From the Guidelines
Treatment for bursitis should prioritize a combination of rest, medication, and physical therapy, with corticosteroid injections considered for persistent cases, as recommended by the most recent guidelines 1. The initial approach to treating bursitis involves resting the affected joint and avoiding activities that worsen pain. Applying ice to the area for 15-20 minutes several times daily for the first 48 hours can help reduce inflammation. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can help manage pain and inflammation. Some key considerations for treatment include:
- Providing patient education and lifestyle recommendations
- Considering physiotherapy and addressing any underlying issues that may be contributing to the bursitis
- Using short courses of oral prednisolone or intra-articular glucocorticoid injections as bridging options, while avoiding the long-term use of glucocorticoids 1. It's also important to note that bursitis can occur due to repetitive motion, injury, or underlying conditions like rheumatoid arthritis, so addressing the underlying cause is essential for preventing recurrence. In severe or recurrent cases that don't respond to conservative treatment, aspiration of fluid from the bursa or surgical removal (bursectomy) might be necessary, as suggested by earlier guidelines 1. However, the most recent recommendations should be prioritized when making treatment decisions.
From the FDA Drug Label
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 initial total daily dose should not exceed 1250 mg of naproxen. Thereafter, the total daily dose should not exceed 1000 mg of naproxen.
Treatment for bursitis with naproxen involves a starting dose of 500 mg, followed by 500 mg every 12 hours or 250 mg every 6 to 8 hours as needed. The maximum initial daily dose is 1250 mg, and subsequent daily doses should not exceed 1000 mg 2. Key points to consider:
- Dose adjustment: may be necessary based on patient response and adverse events
- Maximum daily dose: should not exceed 1000 mg after the initial dose
- Formulation: naproxen sodium may be preferred for acute painful conditions due to its rapid absorption 2
From the Research
Treatment Options for Bursitis
- Nonsurgical management is often the first line of treatment, including ice, activity modification, and nonsteroidal anti-inflammatory drugs 3, 4
- Corticosteroid injection may be used in the management of prepatellar and olecranon bursitis, but its use in retrocalcaneal bursitis is not recommended due to potential adverse effects on the Achilles tendon 3
- Aspiration of bursal fluid may be performed, especially in cases of septic bursitis, and can be guided by ultrasonography 4, 5
- Antibiotics may be administered in cases of septic bursitis, with Staphylococcus aureus being the most common causative organism 5
Surgical Intervention
- Surgical intervention may be required for recalcitrant bursitis, such as refractory trochanteric bursitis 3
- Surgical management options include bursectomy, longitudinal release of the iliotibial band, proximal or distal Z-plasty, osteotomy, and repair of gluteus medius tears 6
- However, surgical management has been shown to have higher rates of overall complications, persistent drainage, and bursal infection compared to nonsurgical management 7
Specific Types of Bursitis
- Olecranon bursitis: nonsurgical management is often effective, but arthroscopy may be considered as a minimally invasive procedure for unresponsive patients 4, 7
- Trochanteric bursitis: traditional nonoperative treatment is often effective, but low-energy shock-wave therapy (SWT) may be a good alternative, and surgery may be effective in refractory cases 6
- Septic bursitis: management varies across centers, and controlled trials are needed to establish standardized recommendations regarding antibiotic treatment protocols and the indications of surgery 5