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Bursitis

Painful swelling of a bursa — one of the small, fluid-filled cushions around the shoulder, elbow, hip, knee and heel — usually from overuse or pressure. Most cases ease within a few weeks with rest and simple care, but an infected bursa needs a doctor the same day.

What is bursitis?

A bursa is a small, fluid-filled sac that acts as a cushion between a bone and other moving parts, such as muscles, tendons or skin (MedlinePlus). Bursae help reduce friction when a joint moves (AAOS OrthoInfo). There are more than 150 of them in the body, and bursitis — painful swelling of a bursa — can affect any of them (Cleveland Clinic). When a bursa is irritated, it fills with extra fluid and swells (AAOS OrthoInfo).

Bursitis is different from arthritis, which is usually a long-term breakdown of cartilage inside a joint, and from tendinitis, which is irritation of a tendon — though the same repetitive activities can cause both bursitis and tendinitis (Cleveland Clinic). See our arthritis guide; a separate MBHA guide to tendonitis is on the way.

Where it happens

  • Shoulder (subacromial bursitis): a dull ache that can turn sharp or pinching when you lift your arm overhead, often worse when lying on that side (Cleveland Clinic).
  • Elbow (olecranon bursitis), at the bony tip of the elbow. Swelling is often the first sign; it may not be noticed at first because the skin there is loose (AAOS OrthoInfo).
  • Outer hip (trochanteric bursitis): pain at the point of the hip that spreads down the outside of the thigh, typically worse at night, when lying on that hip, and when getting up from a chair (AAOS OrthoInfo). Doctors now often call outer-hip pain greater trochanteric pain syndrome (see below).
  • Front of the knee (prepatellar bursitis, “housemaid’s knee”): swelling over the kneecap that you can see and feel, and that often feels squishy (Cleveland Clinic).
  • Heel, usually the bursa between the heel bone and the Achilles tendon: pain and swelling behind the heel that is worse when standing on your toes (Cleveland Clinic).

Causes and risk factors

Symptoms

Common signs are joint pain and tenderness when you press around the joint, stiffness and aching when you move it, swelling, and sometimes warmth or redness (MedlinePlus). The pain is usually a dull ache, worse when you move or press on the joint; redness can be harder to see on brown or black skin (NHS).

Could it be infected? See a doctor the same day — or go to urgent care or the emergency department — if a swollen bursa comes with:

Infected (septic) bursitis must be treated more urgently than ordinary bursitis (AAOS OrthoInfo). Left untreated, it can spread to the rest of the arm or into the bloodstream (AAOS OrthoInfo) and can lead to septic shock or death (Cleveland Clinic). It doesn’t always look obvious: in one report of three hockey players with septic bursitis, none had a visible skin wound and only one had a fever (Tuff and Chrobak, 2016). Don’t wait for a chiropractic, acupuncture or massage appointment, and never have an infected bursa massaged.

How is it diagnosed?

A provider usually diagnoses bursitis with your history and a physical exam. Tell them what you were doing before the pain started and whether your job or hobbies involve repetitive motion (Cleveland Clinic). X-rays can rule out a fracture or other bone problem, and ultrasound, CT or MRI can check the bursa and nearby soft tissues (AAOS OrthoInfo, MedlinePlus). If infection or gout is a possibility, the provider may draw fluid from the bursa with a needle (aspiration) and send it to a lab (NHS, AAOS OrthoInfo).

How long does it last?

Bursitis is usually short-lived, and most people heal within a few weeks (Cleveland Clinic, NHS). Elbow bursitis often settles in three to six weeks (Cleveland Clinic); outer-hip bursitis can take a few weeks to a few months (Cleveland Clinic); serious heel bursitis may take six to 12 months (Cleveland Clinic). Bursitis can come back in the same place, and repeated flare-ups can damage the bursa and limit movement (Cleveland Clinic). Chronic knee bursitis — for example, in people whose jobs require frequent kneeling — can last months or even years if it isn’t treated (Cleveland Clinic). Most people do well with treatment; when the cause can’t be corrected, pain may be long-term (MedlinePlus).

When to see a provider: if symptoms haven’t improved, or are getting worse, after 1 to 2 weeks of home care (NHS); if they come back or don’t improve after 3 to 4 weeks of treatment (MedlinePlus); if pain gets in the way of daily life or your sleep; or if you notice shoulder or arm weakness (Cleveland Clinic).

