What is the treatment for bursitis (bursitis tx)?

Treatment of Bursitis

The first-line treatment for bursitis includes rest, ice, NSAIDs (such as naproxen 500 mg every 12 hours), and activity modification to reduce pressure on the affected area. 1

Types and Diagnosis

Bursitis is inflammation of the fluid-filled sacs (bursae) that cushion joints. Common locations include:

• Olecranon (elbow)
• Prepatellar (knee)
• Trochanteric (hip)
• Retrocalcaneal (heel)

Causes include:

• Chronic microtrauma (most common)
• Acute trauma/hemorrhage
• Inflammatory disorders (gout, rheumatoid arthritis)
• Infection (septic bursitis)

Treatment Algorithm

Step 1: Conservative Management (1-2 weeks)

• RICE protocol:
  • Rest the affected area
  • Ice application (20 minutes several times daily)
  • Compression with elastic bandage
  • Elevation when possible
• NSAIDs: Naproxen 500 mg twice daily 2
• Activity modification: Avoid pressure on affected area

Step 2: If No Improvement After 2 Weeks

• Aspiration may be considered for:
  • Significant fluid collection
  • Pain relief
  • Diagnostic purposes if infection suspected 3
• Important: Always send aspirate for culture if infection is suspected 1

Step 3: For Persistent Symptoms

• Corticosteroid injections may be considered but should be used cautiously as they are associated with complications including skin atrophy and increased risk of infection 1
• Physical therapy for stretching and strengthening exercises

Step 4: Refractory Cases

• Surgical intervention should be reserved only for cases that fail conservative management 1, 4
• Options include bursectomy (open or arthroscopic)

Special Considerations

Septic Bursitis

• Requires immediate aspiration and culture
• Empiric antibiotics effective against Staphylococcus aureus
• May require repeated aspirations
• Some cases need hospitalization and surgical intervention 3

Inflammatory Bursitis

• Treat underlying condition (gout, rheumatoid arthritis)
• Intrabursal corticosteroid injections may be beneficial 3

Prevention

• Address underlying mechanical factors
• Use protective padding over susceptible areas
• Correct biomechanical abnormalities
• Modify activities that cause repetitive trauma 1

Prognosis

• 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

Cautions

• Corticosteroid injections should be used judiciously due to risk of complications 1
• Avoid aspiration of non-septic bursitis unless necessary, as it can introduce infection 3
• NSAIDs should be used at the lowest effective dose, especially in elderly patients or those with renal/hepatic impairment 2

The CDC guidelines emphasize that nonopioid therapies are at least as effective as opioids for many common pain conditions, including bursitis, and should be maximized before considering opioid therapy 5.