From the Guidelines
The best treatment for bursitis typically involves a combination of rest, ice, compression, and elevation (RICE) of the affected area, along with over-the-counter pain relievers such as ibuprofen (Advil, Motrin) at 400-800mg three times daily or naproxen (Aleve) at 220-440mg twice daily for 1-2 weeks to reduce inflammation and pain. This approach is supported by the general principles of managing musculoskeletal symptoms, including those from tendonitis/bursitis, as outlined in the American Heart Association's scientific statement 1.
Key Considerations
- Nonpharmacological approaches, such as physical therapy, heat/cold, and orthotics, should be the initial focus of treatment.
- Pharmacological treatments, including NSAIDs, should be considered when nonpharmacological approaches are ineffective.
- The choice of medication should be based on both safety and efficacy, with the least risky medication tried first.
Treatment Options
- For more severe cases, corticosteroid injections directly into the bursa, such as methylprednisolone or triamcinolone, can provide significant relief within 24-48 hours.
- Physical therapy exercises to strengthen surrounding muscles and improve range of motion are often beneficial once acute pain subsides.
- In cases of septic bursitis (infection), antibiotics such as cephalexin 500mg four times daily for 7-10 days may be necessary.
- For chronic or recurrent bursitis that doesn't respond to conservative measures, surgical removal of the bursa (bursectomy) might be considered.
Underlying Principles
The European League Against Rheumatism (EULAR) recommendations for managing psoriatic arthritis with pharmacological therapies also provide guidance on the use of NSAIDs and other treatments for musculoskeletal symptoms 1. While these recommendations are specific to psoriatic arthritis, they support the general principle of using NSAIDs to relieve musculoskeletal signs and symptoms. Additionally, the use of local injections of glucocorticoids as adjunctive therapy is recommended, which aligns with the consideration of corticosteroid injections for bursitis.
Evidence Base
The most recent and highest quality study relevant to the treatment of bursitis is from 2016, which provides recommendations for the management of psoriatic arthritis but also offers insights into the management of musculoskeletal symptoms more broadly 1. This study, along with others, supports the initial use of nonpharmacological approaches and NSAIDs for managing bursitis, reserving more invasive treatments like corticosteroid injections or surgery for more severe or refractory cases.
From the FDA Drug Label
For relief of the signs and symptoms of tendonitis For relief of the signs and symptoms of bursitis The recommended starting dose of naproxen is 500 mg, followed by 500 mg every 12 hours or 250 mg every 6 to 8 hours as required. The best treatment for bursitis is naproxen with a recommended starting dose of 500 mg, followed by 500 mg every 12 hours or 250 mg every 6 to 8 hours as required 2.
- Key points:
From the Research
Treatment Options for Bursitis
- Nonsurgical management, including ice, activity modification, and nonsteroidal anti-inflammatory drugs, is often effective for most patients with bursitis 3
- Local corticosteroid injection may be used in the management of prepatellar and olecranon bursitis, but steroid injection into the retrocalcaneal bursa may adversely affect the biomechanical properties of the Achilles tendon 3
- Surgical intervention may be required for recalcitrant bursitis, such as refractory trochanteric bursitis 3
Specific Treatment Options for Trochanteric Bursitis
- Conservative measures, such as physical therapy and nonsteroidal anti-inflammatory drugs, are often effective for trochanteric bursitis 4
- Corticosteroid injection can be used as a primary treatment modality, with symptom resolution and return to activity ranging from 49% to 100% 4
- Low-energy shock-wave therapy (SWT) has been found to be superior to other nonoperative modalities in some studies 4
- Surgical options, such as bursectomy, longitudinal release of the iliotibial band, and repair of gluteus medius tears, can be effective for persistent trochanteric bursitis 4
Treatment Options for Olecranon Bursitis
- Conservative methods, such as rest, ice, compression, orthosis wear, and nonsteroidal anti-inflammatory medications, are often effective for olecranon bursitis 5
- Intrabursal corticosteroid injections and surgical bursectomy have been used in the past, but more recent literature has demonstrated adverse effects of these treatments compared to noninvasive management 5