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Health condition · Clinically reviewed

Bursitis, the swelling that quiets down when you treat the driver.

A tender, fluid-filled sac over a bony point - often mechanical, sometimes inflammatory, and occasionally infected. A structured plan settles most cases quickly.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against NICE CKS, BOA and peer-reviewed rheumatology sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK guidance including image-guided aspiration, ultrasound diagnosis and septic bursitis pathways.

Key facts

Bursitis at a glance.

The essentials, in plain English - where it happens, what causes it, and how UK clinicians treat it today.

  • What it is

    Inflammation of a bursa - the fluid-filled sac that cushions a tendon as it glides over bone. Common at shoulder, elbow, hip, knee and heel.

  • Common sites

    Subacromial (shoulder), olecranon (elbow), trochanteric (lateral hip), prepatellar and pes anserine (knee), retrocalcaneal (heel).

  • Main causes

    Mechanical overload and prolonged pressure, inflammatory disease (RA, gout), and infection - septic bursitis is a medical emergency.

  • How it presents

    Localised swelling, warmth, tenderness and reduced active more than passive movement. A fluctuant lump over a bony prominence is classic.

  • Key investigation

    Ultrasound is the gold standard - it shows effusion, guides aspiration and confirms septic versus sterile fluid.

  • Foundation therapy

    Rest, load modification, NSAIDs and physiotherapy - with image-guided steroid injection or aspiration where appropriate.

Why this guide matters

A structured plan, not a hopeful shrug.

Bursitis is common and often self-limiting - but the wrong steer wastes months. The three points below shape everything else on this page.

  • Rule out infection first

    A hot, fever-bearing bursa is septic bursitis until proven otherwise - aspirate, culture and treat empirically before anything else.

  • Ultrasound changes the plan

    It confirms the effusion, distinguishes bursitis from tendinopathy and guides aspiration or injection accurately.

  • Treat the driver, not just the sac

    Load, ergonomics, gout, RA and tendinopathy all keep bursae flaring - the swelling settles when the driver is controlled.

How the diagnosis is made

From swollen joint to a clear plan.

The steps a UK GP, rheumatologist or orthopaedic surgeon will normally follow, in order - so you know what to expect and why.

  1. 01

    Assessing

    History and occupation

    Repetitive activity, prolonged kneeling or leaning, recent trauma, systemic symptoms and immunosuppression all shape the working diagnosis.

  2. 02

    Assessing

    Focused examination

    Inspection for swelling and erythema, palpation for warmth and fluctuance, and active versus passive range of motion at the affected joint.

  3. 03

    Assessing

    Screen for septic bursitis

    Fever, marked warmth, disproportionate pain, red streaking or systemic upset - especially in diabetes, IVDU or immunocompromise - triggers urgent workup.

  4. 04

    Confirming

    Bloods when indicated

    FBC, CRP, urate and urinalysis if inflammatory or crystal disease is suspected. Blood cultures if septic bursitis is possible.

  5. 05

    Confirming

    Ultrasound-guided aspiration

    Fluid sent for Gram stain, culture, microscopy for crystals and white cell count. Diagnostic and therapeutic in one visit.

  6. 06

    Escalating

    Imaging for deeper bursae

    X-ray for underlying arthritis or calcification. MRI for iliopsoas, ischial or deep infrapatellar disease and coexisting tendon pathology.

  7. 07

    Escalating

    Specialist referral

    Rheumatology for inflammatory disease, orthopaedics for refractory or septic bursitis, and sports medicine for tendon-linked cases.

Typical timeline: a first visit to a settled plan in days, not weeks.

Symptoms

What bursitis actually looks like.

The classic patterns by site - shoulder, elbow, hip, knee and heel - and the features that mean it is time to escalate.

  • Subacromial bursitis

    Shoulder pain on reaching overhead, painful arc and night pain lying on the affected side - the most common bursitis pattern.

  • Olecranon bursitis

    A soft, fluctuant swelling over the point of the elbow - the classic "student’s elbow" from prolonged leaning.

  • Trochanteric bursitis

    Lateral hip pain when lying on that side or climbing stairs, often overlapping with gluteal tendinopathy.

  • Prepatellar and infrapatellar bursitis

    Anterior knee swelling from kneeling - "housemaid’s knee" and "clergyman’s knee" are the same pattern in different roles.

  • Pes anserine bursitis

    Medial knee tenderness two to three fingerbreadths below the joint line - common in runners and osteoarthritis.

  • Retrocalcaneal bursitis

    Posterior heel pain at the Achilles insertion, sometimes with a Haglund prominence and thickened tendon.

  • Iliopsoas and ischial bursitis

    Anterior groin pain (iliopsoas) or buttock pain when sitting on hard surfaces - "weaver’s bottom" for the ischial pattern.

  • Red flag - septic bursitis

    Hot, exquisitely tender bursa with fever, red streaking or systemic upset. Urgent aspiration, antibiotics and orthopaedic input.

Treatment

How bursitis is treated in the UK.

Rest, NSAIDs and physiotherapy first, image-guided aspiration and injection next - and bursectomy for the small number that stay chronic or infected.

  • Rest and load modification

    Relative rest, protective padding and ergonomic changes remove the mechanical driver - the single most important step for most cases.

