The Back Pain Doctor
Bursitis is inflammation of a bursa, one of the small fluid-filled sacs that cushion bones and the soft tissues around them. When a bursa is irritated by a knock, prolonged pressure, repetitive activity or a medical condition such as rheumatoid arthritis or gout, it fills with extra fluid, causing swelling and pain. Common sites include the tip of the elbow, the outer hip (usually as part of gluteal tendinopathy), the front of the kneecap, and the shoulder.
The most important first step is deciding whether the bursa is infected. A red, hot, increasingly painful bursa — especially with fever — may be a septic bursa, which is assessed promptly, drained and treated with antibiotics, and should not be injected with a corticosteroid. Fluid can be sampled to check for infection or gout, and ultrasound can help assess the bursa and guide any procedure.
Non-infected bursitis is usually managed with activity modification, padding or a splint, and simple analgesia or short-term anti-inflammatory medication. If it does not settle, the fluid can be drained and a corticosteroid injected. Because recurrent elbow or kneecap bursitis is often driven by pressure or kneeling, addressing the underlying activity and using protective padding is as important as treating the flare.
The options below include the treatments offered at The Back Pain Doctor. Listing a treatment does not mean it is recommended for this condition. The evidence, likely benefit and role of each option are considered against the diagnosis, examination findings, imaging where appropriate, patient goals, risks, cost and alternatives.
This is the starting point for most musculoskeletal conditions.
The priority is to identify the likely pain generator, explain the condition clearly, modify aggravating load and build a realistic plan to restore strength, movement and confidence.
Evidence is condition-specific; it is not a universal pain treatment.
Shockwave is best framed as an adjunct where the diagnosis fits. It is generally more established for selected tendon and plantar heel pain presentations than for many joint or nerve conditions.
Read moreEvidence varies substantially by condition, tissue and preparation method.
PRP may be discussed in selected tendon or joint presentations. It should not be presented as a guaranteed regenerative treatment, and uncertainty, cost and alternatives should be discussed.
Read moreMay provide symptom relief when the pain generator is a joint, bursa, tendon sheath or other defined irritable structure.
Injection treatment may be discussed when pain is limiting sleep, function or rehabilitation. The expected benefit is usually symptom control, not tissue regeneration.
Read moreClinical evidence is still developing and guideline support is limited.
EMTT may be discussed as an adjunct in selected presentations, but should be presented with clear uncertainty and never as a replacement for diagnosis, load management or rehabilitation.
Read moreEvidence is condition-specific and generally less established than exercise-based care.
Prolotherapy may be considered in carefully selected chronic ligament, tendon or joint-related pain presentations, but it is not a first-line treatment.
Read moreMost relevant when focal myofascial pain is a clear contributor.
Trigger point treatment may reduce pain from focal muscle spasm or myofascial tenderness. It should be paired with movement restoration, strength work and recurrence prevention.
Read moreRelevant only when the history and examination support nerve irritation or entrapment.
Nerve-focused treatment may be discussed when there is a plausible peripheral nerve pain generator. Progressive weakness, major neurological deficit or red flags require a different pathway.
Read moreThis is general information only. Suitability is assessed individually. Treatments with limited or condition-dependent evidence may still be discussed, but only with clear explanation of uncertainty, expected benefit, risks, cost and alternatives. Red flags, progressive neurological symptoms or suspected serious pathology require a different pathway.
Ready for a clearer plan for your back or musculoskeletal pain?
Your assessment focuses on understanding the likely source of your pain and the most appropriate non-surgical options for your diagnosis, with the aim of reducing pain and improving function.
Book an appointment