From the Guidelines
Bursal effusion is best diagnosed with MRI, which is highly sensitive and specific for detecting soft tissue abnormalities, including fluid accumulation in the bursa, and treatment should prioritize conservative management with rest, ice, and anti-inflammatory medications, with consideration of aspiration or corticosteroid injections if symptoms persist 1.
Diagnosis
To diagnose bursal effusion, imaging studies are crucial. The following options are available:
- MRI: Highly sensitive and specific for detecting soft tissue abnormalities, including fluid accumulation in the bursa 1.
- Ultrasound (US): Can be used to localize fluid collections and evaluate snapping hip syndrome, but is less sensitive than MRI for detecting labral tears 1.
- CT: Less sensitive for soft tissue evaluation and not recommended as a first-line imaging technique 1.
Treatment
Treatment for bursal effusion should focus on reducing inflammation and relieving symptoms. The following steps can be taken:
- Conservative management: Rest, ice, and anti-inflammatory medications, such as NSAIDs (e.g., ibuprofen 400-600 mg every 6-8 hours or naproxen 220-440 mg every 12 hours), should be the initial treatment approach.
- Aspiration: If symptoms persist, aspiration of the fluid may be necessary to relieve pressure and reduce inflammation 1.
- Corticosteroid injections: May be considered for more severe cases or if symptoms persist after aspiration 1.
- Physical therapy: Can be recommended to improve range of motion and strengthen surrounding muscles.
- Surgical intervention: May be considered for chronic or recurrent cases that do not respond to conservative management.
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 diagnosis of bursal effusion is not directly addressed in the label. For the treatment of bursitis, naproxen may be used, 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
Diagnosis of Bursal Effusion
- Bursal effusion, also known as fluid accumulation in the bursa, can be diagnosed through a combination of physical examination, medical history, and imaging studies 3
- Imaging studies such as ultrasonography can be used to evaluate the presence of effusion in the subacromial-subdeltoid bursa and other pathological conditions 3
- The diagnosis of bursal effusion can be confirmed by the presence of fluid accumulation in the bursa, which can be visualized through imaging studies or aspirated for analysis 4
Treatment of Bursal Effusion
- The initial treatment of bursal effusion should be nonoperative, combining scapular strengthening, postural reeducation, and core strength endurance 5
- Local modalities, nonsteroidal anti-inflammatory drugs, and localized injections may also be helpful in managing bursal effusion 5
- In cases where nonoperative management is unsuccessful, surgical treatment options such as partial scapulectomy or resection of the superomedial angle of the scapula, open bursal resection, and arthroscopic bursectomy may be considered 5
- Empiric antibiotic therapy without bursal aspiration may be a reasonable initial approach to managing suspected septic olecranon bursitis in select patients 4
- Ultrasound-guided barbotage may be an effective treatment option for calcific bursitis, as seen in the case of Gruberi bursitis 6