From the Guidelines
Treatment of prepatellar bursitis should prioritize conservative management with the RICE protocol, NSAIDs, and avoidance of aggravating activities, with invasive approaches considered only if conservative measures fail or if symptoms are severe. The management of prepatellar bursitis involves a multifaceted approach, focusing on reducing inflammation, relieving pain, and preventing further irritation. Initial steps include the RICE protocol: rest, ice application for 15-20 minutes several times daily, compression with an elastic bandage, and elevation of the affected leg 1. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen can be used for 1-2 weeks to help reduce pain and inflammation. It is crucial for patients to avoid kneeling and use knee padding during activities that put pressure on the anterior knee.
Conservative Management
- Rest from aggravating activities
- Ice application for 15-20 minutes several times daily
- Compression with an elastic bandage
- Elevation of the affected leg
- NSAIDs (e.g., ibuprofen 400-800mg three times daily or naproxen 250-500mg twice daily) for 1-2 weeks
Invasive Approaches
If conservative measures fail after 2-3 weeks or if symptoms are severe, aspiration of the bursa may be necessary, performed under sterile conditions with an 18-20 gauge needle. For infected bursitis, oral antibiotics covering Staphylococcus aureus are recommended. Severe or recurrent cases may require surgical intervention, including bursectomy. Although the provided study 1 focuses on gout management, its discussion on acute bursal inflammation due to gout can be applied to the management of prepatellar bursitis, emphasizing the importance of tailored treatment strategies based on the severity and duration of symptoms.
From the FDA Drug Label
For relief of the signs and symptoms of bursitis Naproxen tablets are also indicated: For relief of the signs and symptoms of bursitis Management of Pain, Primary Dysmenorrhea, and Acute Tendonitis and 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.
Treatment of prepatellar bursitis may include the use of naproxen. The recommended starting dose is 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, and thereafter, the total daily dose should not exceed 1000 mg of naproxen 2 2.
From the Research
Treatment Options for Prepatellar Bursitis
- Acute prepatellar bursitis can be treated with early aspiration, compression, and padding 3
- Chronic, nonseptic bursitis can usually be treated with conservative therapy, and occasionally, aspiration or corticosteroid injection 3
- Inflamed bursae should be aggressively evaluated and treated, with some cases requiring aspiration and decompression, and oral or intravenous antibiotics to prevent septicemia 3
Differentiation Between Septic and Non-Septic Bursitis
- The initial differentiation between septic and non-septic bursitis is based on clinical presentation, bursal aspirate, and blood sampling analysis 4
- Physical findings suggesting septic bursitis include fever, prebursal temperature difference, and skin lesions 4
- Relevant findings for bursal aspirate in septic bursitis include purulent aspirate, fluid-to-serum glucose ratio, white cell count, polymorphonuclear cells, positive Gram staining, and positive culture 4
General Treatment Measures
- General treatment measures for both septic and non-septic bursitis consist of bursal aspiration, NSAIDs, and PRICE 4
- For patients with confirmed non-septic bursitis and high athletic or occupational demands, intrabursal steroid injection may be performed 4
- In the case of septic bursitis, antibiotic therapy should be initiated 4
Surgical Treatment
- Surgical treatment, such as incision, drainage, or bursectomy, should be restricted to severe, refractory, or chronic/recurrent cases 3, 4
- The available evidence does not support the concept of immediate bursectomy in cases of septic bursitis, and a conservative treatment regimen should be pursued instead 4