What Is a Bursa?

A bursa is a small, thin-walled sac that helps adjacent tissues glide over one another with minimal friction. The plural is bursae. Bursae occur at interfaces between structures such as bone, tendons, muscles and skin, particularly around joints. A typical synovial bursa has a synovial lining and contains a small amount of lubricating fluid. It is normally relatively flat rather than a large, fluid-filled pocket (StatPearls, Anatomy, Skin Bursa; AAOS, Elbow Bursitis).

Their location reflects their function. At the elbow, the olecranon bursa allows the skin to move over the underlying olecranon process. At the front of the knee, the prepatellar bursa lies between the skin and patella. In the shoulder, the subacromial bursa helps facilitate movement between the rotator cuff and the overlying acromion. These examples show why bursae are relevant both to joint movement and to pressure over bony prominences (AAOS, Elbow Bursitis; Prepatellar Bursitis; Shoulder Pain and Common Shoulder Problems).

Bursitis means inflammation of a bursa. It may involve increased fluid, local tenderness, pain and restricted movement. Potential causes include repeated mechanical irritation, sustained pressure, a direct injury, inflammatory conditions such as rheumatoid arthritis or gout, and infection. For example, frequent kneeling can irritate the prepatellar bursa, while prolonged leaning on the elbows can irritate the olecranon bursa. Bursitis is therefore not always simply an “overuse” problem (Healthdirect Australia, 2025; AAOS, Elbow Bursitis).

For remedial massage therapists, this anatomy has a practical implication: local tenderness over a bony prominence should not automatically be interpreted as a muscular problem. Direct pressure can aggravate an inflamed superficial bursa. Applying this principle to treatment means adjusting positioning, support and contact to avoid compressing a painful or swollen area (clinical application of AAOS guidance, Elbow Bursitis).

A red, hot, swollen area warrants particular attention because infection is a possible cause. Suspected infection requires prompt medical assessment rather than local massage treatment. Medical investigation may include sampling bursal fluid to distinguish infection from other causes of swelling (AAOS, Elbow Bursitis).

Knowledge check

1. What is the primary function of a bursa?

A. To connect a muscle to its attachment on a bone.
B. To reduce friction between adjacent moving tissues.
C. To provide the force required to move a joint.
D. To connect adjacent bones and limit joint movement.

Correct answer: B.

2. A client has a red, hot, swollen area over the elbow, and you suspect an infected bursa. What is the most appropriate action?

A. Apply firm massage to disperse the accumulated fluid.
B. Mobilise the elbow repeatedly to reduce the swelling.
C. Apply local massage and review the area next week.
D. Avoid local massage and arrange prompt medical assessment.

Correct answer: D.

References

• StatPearls. Anatomy, Skin Bursa. StatPearls Publishing. NCBI Bookshelf, NBK554438.

• American Academy of Orthopaedic Surgeons (AAOS). Elbow (Olecranon) Bursitis. OrthoInfo.

• American Academy of Orthopaedic Surgeons (AAOS). Prepatellar (Kneecap) Bursitis. OrthoInfo.

• American Academy of Orthopaedic Surgeons (AAOS). Shoulder Pain and Common Shoulder Problems. OrthoInfo.

• Healthdirect Australia. (2025). Bursitis. Reviewed July 2025.