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) Rest and activity changes, ice, padding, over-the-counter pain relievers and physical therapy first; draining the bursa and a corticosteroid injection if needed; antibiotics for infection; surgery rarely. Physical therapy about $50–$350+ a session without insurance ($10–$75 copay with); Medicare Part B covers medically necessary PT. Injection cost estimate being researched. Most cases heal within a few weeks. Injections often help for months but not for everyone; for outer-hip pain, education plus exercise led to more overall improvement than an injection at one year in one trial.
Chiropractic Soft-tissue work, stretching and exercise around the sore joint, plus help with posture and movement habits — never on an infected bursa. About $50–$200 a visit without insurance; first evaluations $100–$250. Medicare covers only spinal adjustments for subluxation. No controlled trials for bursitis itself — only single case reports. Exercise-based care fits the research best.
Acupuncture Needle treatments for pain around the hip, shoulder or other sore joint, alongside medical care and exercise. About $125–$230 for a first private visit and $90–$185 for follow-ups; community clinics about $50–$90. Not well studied for bursitis. One very-low-certainty review found dry needling no different from a steroid injection for outer-hip pain. Sterile needles matter.
Herbal medicine No herb or supplement is proven for bursitis. Turmeric (curcumin) is sometimes tried, based on osteoarthritis research. Cost estimate being researched. Evidence comes from knee osteoarthritis, not bursitis. Watch for side effects, interactions and products tainted with hidden drugs.
Massage therapy Gentle work on tight muscles around the hip, shoulder or knee — not direct pressure on a swollen bursa, and never on an infected one. About $60–$120 for 45–60 minutes with a private therapist, or $50–$90 at clinics, gyms and spas. Often part of physical therapy, but not proven for bursitis itself; short-term relief for neck and shoulder pain in general.
MBHA Wellness Coach Changing repetitive tasks, kneeling and elbow pads, better posture and technique, warm-ups, strength and flexibility, a healthy weight, and a gradual return to activity. Cost estimate being researched. Supports — never replaces — medical care. These habits lower the chance of bursitis coming back.

Approach 1 of 6

Conventional medicine (AMA)

Most bursitis heals with rest and simple home care (Cleveland Clinic). Your provider will likely ask about signs of infection, such as fever or chills, because infected bursitis needs a different treatment plan (AAOS OrthoInfo).

1. Rest, activity changes and padding

2. Ice, heat and elevation

An ice pack wrapped in a towel, used for short periods a few times a day, can ease pain and swelling (Cleveland Clinic, NHS). Don’t fall asleep with ice on (MedlinePlus). Your provider may suggest alternating ice and heat (Cleveland Clinic), and raising a swollen knee when you rest (AAOS OrthoInfo).

3. Over-the-counter pain relievers

NSAIDs such as ibuprofen or naproxen, or acetaminophen, can ease pain (Cleveland Clinic); acetaminophen is an alternative if you can’t take NSAIDs (AAOS OrthoInfo). Use NSAIDs cautiously and for limited periods — they can cause side effects with certain health conditions or medicines (AAOS OrthoInfo) — and don’t take pain relievers for more than 10 days in a row without talking to your provider (Cleveland Clinic). We don’t list doses; ask your doctor or pharmacist what is safe for you.

4. Physical therapy and exercise

As pain eases, exercises to build strength and keep the joint moving are part of recovery (MedlinePlus). For the hip, a physical therapist may teach stretches for the IT band and exercises for hip strength and flexibility (AAOS OrthoInfo). For the shoulder, PT can strengthen the muscles and improve flexibility, and a few months of it may help keep bursitis from coming back (Cleveland Clinic). For the heel, Achilles and calf stretches plus strengthening may bring relief (Cleveland Clinic). Occupational therapy can teach you to move in ways that don’t stress the area (Cleveland Clinic). For outer-hip pain, see the evidence for education plus exercise below.

5. Draining the bursa and corticosteroid injections

If swelling and pain don’t respond, your doctor may drain the bursa with a needle and inject a corticosteroid, a stronger anti-inflammatory than pills (AAOS OrthoInfo); for the elbow, this is usually considered after 3 to 6 weeks of other care (AAOS OrthoInfo).

6. Antibiotics for infection

Infected bursitis is treated with antibiotics, by mouth or through an IV (Cleveland Clinic). Your doctor may start them before lab results come back, and may drain the bursa to relieve symptoms and identify the germ (AAOS OrthoInfo). Take the full course for as long as prescribed, even if you feel better (Cleveland Clinic). If gout is behind the bursitis, treating the gout may ease pain and swelling (American College of Rheumatology).

