What is the treatment for bursitis?

From the Guidelines

Treatment for bursitis should initially focus on nonpharmacological approaches, such as physical therapy, heat/cold, and orthotics, before considering pharmacological treatments like nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroid injections. When pharmacological treatments are necessary, the least risky medication should be tried first, with escalation only if the first medication is ineffective, as suggested by 1.

Nonpharmacological Approaches

• Physical therapy to strengthen surrounding muscles and improve flexibility
• Heat or cold therapy to reduce inflammation and pain
• Orthotics to reduce pressure on the affected area

Pharmacological Treatments

• Over-the-counter NSAIDs such as ibuprofen or naproxen to manage pain and reduce inflammation
• Corticosteroid injections directly into the bursa for significant anti-inflammatory relief in more severe cases, as mentioned in 1

Additional Considerations

• Aspiration of fluid from the bursa for diagnostic purposes or to relieve pressure
• Antibiotics such as cephalexin or clindamycin for cases of septic bursitis
• Lifestyle modifications, ergonomic adjustments, or surgical removal of the affected bursa (bursectomy) for chronic or recurrent bursitis, with the latter being a rare consideration. The most recent and highest quality study 1 prioritizes nonpharmacological approaches and cautious use of medications, guiding the treatment strategy for bursitis.

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. 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. The initial total daily dose should not exceed 1250 mg of naproxen. Thereafter, the total daily dose should not exceed 1000 mg of naproxen. For relief of the signs and symptoms of bursitis

The treatment for bursitis is 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. Naproxen is indicated for the relief of the signs and symptoms of bursitis 2.

From the Research

Bursitis Treatment Options

• Conservative measures are often the first line of treatment for bursitis, including rest, nonsteroidal anti-inflammatory drugs (NSAIDs), and stretching exercises 3, 4, 5, 6
• Ice, activity modification, and NSAIDs are commonly used to manage bursitis symptoms 4, 5, 6
• Local corticosteroid injection may be used to manage prepatellar and olecranon bursitis, but its use in retrocalcaneal bursitis may be adverse 4
• Surgical intervention may be required for recalcitrant bursitis, such as refractory trochanteric bursitis 3, 4, 5

Non-Surgical Management

• Conservative therapy includes rest, NSAIDs, and stretching exercises focused on the affected area 3
• NSAIDs have anti-inflammatory, analgesic, antipyretic, and antithrombotic effects, but their use should be cautious and situation-specific 7
• Simple analgesia, such as paracetamol, may be preferred over NSAIDs for musculoskeletal injury, due to the higher risk profile of NSAIDs 7

Surgical Intervention

• Open excisional procedures or arthroscopy may be considered for unresponsive patients with olecranon bursitis 5
• Surgical bursectomy may be an option for refractory trochanteric bursitis 3
• However, recent literature suggests that non-invasive management may be preferred for initial treatment of non-septic olecranon bursitis 6