Bursitis can be distinguished by cause, course, and location:

1. **Acute bursitis:** Sudden onset inflammation, often with severe pain and swelling.

2. **Chronic bursitis:** Long-lasting or recurring inflammation, often caused by constant overuse.

3. **Infectious bursitis:** Inflammation caused by bacteria, usually accompanied by fever and redness.

4. **Traumatic bursitis:** Results from direct injuries, such as bumps or bruises.

5. **Rheumatic bursitis:** Accompanies systemic diseases like rheumatoid arthritis.

The causes of bursitis are varied and often related to mechanical or inflammatory processes:

• Mechanical overload:
  • Repeated movements or sustained pressure on an area, such as through sports or physical work.
  • Incorrect posture or overexertion, for example during intensive gardening or heavy lifting.
• Traumatic influences:
  • Direct injuries from falls, blows, or repeated microtraumas.
• Inflammatory diseases:
  • Accompanying symptoms in rheumatism, gout, or lupus.
• Infections:
  • Penetration of bacteria into the bursa, usually through open wounds or injections.
• Anatomical misalignments:
  • Deviations such as knock-knees or bowlegs, leading to uneven stress.

The symptoms vary depending on the cause and severity of the inflammation, but typically include:

- **Localized pain:** Sharp or dull pain in the area of the affected bursa.

- **Swelling:** Visible and palpable swelling, often with redness and warmth of the skin.

- **Movement restrictions:** Pain during movement or pressure on the affected area.

- **Tenderness:** Severe pain when touching the inflamed bursa.

- **Fever and general malaise:** In cases of infectious bursitis.

The diagnosis is made through a combination of medical history, clinical examination, and, if necessary, imaging techniques:

- **Medical History:**

- The doctor inquires about symptoms, possible overuse or injuries, and existing preconditions.

- **Physical Examination:**

- Examination for swelling, redness, tenderness, and movement restrictions.

- **Imaging:**

- **Ultrasound:** To assess the bursa and possible fluid accumulations.

- **MRI:** Detailed imaging in cases of suspected chronic or complex inflammations.

- **X-ray:** To rule out bony changes.

- **Laboratory Tests:**

- Blood tests to identify markers of inflammation or infections.

- Aspiration of the bursa to analyze the fluid in case of suspected bacterial infection.

Conservative Therapy

Most bursitis cases can be treated without surgical intervention:

• Immobilization and Relief:
  • Avoidance of strain and protection of the affected area.
• Medication Therapy:
  • NSAIDs: To alleviate pain and inflammation.
  • Antibiotics for infectious bursitis.
• Physiotherapy:
  • Mobilization and strengthening of the affected area after acute symptoms subside.
• Local Applications:
  • Cold packs to reduce pain and swelling in acute inflammations.
  • Heat therapy for chronic complaints to promote circulation.
• Injections:
  • Corticosteroids to reduce inflammation in severe cases.

Surgical Therapy

In cases of persistent symptoms or complicated courses, surgery may be necessary:

• Aspiration: Removal of excess fluid to relieve pressure.
• Bursectomy: Surgical removal of the inflamed bursa in chronic or recurrent inflammations.
• Debridement: Cleaning and removal of infected tissue.

To prevent bursitis and alleviate existing symptoms, the following measures are recommended:

1. Ergonomic posture: Avoidance of poor posture and overstrain in everyday life or work.
2. Protective measures: Use of cushions or pads during kneeling or strenuous activities.
3. Regular exercise: Promotion of joint flexibility and stability through targeted training.
4. Healthy lifestyle: Reduction of inflammation-promoting factors such as overweight or smoking.
5. Early treatment: Seek medical help promptly at the first signs of overstrain.