What is the initial treatment for shoulder bursitis?

From the FDA Drug Label

In the treatment of conditions such as tendinitis or tenosynovitis, care should be taken following application of a suitable antiseptic to the overlying skin to inject the suspension into the tendon sheath rather than into the substance of the tendon. 2. Bursitis. The area around the injection site is prepared in a sterile way and a wheal at the site made with 1 percent procaine hydrochloride solution A 20 to 24 gauge needle attached to a dry syringe is inserted into the bursa and the fluid aspirated. The needle is left in place and the aspirating syringe changed for a small syringe containing the desired dose. After injection, the needle is withdrawn and a small dressing applied.

The initial treatment for shoulder bursitis is an injection of methylprednisolone acetate into the bursa.

• The area around the injection site should be prepared in a sterile way.
• A wheal at the site should be made with 1 percent procaine hydrochloride solution.
• A 20 to 24 gauge needle attached to a dry syringe should be inserted into the bursa and the fluid aspirated.
• The needle should be left in place and the aspirating syringe changed for a small syringe containing the desired dose.
• After injection, the needle should be withdrawn and a small dressing applied 1.

From the Research

The initial treatment for shoulder bursitis should focus on conservative measures, including rest, ice application, and over-the-counter anti-inflammatory medications, as these address the underlying inflammation of the bursa and are supported by the most recent and highest quality study 2. The treatment approach for shoulder bursitis involves several key components:

• Resting the affected shoulder and avoiding activities that worsen pain, particularly overhead movements.
• Applying ice to the shoulder for 15-20 minutes every 2-3 hours during the first 48-72 hours to reduce inflammation and pain.
• Taking non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (400-800mg three times daily with food) or naproxen (220-500mg twice daily) to decrease inflammation and manage pain, as shown to be effective in studies like 3 and 4.
• After the acute phase, gentle stretching and range-of-motion exercises can help prevent stiffness.
• Physical therapy may be recommended to strengthen the rotator cuff muscles and improve shoulder mechanics. If symptoms persist despite these measures for 2-3 weeks, a medical evaluation is warranted, and corticosteroid injections might be considered, as supported by the study 2, which found that corticosteroid subdeltoid injection, or combined with physiotherapy, was superior to physiotherapy alone in treating chronic subacromial bursitis. Key points to consider in the treatment of shoulder bursitis include:
• The importance of early intervention with conservative measures to reduce inflammation and pain.
• The potential benefits of physical therapy in strengthening the rotator cuff muscles and improving shoulder mechanics.
• The role of corticosteroid injections in treating persistent symptoms, as evidenced by studies like 2 and 4.