From the Guidelines
Treatment for bursitis should initially focus on nonpharmacological approaches, including physical therapy, heat/cold, and orthotics, with pharmacological treatments considered only if symptoms are not controlled. According to 1, initial treatment should categorize musculoskeletal symptoms and focus on nonpharmacological approaches.
When considering pharmacological treatments, the choice of medication should prioritize both safety and efficacy, starting with the least risky option, such as acetaminophen or aspirin at the lowest efficacious dose, especially for short-term needs. For more severe cases, over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can help manage pain and reduce inflammation.
Key considerations in treating bursitis include:
- Rest, ice, compression, and elevation (RICE) of the affected area to reduce inflammation and pain
- Use of NSAIDs for pain and inflammation management
- Corticosteroid injections for more severe cases
- Physical therapy to strengthen surrounding muscles and improve range of motion
- Antibiotics for septic bursitis, with options like cephalexin or clindamycin
- Surgical removal of the bursa (bursectomy) for chronic or recurrent cases not responding to conservative treatment
Preventive measures are also crucial and include using proper protective equipment, taking regular breaks during repetitive tasks, maintaining good posture, and strengthening exercises for the muscles around vulnerable joints. While 1 discusses specific treatment options for heel pain, including orthoses, accommodative padding, and NSAID therapy, the general approach to treating bursitis, as outlined in 1, prioritizes nonpharmacological methods and cautious use of medications, guiding the most appropriate treatment strategy.
From the Research
Treatment Options for Bursitis
- Conservative measures are often the first line of treatment, including rest, nonsteroidal anti-inflammatory drugs (NSAIDs), and stretching exercises 2, 3
- Corticosteroid injections may be used to treat bursitis, particularly for trochanteric bursitis 2 and prepatellar and olecranon bursitis 4
- Surgical intervention may be required for recalcitrant bursitis, such as refractory trochanteric bursitis 2, 4
- For septic bursitis, antibiotic therapy is essential, and the optimal duration of treatment is not defined 5, 6
- Surgical management, including endoscopic bursectomy, may be necessary for septic bursitis 5, 6
Management of Specific Types of Bursitis
- Trochanteric bursitis: conservative measures, followed by corticosteroid injection if necessary, and surgical procedures such as iliotibial band release, subgluteal bursectomy, and trochanteric reduction osteotomy in rare cases 2
- Prepatellar and olecranon bursitis: local corticosteroid injection may be used, but steroid injection into the retrocalcaneal bursa may adversely affect the biomechanical properties of the Achilles tendon 4
- Septic bursitis: antibiotic therapy, with or without surgical management, and a treatment duration of at least 14 days 6
General Principles of Treatment
- A systematic approach to evaluation and treatment, including prevention, relative rest, ice, compression, elevation, anti-inflammatory medication, and treatment modalities such as ultrasound and electrical stimulation, combined with a structured rehabilitation program, can facilitate the healing process 3
- Early recognition and prompt initiation of appropriate antibiotic therapy are crucial for septic bursitis 5, 6