Bursitis Treatment
Initial treatment for bursitis should include rest, ice application, NSAIDs (e.g., naproxen 500 mg twice daily), and activity modification to reduce pressure on the affected area, as these conservative measures are effective for most cases of non-septic bursitis. 1
Types of Bursitis and Initial Assessment
Bursitis can be classified as:
- Septic (infectious): Presents with significant erythema, warmth, pain, and systemic symptoms
- Non-septic: Usually from trauma or inflammation, with less severe symptoms and history of repetitive pressure
Key Diagnostic Considerations
- Determine if septic vs. non-septic based on clinical presentation
- Check for erythema, warmth, fluctuance, and systemic symptoms
- Consider aspiration if infection is suspected (always send for culture)
- Plain radiographs may be needed to rule out fractures or other bony abnormalities
Treatment Algorithm
1. Conservative Management (First-Line)
RICE Protocol: Rest, Ice, Compression, Elevation
- Ice application for 10-minute periods through a wet towel 1
- Rest and avoid pressure on the affected area
- Compression with elastic bandage if appropriate
- Elevation of the affected limb when possible
NSAIDs: Naproxen 500 mg twice daily (not exceeding 1250 mg initially, then 1000 mg daily) 1, 2
- Duration: 1-2 weeks for acute symptoms
- Adjust dose for elderly patients or those with renal/hepatic impairment 2
Activity Modification: Avoid activities that put pressure on the affected bursa 1
2. For Non-Responsive Cases (Second-Line)
Aspiration: Consider for persistent swelling in non-septic cases 1
- Always send aspirate for culture if infection is suspected
Corticosteroid Injections: Use with caution
- May be considered if conservative treatment fails
- Associated with increased complications including skin atrophy, infection, and chronic local pain 1
- Should be used as a short-term bridging option only
3. For Septic Bursitis
- Aspiration and Culture: Required for diagnosis and treatment 1
- Antibiotics: Target Staphylococcus aureus (most common pathogen) 3
- Possible Hospitalization: For acutely ill patients requiring IV antibiotics 3
- Repeated Aspirations: May be necessary to drain purulent material
4. For Refractory Cases
- Surgical Management: Reserved for cases that fail conservative treatment 1
- Options include bursectomy or other procedures specific to the location
- Surgical intervention carries higher risks of complications including persistent drainage and infection
Special Considerations for Common Types of Bursitis
Olecranon Bursitis (Elbow)
- Typically responds well to conservative measures
- Padding to prevent further trauma
- Consider aspiration for significant swelling
Prepatellar Bursitis (Knee)
- Activity modification to avoid kneeling
- Knee padding if continued kneeling is necessary
- Conservative treatment usually effective
Trochanteric Bursitis (Hip)
- Stretching exercises focused on lower back and sacroiliac joints 4
- NSAIDs and rest are first-line treatments
Prevention Strategies
- Strengthening exercises for supporting muscles around susceptible joints
- Activity modification to avoid repetitive pressure
- Address biomechanical factors (e.g., altered gait, leg length discrepancy) 1
- Padding for vulnerable areas during activities
Expected Outcomes
- Non-septic bursitis typically resolves within 2-3 weeks with conservative treatment
- Septic bursitis recovery can take months
- Recurrence is common if causative factors are not addressed 1
Remember that conservative management is significantly more effective and safer than surgical management for most cases of bursitis 1. Only consider more invasive treatments when conservative measures fail.