Bursitis Treatment
in Tulsa, Oklahoma

A bursa is a small, fluid-filled sac lined with synovial tissue that sits between a bony prominence and an overlying tendon, muscle, or skin. Its job is to reduce friction during movement. The body contains roughly 150 bursae, but only a subset become symptomatic, most commonly the subacromial bursa in the shoulder, the trochanteric bursa at the lateral hip, the prepatellar and pes anserine bursae at the knee, the olecranon bursa at the elbow, and the retrocalcaneal bursa behind the heel. When a bursa is repeatedly compressed or irritated, its lining thickens and fills with excess fluid, that is bursitis.

Non-infected (aseptic) bursitis typically produces pain, swelling, and tenderness without systemic symptoms. Septic bursitis (which is most commonly seen in the olecranon or prepatellar bursa after a skin break) adds warmth and redness that spreads beyond the bursa, often fever or chills, and severe pain with any movement. The bursae that sit directly beneath skin (elbow, kneecap) are the highest-risk for infection. Any rapidly expanding, red, hot, extremely tender bursa (especially with fever) should be evaluated promptly, because septic bursitis is treated with aspiration and antibiotics, not with a steroid injection.

A markedly distended bursa (particularly olecranon or prepatellar) often benefits from aspiration before any injection. Drawing off the fluid relieves mechanical pressure, allows the fluid to be inspected (clear, bloody, cloudy) and cultured if infection is suspected, and creates room for the medication to reach the bursa lining rather than being diluted by a large effusion. Ultrasound guidance improves the accuracy of both aspiration and injection, particularly in the shoulder and hip where the bursa lies deep to other structures.

There is no absolute universal limit, but most practitioners limit corticosteroid injections to a single bursa to roughly three or four per year, with at least several weeks between injections, and monitor for diminishing returns. Steroid injected into a bursa is generally safer than injection directly into a weight-bearing tendon, but repeated steroid exposure can weaken adjacent tendon tissue and depigment or thin overlying skin. If a bursa keeps reinflaming despite appropriate injections, the real question is usually why, a mechanical driver upstream (rotator cuff disease, IT-band tightness, gait pattern) often needs addressing before the bursa will settle.

Recurrent bursitis almost always points to an ongoing source of friction or compression. Trochanteric bursitis commonly recurs because of underlying gluteus medius or minimus tendinopathy and pelvic mechanics. Subacromial bursitis recurs when rotator cuff impingement hasn't been corrected. Prepatellar bursitis recurs with repeated kneeling occupations. The bursa is often the messenger, not the message, durable relief usually requires identifying and addressing the upstream mechanical driver, not just repeatedly quieting the inflamed sac.

PRP is most established for tendon and ligament pathology, but it has a growing role in chronic, recurrent bursitis, particularly when the bursitis is driven by adjacent tendinopathy that needs to heal before the bursa will settle. In greater trochanteric pain syndrome, for example, the real pathology is often gluteus medius/minimus tendinopathy with secondary bursitis, and PRP targets the tendon directly. For isolated bursitis without a clear tendon driver, a well-placed corticosteroid injection combined with addressing the mechanical cause remains the usual first-line approach.