7. Surgery (rarely)

Surgery is rarely needed (NHS, AAOS OrthoInfo). It may be considered when an infection doesn’t clear with antibiotics and drainage, or when non-infected bursitis keeps causing symptoms despite other treatment; removing the bursa is usually done as an outpatient procedure (AAOS OrthoInfo, Cleveland Clinic). Cleveland Clinic describes surgery for symptoms lasting six months or longer (Cleveland Clinic). The hip works normally without the bursa (AAOS OrthoInfo), and an elbow bursa usually grows back as a normal, non-inflamed bursa over several months (AAOS OrthoInfo).

What it costs

  • Physical therapy: about $50–$350 or more a session without insurance, or a $10–$75 copay or 10%–50% coinsurance with it (cost guide: CostHelper). Medicare Part B covers medically necessary outpatient PT when your provider certifies you need it; you pay 20% of the approved amount after the deductible (Medicare.gov).
  • Office visits, aspiration, corticosteroid injections, imaging and surgery: MBHA cost estimate being researched.

Find a medical doctor in our directory

Approach 2 of 6

Chiropractic

Some people with a sore shoulder, hip or knee see a chiropractor. It’s worth knowing what the research does — and doesn’t — show.

What the research says

  • For bursitis itself, we found no controlled trials. The chiropractic literature on bursitis is mostly single case reports — for example, one woman with calcium deposits in a hip bursa who improved after two weeks of ultrasound, ice massage, electrical stimulation and lower-back and pelvic manipulation (Gerber and Herrin, 1994). A single case can’t show that a treatment works.
  • Spinal manipulation has been studied mainly for low back and neck pain, where it may bring small or modest improvements (NCCIH) — not for bursitis.
  • Exercise is what the evidence supports. For outer-hip pain, a 2024 review found exercise slightly reduced pain over the long term and recommended it as first-line treatment (Kjeldsen et al., 2024). If you see a chiropractor, ask whether the plan includes the stretching and strengthening your bursitis needs.

Safety

  • Never have manipulation or soft-tissue work on a bursa that might be infected — see the warning signs above. Septic bursitis can be hard to tell apart from ordinary bursitis without testing the fluid, so clinicians are urged to stay alert even when there is no wound or fever (Tuff and Chrobak, 2016).
  • Mild, short-lived side effects such as more pain, stiffness or headache often follow spinal manipulation and usually go away within 24 hours; serious problems, including strokes involving neck arteries, have been reported but are very rare (NCCIH).

What it costs

Find a chiropractor in our directory

Approach 3 of 6

Acupuncture

Acupuncture is sometimes used for painful shoulders and hips, but there is very little research on bursitis specifically, so any benefit is unproven.

What the research says

  • Bursitis: MBHA found no good-quality trials of traditional acupuncture for bursitis.
  • Dry needling (a related needling technique, not traditional Chinese acupuncture): a 2021 review found no difference between dry needling and a corticosteroid injection for greater trochanteric pain syndrome, but the evidence was of very low certainty and larger, better trials are needed (Sousa Filho et al., 2021).
  • Other pain: acupuncture may help back and neck pain and knee osteoarthritis pain, though some of its benefit appears to come from nonspecific effects (NCCIH). Those findings don’t tell us how it works for bursitis.

Safety

Relatively few complications have been reported, but problems have come from non-sterile needles and poor technique; the FDA requires acupuncture needles to be sterile and single-use (NCCIH). Sterile technique matters around joints: in Australia, an outbreak of serious MRSA infections — including infected joints and bursae — was traced to one medical practitioner’s breakdown in sterile technique during acupuncture and joint injections (Murray et al., 2008). Never have needles placed into or near a bursa that might be infected.

What it costs

Published cash prices run about $125–$230 for a first private visit and $90–$185 for follow-ups; community clinics about $50–$90 a visit (The Pricer).

Find an acupuncturist in our directory

Approach 4 of 6

Herbal medicine

Is any herb proven for bursitis?

No. MBHA found no herb or supplement that has been tested and shown to help bursitis. Online claims usually borrow from research on other conditions.

Turmeric (curcumin)

Turmeric is promoted for osteoarthritis, and early evidence for curcumin taken by mouth for knee osteoarthritis pain is positive, but higher-quality studies are needed; it’s unclear whether curcumin ointment helps (NCCIH). None of this research is about bursitis. Turmeric can cause nausea, acid reflux, stomach upset or diarrhea; liver damage has been reported with highly absorbable curcumin products; and turmeric supplements may be unsafe in pregnancy (NCCIH).

Products to be careful with

  • The FDA has warned about supplements promoted for arthritis or pain that were secretly tainted with prescription drugs, which could cause side effects or harmful interactions (NCCIH).
  • Some herbs interact with medicines — for example, ginkgo with the blood thinner warfarin raises the risk of major bleeding (NCCIH).

