From the Guidelines
Treatment for adventitial bursal distention should begin with conservative measures, including open-backed shoes, orthoses, NSAIDs, decreased activity, stretching exercises, and weight loss (if indicated), as these methods have been shown to provide symptom relief without the need for more invasive procedures. When considering treatment options, it is essential to prioritize methods that reduce pressure on the affected area and promote healing.
- Initial treatment options may include:
- Open-backed shoes to reduce pressure on the area
- Orthoses or heel lifts to provide additional support
- NSAIDs to reduce inflammation and pain
- Decreased activity to allow the affected area to heal
- Stretching exercises to promote flexibility and reduce stiffness
- Weight loss (if indicated) to reduce pressure on the affected area According to 1, local injections of corticosteroids are not recommended, and immobilization may be considered in particularly acute or refractory cases. It is crucial to continue treatments until symptoms resolve, and if improvement occurs within six to eight weeks, treatments should be continued as indicated by 1. In cases where symptoms persist, it may be necessary to consider other diagnoses and refer the patient to a specialist for further evaluation and treatment. Proper footwear, ergonomic adjustments, and activity modification are essential components of both treatment and prevention of recurrence, and addressing the underlying cause of bursal distention is critical to preventing future episodes.
From the FDA Drug Label
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. 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 treatment for adventitial bursal distention may involve the use of 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.
From the Research
Treatment Options for Adventitial Bursal Distention
- Conservative management, including ice, rest, anti-inflammatory and analgesic drugs, and occasionally, bursal fluid aspiration, is often considered the first line of treatment 3
- In cases where conservative management is unsuccessful, surgical options such as marginal resection or open excisional procedures may be considered 4, 3
- Arthroscopy is also being considered as a suitable modality of management, offering a minimally invasive alternative to open excision 3
- Combined bursal aspiration and corticosteroid injection may be effective in reducing pain and improving symptoms in patients with rotator cuff tears and subacromial-subdeltoid bursitis 5
- Local corticosteroid injection may be used in the management of certain types of bursitis, such as prepatellar and olecranon bursitis, but its use in other types, like retrocalcaneal bursitis, may be contraindicated due to potential adverse effects on the Achilles tendon 6
Diagnostic Evaluation
- Ultrasonography and MRI can be used to identify bursal inflammation and its relation to underlying conditions, such as osteochondroma 4
- Imaging studies can help confirm the diagnosis of adventitial bursal distention and guide treatment decisions
Management of Related Conditions
- Rest, ice, compression, and elevation (RICE) therapy may be recommended for acute ankle sprains, but the evidence for its effectiveness is limited 7
- Treatment decisions for adventitial bursal distention and related conditions should be made on an individual basis, taking into account the specific diagnosis, symptoms, and patient needs 7