  • NSAIDs and analgesia

    Short courses of oral or topical NSAIDs settle pain and inflammation while the bursa recovers.

  • Physiotherapy

    Targeted strengthening, movement retraining and stretching correct the biomechanics that drove the flare.

  • Image-guided aspiration

    Ultrasound-guided drainage relieves large tense bursae and provides fluid for microscopy, culture and crystal analysis.

  • Steroid injection

    Intra-bursal corticosteroid, image-guided where possible, once infection is excluded. Avoided near Achilles or patellar tendons.

  • Antibiotics for septic bursitis

    Empirical flucloxacillin, or vancomycin if MRSA risk, with culture-directed change. IV therapy and orthopaedic input if systemic.

  • Bursectomy

    Endoscopic or open removal of chronically inflamed or infected bursae - typically subacromial, trochanteric, olecranon or prepatellar.

  • Treat the underlying driver

    Manage RA, gout, pseudogout, tendinopathy and osteoarthritis - the bursa keeps flaring until the driver is controlled.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP, rheumatologist or orthopaedic surgeon knows your history and can tell you which parts apply to you. If in doubt, get seen.

  • NICE CKS. Bursitis: assessment and management.

  • British Orthopaedic Association (BOA). Standards for musculoskeletal soft tissue infection.

  • Royal College of Radiologists. Guidance on musculoskeletal ultrasound and image-guided injection.

  • European League Against Rheumatism (EULAR). Recommendations for the management of gout and crystal disease.

Red flags

When bursitis needs urgent attention.

Most bursitis is manageable in primary care. These are the situations that are not - and where a same-day opinion is needed.

  • Septic bursitis

    Hot, exquisitely tender bursa with fever, red streaking or systemic upset. Urgent aspiration, empirical antibiotics and orthopaedic input.

  • Immunocompromise or diabetes

    A lower threshold for suspecting infection and for admission - deterioration can be rapid and atypical.

  • Rapidly enlarging swelling

    Fast growth over hours to days suggests infection or bleeding into the bursa and warrants same-day assessment.

  • Post-injection flare

    New severe pain, fever or redness within 48 hours of a steroid injection is septic arthritis until proven otherwise.

  • Systemic features

    Fevers, rigors, weight loss or malaise point to infection, crystal flare or systemic inflammatory disease.

  • Suspected crystal disease

    Sudden severe monoarthritis with a swollen bursa and hyperuricaemia needs synovial and bursal fluid analysis.

  • Chronic refractory bursitis

    Persistent swelling despite conservative care and injection - consider imaging for underlying tendon pathology and surgical opinion.

  • Achilles or patellar tendon involvement

    Steroid injection into these tendons risks rupture - image-guided care and specialist input are essential.

  • Occupational overuse

    Recurrent bursitis linked to kneeling, leaning or repetitive overhead work - occupational health input often prevents relapse.

Living with it

A treatable condition, with a clear ladder.

Four things that make the biggest difference day to day - offloading the bursa, rebuilding strength, escalating hot swellings and treating the underlying driver.

A quiet reminder

Rest alone rarely fixes recurrent bursitis.

Load management plus targeted rehab beats prolonged inactivity - and it keeps the swelling from coming back.

  1. 01 Protect

    Offload the bursa

    Padding, ergonomic changes and short rest breaks stop the mechanical driver that keeps the bursa inflamed.

  2. 02 Rebuild

    Physiotherapy pays off

    Graduated strengthening and movement retraining lower the chance of recurrence far more than rest alone.

  3. 03 Escalate

    Do not sit on hot swelling

    Rapid growth, fever or intense warmth needs urgent review - septic bursitis is treatable when caught early.

  4. 04 Underlying

    Treat what drives it

    Weight, gout, RA and tendinopathy all feed recurrent bursitis - control them and flares get rarer.

Frequently asked

Everything we get asked about bursitis.

Quick answers on common sites, septic bursitis, image-guided injection and surgery.

  • What is bursitis?

    Bursitis is inflammation of a bursa - a small fluid-filled sac that reduces friction between a tendon and bone. It causes localised swelling, warmth, tenderness and pain on moving the nearby joint.

  • Which sites are most commonly affected?

    The subacromial bursa in the shoulder is the most common. Olecranon (elbow), trochanteric (lateral hip), prepatellar and pes anserine (knee) and retrocalcaneal (posterior heel) bursitis are all frequent presentations.

  • How do I know if my bursitis is infected?

    Septic bursitis is hotter, more tender and often accompanied by fever, red streaking or systemic upset. Risk is higher in diabetes, IVDU and immunocompromise. Any of these features means urgent same-day assessment and aspiration for culture.

  • Is a steroid injection safe?

    Image-guided intra-bursal steroid can be very effective once infection is excluded, especially for subacromial and trochanteric bursitis. It is avoided near the Achilles and patellar tendons because of the risk of rupture.

  • When is surgery needed?

    Bursectomy - endoscopic or open - is considered for chronic refractory bursitis, infected bursae that fail antibiotics, and recurrent cases at the subacromial, trochanteric, olecranon or prepatellar sites.

  • How long does bursitis take to settle?

    Most mechanical bursitis settles over two to six weeks with load modification, NSAIDs and physiotherapy. Aspiration and image-guided injection speed recovery for tense or persistent bursae. Chronic cases may need months of retraining.

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