From the Guidelines
Yes, subacromial bursitis can often be treated without drainage. The primary goal of treatment is to reduce inflammation and pain, and this can typically be achieved through conservative management. Initial treatment may include rest, ice application, and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen for 1-2 weeks to reduce inflammation and pain. According to the study 1, subacromial corticosteroid injections can be used in patients when pain is thought to be related to injury or inflammation of the subacromial region (rotator cuff or bursa) in the hemiplegic shoulder, which can be applied to the general treatment of subacromial bursitis. Some key points to consider in the treatment of subacromial bursitis without drainage include:
- Gentle stretching and mobilization techniques to increase range of motion, as suggested by the study 1
- Use of analgesics such as acetaminophen or ibuprofen for pain relief, as mentioned in the study 1
- Consideration of subacromial corticosteroid injections for persistent cases, as recommended by the study 1
- Physical therapy focusing on gentle stretching and strengthening exercises for the rotator cuff muscles, usually 2-3 sessions weekly for 4-6 weeks. Drainage (aspiration) is typically reserved for cases with significant fluid accumulation causing severe pain or limited range of motion, or when infection is suspected. Most cases of subacromial bursitis resolve with conservative management because these treatments effectively reduce the inflammation in the bursa.
From the Research
Treatment Options for Subacromial Bursitis
- Subacromial bursitis can be treated with various methods, including corticosteroid injections, physiotherapy, and hyaluronic acid injections 2, 3.
- A study comparing corticosteroid injection, physiotherapy, and combined treatment for patients with chronic subacromial bursitis found that corticosteroid injection and combined treatment were superior to physiotherapy alone in terms of pain reduction and functional improvement 2.
- Another study found that ultrasound-guided corticosteroid injection into the subacromial-subdeltoid bursa was effective and superior to hyaluronic acid and normal saline injection for treating chronic subacromial bursitis 3.
Drainage and Aspiration
- While some studies suggest that aspiration and drainage may be necessary in certain cases of bursitis, such as infected or inflamed bursae, there is limited evidence to support the use of drainage as a primary treatment for subacromial bursitis 4.
- A study on olecranon and prepatellar bursitis found that incision and drainage was rarely needed, but may be indicated for injuries that do not respond to other treatments 4.
Alternative Treatments
- Rilonacept, an interleukin-1 trap, has been investigated as an alternative to corticosteroid injection for the management of subacromial bursitis, but was found to be less efficacious than triamcinolone acetonide injection 5.
- Ultrasound-guided corticosteroid injection into the subacromial-subdeltoid bursa is a common treatment approach, and has been found to be virtually painless and effective when performed by an experienced physician 6.