Before you take any herb or supplement, show it to your doctor or pharmacist — especially if you take a blood thinner, have liver problems, or are pregnant (NCCIH, NCCIH). We don’t list doses here, and no supplement treats an infected bursa — that needs a doctor the same day.

Approach 5 of 6

Massage therapy

Massage can’t drain or heal a bursa, but it is often part of physical therapy for the surrounding muscles. For hip bursitis, a physical therapist may use rolling therapy (massage) alongside stretching, ice or heat (AAOS OrthoInfo).

What the research says

  • Bursitis: we found no controlled trials. In a survey of 361 physiotherapists in Australia, New Zealand and Ireland, 90% used massage for outer-hip pain, but the authors noted that some add-on treatments are used without clear rationale or supporting evidence; education plus exercise is the approach in line with the evidence (French et al., 2020).
  • A 1993 report of two patients describes transverse friction massage for chronic hip and shoulder bursitis, and notes that earlier writing had discouraged friction massage for bursitis (Hammer, 1993). Two cases can’t show that it works.
  • Neck and shoulder pain in general: massage may help, but benefits may last only a short time (NCCIH).

Safety

Bursitis care means avoiding pressure on the swollen bursa (AAOS OrthoInfo, NHS), so MBHA suggests asking your therapist to work gently on the muscles around it rather than on the bursa itself — and to skip the area completely if it is red, hot or you have a fever. Rare serious problems such as a blood clot, nerve injury or broken bone have been reported, some with vigorous deep-tissue massage or in older adults (NCCIH).

What it costs

  • About $60–$120 for 45–60 minutes with a private therapist, or $50–$90 at clinics, gyms and spas; massage schools sometimes offer discounts (CostHelper).

Find a massage therapist in our directory

Approach 6 of 6

MBHA Wellness Coach

Bursitis is usually preventable, and the first step is figuring out which movements caused it (Cleveland Clinic). An MBHA Wellness Coach can help you change those habits, alongside — never instead of — your medical care.

Change repetitive tasks

Pads and protection

Warm up, stretch and strengthen

Weight

Being overweight puts more pressure on your joints (NHS). For bursitis around the hips, knees or ankles, losing weight may help (MedlinePlus).

A gradual return to activity

Ease into new exercises or activities (Cleveland Clinic). Don’t go back before the bursa has healed — even if pain improves, stressing it too soon raises the risk of reinjury (Cleveland Clinic). Don’t work or play through pain, and don’t rush back to the activity that caused the problem (Cleveland Clinic). Seek medical attention if pain worsens or doesn’t improve in a few weeks (American College of Rheumatology).

Another approach

Outer hip pain: greater trochanteric pain syndrome

For years, pain on the outside of the hip was usually diagnosed as trochanteric bursitis and treated with NSAIDs, corticosteroid injections and physical therapy. Doctors now often use the broader term greater trochanteric pain syndrome (GTPS), which includes trochanteric bursitis, snapping hip and problems with the gluteal (abductor) tendons (Redmond et al., 2016). One review describes the most common underlying problem as wear or tearing of the gluteus medius and minimus tendons where they attach to the hip bone, with inflammation not a major feature (Torres et al., 2018).

What the research says about treatment

  • Education plus exercise vs. an injection: in the LEAP trial, 204 adults with gluteal tendinopathy (the main condition within GTPS) received an eight-week, physiotherapist-led program of education about managing load plus exercise, one corticosteroid injection, or a “wait and see” approach. At eight weeks both treatments beat waiting, and education plus exercise did better than the injection. At one year, education plus exercise still led to more people reporting overall improvement than the injection, although pain levels were similar (Mellor et al., 2018).
  • Exercise as first-line care: a 2024 review of six trials found that, over the long term, exercise slightly reduced hip pain and improved function compared with control treatments, and was better than an injection at producing meaningful overall improvement. The authors recommend exercise as first-line treatment but note the evidence comes from few trials (Kjeldsen et al., 2024).
  • Injections still have a place: injections may give months of relief (AAOS OrthoInfo), and one review rated corticosteroid injections among the most effective conservative options (Torres et al., 2018). Ask your provider how an injection would fit with an exercise program.

In practice: if you have outer-hip pain, ask about a physical therapist who can guide a strengthening program and teach you how to manage the load on your hip. Hip pain that gets worse or doesn’t ease in a week or two of rest deserves a visit to your provider (Cleveland Clinic).

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This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

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