Bursitis is a common condition where the bursa, a small, fluid-filled sac cushioning joints, becomes inflamed. These sacs reduce friction between bone, muscle, and tendon tissues, but when irritated, they cause pain, swelling, and tenderness. Bursitis frequently develops in major joints experiencing repetitive motion, such as the shoulder, elbow, hip, and knee. The appropriate medical professional depends on the severity, the underlying cause, and the response to initial care. Recovery often involves a team of providers, starting with your established physician and potentially moving to specialists.
Starting with Primary Care
For the majority of bursitis cases, the first medical contact is your Primary Care Provider (PCP), including general practitioners, family medicine doctors, or internal medicine physicians. The PCP conducts the initial physical examination, takes a detailed medical history, and accurately diagnoses the condition. They also rule out other musculoskeletal issues that mimic bursitis, such as tendinitis or various forms of arthritis.
Initial management for uncomplicated bursitis is conservative, focusing on reducing inflammation and pain. This involves advising home care measures like the RICE method—Rest, Ice, Compression, and Elevation—to minimize swelling. The PCP will prescribe or recommend nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, to manage discomfort.
If bursitis does not improve after a week or two of conservative treatments, the PCP coordinates care. They determine if the condition requires specialized intervention based on the persistence of symptoms, the severity of the pain, and any suspicion of an underlying systemic cause or infection.
Specialist Physicians for Advanced Treatment
When initial treatments are ineffective or the diagnosis is complex, your PCP will refer you to a specialist physician. The two main types involved are orthopedic surgeons and rheumatologists, each focusing on a different aspect of the condition. Orthopedic surgeons specialize in the musculoskeletal system, offering advanced procedural and surgical solutions for mechanical problems.
Orthopedic Surgeons
An orthopedic surgeon may perform corticosteroid injections directly into the inflamed bursa to deliver anti-inflammatory medication. They may also perform aspiration, using a needle to draw excess fluid out of the swollen bursa, which is both diagnostic and therapeutic. If bursitis is chronic and severely limits function, or if the bursa is permanently thickened, they perform a bursectomy—the surgical removal of the inflamed sac.
Rheumatologists
A rheumatologist is an internal medicine physician specializing in inflammatory conditions affecting the joints and soft tissues. Referral is appropriate when bursitis is suspected to be a manifestation of a systemic disease, such as gout, rheumatoid arthritis, or lupus. They focus on identifying and treating the underlying systemic cause, often involving specialized blood tests and long-term medication management to prevent future flare-ups.
Recovery and Rehabilitation Specialists
Once acute inflammation is controlled, the focus shifts to preventing recurrence, which is the domain of rehabilitation specialists. Physical Therapists (PTs) play a primary role in restoring function and strengthening surrounding joint structures. They develop tailored exercise programs, including specific stretching routines to improve flexibility and strengthening exercises to stabilize the joint.
Physical Therapists
PTs assess and correct underlying biomechanical issues, such as poor posture or gait abnormalities, that contributed to the initial strain. Their goal is to improve movement patterns, ensuring stress is properly distributed across the joint and off the sensitive bursa. This functional retraining is a major component in preventing recurrence.
Occupational Therapists
Occupational Therapists (OTs) focus on modifying daily activities and environments to reduce strain on the affected area. They help patients adapt work habits, sports techniques, or household tasks to avoid repetitive motions that irritate the bursa. This may involve recommending adaptive equipment or suggesting changes in body positioning while sitting, kneeling, or lifting. The combined efforts of PTs and OTs are often necessary to ensure a complete and lasting recovery.
When Bursitis Requires Emergency Attention
While most bursitis cases are not medical emergencies, certain warning signs indicate septic bursitis, an infection of the bursa. Immediate medical attention at an Emergency Room or Urgent Care facility is required if you experience severe local symptoms combined with signs of systemic illness.
The critical red flags are a fever, often accompanied by chills, and rapidly spreading redness or red streaks extending away from the affected joint. Other urgent symptoms include intense, debilitating pain disproportionate to the swelling, or the presence of an open wound or pus draining from the area. Septic bursitis requires immediate aspiration of the fluid to diagnose the specific bacteria, typically Staphylococcus aureus, and prompt treatment with intravenous antibiotics to prevent the infection from spreading.