Bursa injections (bursitis) in Hamburg

What is a bursa – and why does it become inflamed?

Bursae are thin-walled cushions filled with synovial fluid. They are located in places with high pressure or friction, for example between tendons and bone protrusions. Repetitive stress, unfavorable biomechanics, tight shoes, increased training or direct impacts can irritate the shell - resulting in bursitis. Calcifications, crystal diseases (e.g. gout/pseudogout) or bacterial infections are less common triggers.

• Common locations: subacromial bursitis of the shoulder
• Hip: trochanteric bursitis (lateral hip)
• Knee: prepatellar bursitis and pes anserinus bursitis
• Elbow: Olecranon bursitis
• Heel: retrocalcaneal bursitis (near Achilles tendon)

Conservative first: basic therapy for bursitis

Gentle measures are taken before each injection. The goal is to reduce irritation, promote healing and correct triggers. Many cases of bursitis resolve within a few weeks.

• Load adjustment: temporarily less pressure/friction; Sport-specific modifications
• Cooling during periods of pain, anti-inflammatory ointments; If necessary, short-term NSAIDs – only after consultation
• Physiotherapy: mobility, muscle balance, technique/posture coaching; Targeted glute training for lateral hip pain
• Tapes, pads, bandages or soft knee pads (e.g. for kneeling activities)
• Shoe and insole advice, especially for irritation near the Achilles tendon
• Ergonomics in the workplace and practical everyday tips

In addition, shock wave therapy (e.g. in greater trochanter pain syndrome) or manual therapeutic procedures can be considered for selected findings. We will clarify individually whether this makes sense.

When is a bursa injection useful?

An injection should be considered if symptoms persist despite basic therapy according to guidelines or if severe inflammation is localized. First, we rule out bacterial bursitis and check for comorbidities.

• Persistent pain for several weeks despite rest and physiotherapy
• Significantly tender, possibly swollen bursa (e.g. olecranon, prepatellar)
• Pain at night and at rest that hinders rehabilitation measures
• Evidence of fluid accumulation, detectable on ultrasound
• Individual situations (e.g. planned competition) – always with a risk-benefit assessment

Important: If you have a fever, severe redness of the skin, overheating or general symptoms, we think of a bacterial infection. Then there is no place for a sterile cortisone injection; A medical clarification with diagnostics (if necessary aspiration, laboratory) is necessary.

Bursa injection procedure in our practice

The procedure usually takes 10-20 minutes. Imaging increases hit accuracy and helps protect sensitive structures.

Active ingredients and options – evidence-based and moderate

• Local anesthetic: short-term pain relief and diagnostic indication of whether the bursa is the source of pain.
• Corticosteroid: can effectively reduce inflammation in the bursa (e.g. shoulder, hip, knee). We use the lowest possible doses and avoid frequent repetitions.
• PRP/ACP (autologous blood concentrate): discussed for some bursitis (especially in the context of greater trochanter pain syndrome). Evidence heterogeneous; can be considered as a supplement in selected cases.
• Hyaluronic acid: not standard for bursae; more for joints. Usually not a routine indication.
• Antibiotics: only if bacterial bursitis is proven, then specifically after the pathogen has been detected and in a different treatment path.

We plan repeat injections cautiously. One session is often enough; If necessary, 1-2 additional injections spaced 2-6 weeks apart may be considered. We avoid multiple cortisone injections at short intervals to minimize side effects.

Risks and contraindications

Injections are considered minimally invasive, but remain medical procedures with possible side effects. We work under sterile conditions and provide individual information.

• Infection (rare), hematoma, temporary increased pain
• Skin redness/flushing, blood sugar increase in diabetes after corticosteroid
• Skin/fatty tissue atrophy or depigmentation at the injection site
• irritation of adjacent tendons; Injection into tendons is avoided
• Allergic reactions to active ingredients or disinfectants
• Contraindications: acute infection, anticoagulation that has not been adjusted, pronounced skin lesions at the injection site, known allergies to components. Pregnancy/breastfeeding: Benefit-risk assessment required.

Aftercare: What you should pay attention to after the injection

• Protect the region for 24-48 hours, then slowly build up the load
• Cool as needed, dry bandage for a few hours
• No sauna/swimming pool on the same day, showering is possible after bandages are removed
• Continue physiotherapy promptly; Address technology and causes (e.g. running style, workplace).
• Warning signs: increasing redness, severe swelling, fever - please contact us immediately

The pain-relieving effect may occur immediately and wear off from the local anesthetic; The anti-inflammatory effects of corticosteroids often begin within 24-72 hours.

How many sessions? Realistically assess your chances of success

The aim of the injection is to reduce inflammation and pain so that you can actively work on eliminating the cause. One treatment is often enough, but occasionally up to three sessions are useful. Long-lasting results depend largely on adjusting loads and correcting muscular imbalances. Individual responses vary - no guarantees can be given.

Typical locations and special features

• Shoulder (subacromial bursitis): often associated with tightness/rotator cuff syndrome; Injection can dampen irritation and enable physiotherapy.
• Hip (trochanteric bursitis): lateral hip pain; Gluteus medius/minimus training is important. Inject specifically into the bursa/peritendineum, never into the tendon.
• Knee (prepatellar, pes anserinus): if swelling is severe, aspiration can help relieve pressure; Padding is important in everyday life.
• Elbow (olecranon bursitis): common after pressure/shock; differentiate between aseptic and septic. If infection is suspected, no cortisone injection.
• Heel (retrocalcaneal bursa): Differentiation from insertional tendinopathy of the Achilles tendon; Adjust shoes, heel wedges if necessary, eccentric training.

We will clarify which location you have clinically and with ultrasound. This allows the therapy to be tailored precisely.

Alternatives and supplements to injection

• Consistent physiotherapy and exercise program
• Load and workplace adjustment, padding/bandages
• Shoe/insole supply, sports technique coaching
• Shock wave therapy: possible for selected indications (e.g. GTPS).
• Pain management: topical analgesics, time-limited systemic medications after medical consultation
• Surgical measures (bursectomy) are rarely necessary and are reserved for stubborn cases

Your appointment in Hamburg – well prepared for the consultation hours

If available, bring previous findings, imaging (ultrasound, MRI, X-ray) and your current medication list with you. Please inform us about anticoagulants, diabetes or allergies. Comfortable clothing makes it easier to examine the affected area.

• Practice address: Dorotheenstraße 48, 22301 Hamburg
• Directions: good public transport connections; If necessary, plan a short rest period after the injection
• After treatment: You are usually mobile; If surgery is being carried out on a heavily stressed area, it is better not to do intensive activity on the same day