From the Guidelines
Treatment for bursitis of the shoulder should initially focus on conservative measures, including rest, ice application, and over-the-counter anti-inflammatory medications, with subacromial corticosteroid injections considered for patients with pain related to injury or inflammation of the subacromial region (rotator cuff or bursa). When considering treatment options, it's essential to prioritize approaches that minimize morbidity, mortality, and improve quality of life. For shoulder bursitis, the primary goal is to reduce pain and inflammation, and promote recovery. Key considerations include:
- Rest and ice application to reduce inflammation
- Over-the-counter anti-inflammatory medications, such as ibuprofen or naproxen, for pain relief 1
- Physical therapy focusing on gentle stretching and strengthening exercises to prevent recurrence
- Subacromial corticosteroid injections for moderate to severe cases, as they can provide significant relief for patients with pain related to injury or inflammation of the subacromial region (rotator cuff or bursa) 1 It's crucial to avoid activities that aggravate symptoms, particularly overhead movements, during the recovery period. Most cases of shoulder bursitis resolve within a few weeks with conservative approaches. However, if symptoms persist beyond 6-8 weeks or are severe, medical evaluation is necessary, and surgery might be considered to remove the inflamed bursa. The use of analgesics, such as acetaminophen or ibuprofen, can also be considered for pain relief, although the evidence level for this is lower (Evidence Level C) 1. In general, a stepped approach to treatment, starting with conservative measures and progressing to more invasive options as needed, is recommended to minimize risks and optimize outcomes.
From the FDA Drug Label
Naproxen tablets are also indicated: For relief of the signs and symptoms of tendonitis For relief of the signs and symptoms of bursitis Management of Pain, Primary Dysmenorrhea, and Acute Tendonitis and Bursitis Because the sodium salt of naproxen is more rapidly absorbed, naproxen sodium is recommended for the management of acute painful conditions when prompt onset of pain relief is desired. Naproxen may also be used 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.
Treatment for bursitis of the shoulder with naproxen includes:
- A recommended starting dose of 500 mg, followed by 500 mg every 12 hours or 250 mg every 6 to 8 hours as required.
- The initial total daily dose should not exceed 1250 mg of naproxen.
- Thereafter, the total daily dose should not exceed 1000 mg of naproxen 2, 2.
From the Research
Treatment Options for Bursitis of the Shoulder
- Nonsurgical management, including ice, activity modification, and nonsteroidal anti-inflammatory drugs, is often effective in treating bursitis 3
- Local corticosteroid injection may be used in the management of bursitis, but its effectiveness varies depending on the location and type of bursitis 3, 4, 5, 6
- Aspiration and aspiration with steroid injection are also treatment options for bursitis, but their effectiveness compared to other treatments is not well established 7, 5
Specific Treatments for Subacromial Bursitis
- Hypertonic dextrose prolotherapy and steroid injections can provide short-term improvements in pain and disability for chronic subacromial bursitis patients 4
- Steroid injections have been shown to be more effective than hypertonic dextrose prolotherapy in ameliorating pain and improving function in chronic subacromial bursitis patients 4
Considerations for Treatment
- The effectiveness of treatment for bursitis can depend on the duration of symptoms before treatment, with longer durations potentially leading to treatment failure 7
- Corticosteroid injections can provide short-term pain relief and improvement in function for various musculoskeletal conditions, including subacromial impingement syndrome and adhesive capsulitis 6