Bursitis: Treatments for Hip, Knee Shoulder and More
What Is a Balance Disorder?
A balance disorder is a condition that makes you feel unsteady or dizzy, as if you are moving, spinning, or floating, even though you are standing still or lying down. Balance disorders can be caused by certain health conditions, medications, or a problem in the inner ear or the brain.
What Is the Vestibular System, and How Does it Work?
The medical term for all of the parts of the inner ear involved with balance is referred to as the vestibular system. It controls our sense of balance, posture, the body’s orientation in space, locomotion, and other movements; and keeps objects in visual focus as the body moves. The vestibular system works with other sensory systems in the body, for example, the eyes, bones, and joints, to check and maintain the positioning of the body at rest and in motion.
What Is the Labyrinth?
Our sense of balance is primarily controlled by a maze-like structure in the inner ear called the labyrinth, which is made of bone and soft tissue. The semicircular canals and otolithic organs within the labyrinth help maintain our balance. The cochlea within the labyrinth enables us to hear.
What Are the Symptoms of a Balance Disorder?
Some of the common symptoms of a balance disorder include:
- Dizziness or vertigo
- Falling or a feeling as if you are going to fall
- Lightheadedness, fainting, or a floating sensation
- Blurred vision
- Confusion or disorientation
- Nausea and vomiting
- Diarrhea
- Changes in blood pressure and heart rate
- Fear
- Anxiety
- Panic
Symptoms may come and go over short periods of time, or last for longer periods of time.
What Causes a Balance Disorder?
A balance disorder may be caused by viral or bacterial infections in the ear, head injuries, or blood circulation disorders that affect the inner ear or brain. Many people experience problems with their sense of balance as they age. Balance problems and dizziness also can result from taking certain medications. Problems in the nervous and circulatory systems can be the source of some posture and balance problems. Problems in the skeletal or visual systems, such as arthritis or eye muscle imbalance, also may cause balance problems. However, many balance disorders can begin very suddenly with no obvious cause.
What Are the Types of Balance Disorders?
There are more than a dozen types of balance disorders. Some of the most common include:
- Vertigo
- Benign paroxysmal positional vertigo (BPPV)
- Labyrinthitis
- Meniere’s disease
- Vestibular neronitis
- Perilymph fistula
- Mal de debarquement syndrome (MdDS)
Vertigo
Vertigo is an abnormal sensation that is described by a person as a feeling that they are spinning, or that the world is spinning around them; and may be accompanied by intense nausea and vomiting. This feeling may be associated with loss of balance to the point that the person walks unsteadily or falls. Vertigo itself is a symptom or indicator of an underlying balance problem, either involving the labyrinth of the inner ear, or the cerebellum of the brain.
Benign Paroxysmal Positional Vertigo (BPPV)
Benign paroxysmal positional vertigo (BPPV) or positional vertigo is a brief, intense episode of vertigo that occurs because of a specific change in the position of the head. A person also may experience BPPV when he or she rolls over in bed. BPPV sometimes may result from a head injury or aging.
Labyrinthitis
Labyrinthitis is an infection or inflammation of the inner ear that causes dizziness and loss of balance. It frequently is associated with an upper respiratory infection such as the flu.
Ménière's Disease
Ménière's disease is associated with a change in fluid volume within parts of the labyrinth, one of the structures of the inner ear. Ménière's disease causes episodes of vertigo, irregular hearing loss, tinnitus (a ringing or buzzing in the ear), and a feeling of fullness in the ear. The cause of Ménèire's disease is unknown.
Vestibular Neuronitis
Vestibular neuronitis is an inflammation of the vestibular nerve and may be caused by a virus. Vestibular neuronitis is a paroxysmal attack of severe vertigo. It affects young to middle-aged adults, and often follows a nonspecific upper respiratory infection.
Perilymph Fistula
Perilymph fistula is a leakage of inner ear fluid into the middle ear. It can occur after a head injury, drastic changes in atmospheric pressure (such as when scuba diving), physical exertion, ear surgery, or chronic ear infections. Its most notable symptom, besides dizziness and nausea, is unsteadiness when walking or standing that increases with activity and decreases with rest. Some babies may be born with perilymph fistula, usually in association with hearing loss that is present at birth.
