid arthritis, lupus, scleroderma, ankylosing spondylitis)
  • Obesity
  • Metabolic disorders such as diabetes

Bursitis Diagnosis

Bursitis is most often diagnosed through a physical exam. X-rays of the joint involved can help to rule out other conditions. Additionally, an ultrasound or MRI may be ordered to provide better visualization of the joint and accompanying inflammation. Lastly, blood tests can help to rule out or ascertain the presence of infection.

Management

  • Maintain a healthy weight to take pressure off painful and swollen joints
  • Use or practice good posture
  • Rest affected area
  • Elevate extremity to decrease swelling
  • Moderate exercise such as properly stretching
  • Apply ice for an acute injury and heat for ongoing pain
  • Medications (e.g., NSAIDs for inflammation and pain, antibiotics for infection)

Bursitis Nursing Care Plan

Nursing Considerations

Use the nursing process to develop a plan of care for individuals. The nursing assessment (with common findings listed), diagnosis, interventions, expected outcomes, and patient education for individuals with bursitis are listed below.

Assessment

  • History
    • Strain/overuse in area two to three days before pain
    • Gradual or sudden onset of pain
    • Repetitive motions at work or leisure activities
  • Physical Examination
    • Tenderness, warmth in affected area
    • Swelling with severe bursitis
  • Laboratory Tests
    • If septic bursitis is suspected, testing may include white blood cell count, erythrocyte sedimentation rate, and blood cultures.
  • Radiological and Imaging Studies
  • X-rays to rule out fractures or dislocations
  • Ultrasound to evaluate fluid build-up
  • Other Studies
    • Arthrocentesis and fluid analysis

Nursing Diagnosis/Risk For

  • Loss of joint function related to pain and/or swelling
  • Potential for infection related to redness and swelling
  • Alteration in mobility related to pain and stiffness
  • Self-Care deficit related to impaired mobility
  • Alteration in skin integrity related to infection

Interventions

  • General
    • Cold therapy
    • Heat therapy
    • RICE treatment (rest, ice, compression, elevation) is effective in most individuals
    • Physical therapy
    • Occupational therapy
  • Activity
    • Rest for affected joint
    • ROM exercises for affected area
  • Diet
    • No restrictions; well-balanced diet
  • Medications
    • Analgesics and NSAIDs as prescribed
    • Corticosteroids
      • Dexamethasone (Decadron®): 4 to 16 mg intrabursal injection; may repeat every three to four weeks
      • Hydrocortisone (Solu-Cortef®): 25 to 37.5 mg intrabursal injection; may repeat in one to three weeks
      • Methylprednisolone (Depo-Medrol®): 20 mg intrabursal injection; repeat in one to three weeks Triamcinolone (Aristocort®): 2 to 10 mg intrabursal injection; repeat as needed
    • Broad-spectrum antibiotics
      • Cephalexin (Keflex®)
      • Cefazolin (Ancef®)
      • Vancomycin (Vancocin®)
  • Surgery
    • None indicated unless bursitis is septic or recurrent
    • May be required if there is no improvement with symptoms between six months and a year

Expected Outcomes

  • Expected
    • Maintain mobility in affected area
    • Maintain adequate level of comfort
    • Understand causes of injury

Individual/Caregiver Education

  • Causes, and treatment
  • Importance of following medication regimen
  • Demonstration of proper body alignment
  • Safe use of heat/cold therapies

Discharge Instructions/Planning

  • Manage weight
  • Use appropriate equipment when exercising or participating in athletics
  • Follow up with physician if symptoms worsen or do not improve

Bursitis Prevention

  • Improve flexibility and strength
  • Learn about and use proper body mechanics
  • Limit the activity contributing to bursitis
  • Wear appropriate attire for participation in sports

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Additional Information

Content Release Date 

4/1/2022

Content Expiration

12/31/2027

Course Contributor

The content for this course was created/revised by Relias Subject Matter Expert Cassandra B. Shine, BSN, RN. Cassandra earned her Bachelor of Science Degree in Nursing from Winston-Salem State University. She has worked as a registered nurse for more than 20 years and has clinical experience specializing in Nephrology Research, Critical Care with Cardiothoracic Surgery and Trauma, Med/Surg, Community Health Outreach, and Education.

Resources

References

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