Motion Sickness
Motion sickness, sometimes referred to as sea sickness or car sickness, is a very common disturbance of the inner ear that is caused by repeated motion such as from the swell of the sea, movement of a car, or the motion of turbulent air on a plane. The symptoms of motion sickness are nausea, vomiting, dizziness, sweating, and a sense of feeling unwell. These symptoms arise from the inner ear (labyrinth) due to changes in one's sense of balance and equilibrium.
Mal de Debarquement Syndrome (MdDS)
Mal de debarquement syndrome (MdDS) is a balance disorder in which a person feels as if he or she is continuously rocking or bobbing. It generally occurs after an ocean cruise or other sea travel. Usually, the symptoms will resolve in a matter of hours or days after the person reaches land. However, severe cases can last months or even years.
How is a Balance Disorder Diagnosed?
Diagnosis of a balance disorder is difficult. There are many potential causes - including medical conditions and medications. To help evaluate a balance problem, a doctor may suggest the patient visit an otolaryngologist (a physician and surgeon who specializes in the ear, nose, and throat). The otolaryngologist may order a hearing examination, blood tests, an electronystagmogram (which measures eye movements and the muscles that control them), or imaging studies of the head and brain. Another possible test is called posturography. For this test, the patient stands on a special movable platform in front of a patterned screen. The doctor measures how the patient’s body moves in response to movement of the platform, the patterned screen, or both.
How Is a Balance Disorder Treated?
The first thing a doctor will do to treat a balance disorder is determine if the patient’s dizziness is caused by a medical condition or medication. If it is, the doctor will treat the condition or suggest a different medication for the patient.
The treatment for the different types of balance disorders described previously will depend on the specific balance disorder. Some treatment options include medication, vestibular rehabilitation therapy, head; body; and eye exercises, and modifications to home fixtures to make them safer (for example, handrails in the home).
How Do I Know if I Have a Balance Disorder?
Everyone has a dizzy spell now and then, but the term “dizziness” may mean something different to different people. For some people, dizziness might be a fleeting sensation of spinning, while for others it's intense and lasts a long time. Experts believe that more than four out of 10 Americans will experience an episode of dizziness significant enough to seek medical care.
To help you decide whether or not you should seek medical help for a dizzy spell, ask yourself the following questions. If you answer “yes” to any of these questions, talk to your doctor.
How Can I Help My Doctor Make a Diagnosis?
You can help your doctor make a diagnosis and determine a treatment plan by answering these questions. Be prepared to discuss this information during your appointment.
At your appointment, take a minute to write down any instructions your doctor has given you. Be sure to ask any questions you have before you leave the office.
Reviewed by Peter O'Connor, M.D. on 6/21/2016
This tool does not provide medical advice. See additional information:
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Bursitis: Treatments for Hip, Knee Shoulder and More
What Is Bursitis?
Bursitis is inflammation of the bursae, the fluid-filled sacs that protect against friction between bones and other tissues. Depending on the location in the body, bursae may cushion bones from other bones, tendons, muscle, or skin. Bursitis can occur in many areas of the body. It is most common in the elbows and wrists. The ankles, hips, or knees may also be affected. Bursitis is caused by overuse injury or other trauma. Repetitive movements increase the risk of bursitis. Certain conditions like thyroid disease, diabetes, arthritis, and infections can inflame the bursa.
Hip Bursitis
Hip bursitis occurs as a result of inflammation of one of two bursae located around the hip. Trochanteric bursitis is inflammation of the bursa that covers the end of the long bone of the leg (femur). It is more common than iliopsoas bursitis, which is inflammation of the bursa on the inside of the hip in the groin. In addition to the usual risk factors for bursitis, a difference in the length of the legs and spine disorders (arthritis, scoliosis, and others) also increase the risk of bursitis.
Knee Bursitis
Knee bursitis occurs when the bursa in front of the kneecap becomes inflamed. Strain on the knees from kneeling is a common cause of knee bursitis. Direct trauma to the knee or conditions such as rheumatoid arthritis or gout also increases the risk. Sometimes a bug bite or wound introduces bacteria into the bursa, causing inflammation associated with infection. Knee bursitis may produce symptoms like swelling, warmth, and pain with use.
Elbow Bursitis
Elbow bursitis is inflammation of the bursa covering the pointy part of the elbow called the olecranon. Leaning on the elbows for extended periods of time may cause elbow bursitis. Injury, infection, and arthritic conditions may contribute to the condition. Elbow bursitis may cause swelling and pain. If swelling is very severe, it may impair use of the elbow joint.
Shoulder Bursitis
The shoulder is a complicated joint that allows for a wide range of motion. The upper arm bone (humerus) is held within the socket by muscles and tendons on the top of the shoulder known as the rotator cuff. The rotator cuff attaches the arm to the shoulder blade (scapula). A bursa cushions the space between the rotator cuff and a portion of the scapula called the acromion. Inflammation of the bursa may cause pain, swelling, and stiffness. Overuse injuries due to sports like swimming and tennis may cause shoulder bursitis. Pain may occur when using the arm as well as at rest.
Heel Bursitis
Heel pain can be caused by a variety of reasons. Pain in the back of the heel may be due to inflammation of the bursa located in the area where the heel bone connects to the Achilles tendon. This bursa is called the retrocalcaneal bursa. Overuse injury from running may cause retrocalcaneal bursitis. Ill-fitting shoes that cut into the back of the heel can also provoke the condition. This type of bursitis may be very painful and make it hard to walk and do normal activities.
Ischial Bursitis
Ischial bursitis is inflammation of the bursa that lies between the buttocks and the sitting bones. Sitting too long may cause ischial bursitis. Falling on the area may also provoke the condition. Once the ischial bursa is inflamed, sitting, walking, running, and climbing stairs may aggravate the condition and cause pain.
Aseptic vs. Septic Bursitis
Septic bursitis refers to inflammation of the bursa caused by an infection. Aseptic bursitis refers to inflammation of the bursa that is caused by something other than infection, such as rheumatoid arthritis, gout, physical trauma, or overuse injury. The majority of cases of septic knee bursitis (80%) are caused by the bacteria Staphylococcus aureus. Other organisms, including fungi, Streptococcus, Brucella, and Mycobacteria may cause septic bursitis. The condition is managed by resting, draining excess fluid, and administering antibiotics.
Calcific Bursitis
Calcific bursitis refers to calcium deposits that build up in a bursa and cause pain and inflammation. The shoulders are the most common site for calcific bursitis although the hips, knees, wrists, and elbows may also be affected. Calcific bursitis may be associated with buildup of calcium deposits in nearby tendons as well.
Bursitis Diagnosis
Bursitis can be diagnosed by a doctor based on a medical history, exam, and tests. Tests may include imaging with X-rays, an ultrasound, or an MRI. The doctor may order blood work or microscopic investigation of fluid drained from the affected bursa. Once the underlying cause of bursitis has been identified, the doctor can determine the appropriate course of treatment.
Bursitis Treatment
Treatment for bursitis depends on the underlying cause. Rest, Ice, Compression, and Elevation (RICE) is one strategy to decrease the symptoms of bursitis. Pain and swelling may be managed with nonsteroidal anti-inflammatory drugs (NSAIDs). If the bursa is very swollen, the doctor may drain excess fluid. Corticosteroids injected into the affected bursa are sometimes used to decrease inflammation. The doctor may recommend the use of a cane, splint, brace, or other support to reduce stress on the affected joint. In some cases, physical therapy may be ordered to help strengthen the area and encourage improved mobility. Surgery may be considered in severe cases when other treatments have been ineffective.
Bursitis Prevention
Taking certain precautions with movement is a way to protect joints and decrease the risk of bursitis. Changing positions and taking breaks every 20 to 40 minutes helps minimize strain on any one joint. Warming up and stretching before exercise helps protect joints. Exercising regularly and building up strength is better than pushing oneself too hard and straining joints that have not yet had the chance to adapt to increased amounts of activity. Stopping activities that cause pain is also a good idea.
Reviewed by Aimee V. Hachigian-Gould, MD on 6/21/2016
This tool does not provide medical advice.
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