What steroid is recommended for treating bursitis?

Recommended Steroid for Bursitis Treatment

Triamcinolone hexacetonide is strongly recommended for intra-articular or bursal injections in bursitis due to its superior efficacy and longer duration of action compared to other corticosteroid preparations. 1

Corticosteroid Options for Bursitis

First-Line Injectable Corticosteroid:

• Triamcinolone hexacetonide: Strongly recommended based on high-quality evidence showing more complete and longer duration of clinical response without increased adverse effects 1
• Triamcinolone acetonide: Alternative when hexacetonide is unavailable; FDA-approved for acute and subacute bursitis 2

Dosing Guidelines:

• Typical dose: 20-40 mg for larger joints/bursae
• For smaller bursae: 10-20 mg
• Mixture with 1% lidocaine is common practice 3, 4

Treatment Algorithm for Bursitis

1. Initial Management:

   • NSAIDs as first-line medication for pain and inflammation 1, 5
   • Rest and activity modification of the affected area
   • Physical therapy with appropriate exercises

2. For Persistent Symptoms (after 2-4 weeks of conservative treatment):

   • Corticosteroid injection into the affected bursa
   • Limit to 2-3 injections with 4-6 weeks between injections 5

3. Injection Technique:

   • Ultrasound guidance improves accuracy and outcomes 4, 6
   • Aseptic technique is essential
   • Approach depends on specific bursa location

Evidence for Specific Bursitis Types

Trochanteric Bursitis:

• One or two local corticosteroid injections provide excellent response in approximately two-thirds of patients 7
• Betamethasone (24 mg) with 1% lidocaine has shown efficacy 3

Subacromial Bursitis:

• Triamcinolone (20 mg) under ultrasound guidance demonstrated superior efficacy compared to hyaluronic acid and normal saline 6
• Significant improvement in pain scores and shoulder function at 8 weeks

Scapulothoracic Bursitis:

• Steroid injections (often combined with hyaluronate) provide significant pain relief 8
• Mean VAS pain scores decreased from 7.8 to 2.2 at 3-month follow-up

Important Considerations

• Duration of Effect: Approximately 60-75% of patients experience significant relief after corticosteroid injection, with effects typically lasting 3-6 months 6, 7

• Contraindications:

  • Local or systemic infection
  • Uncontrolled diabetes (may cause transient hyperglycemia)
  • Significant skin pathology at injection site

• Potential Adverse Effects:

  • Local skin atrophy or depigmentation
  • Temporary pain flare ("steroid flare")
  • Tendon weakening with repeated injections near tendons
  • Systemic effects are minimal with local injections

• Pitfalls to Avoid:

  1. Injecting directly into tendons (risk of rupture)
  2. Multiple repeated injections in the same site (tissue atrophy)
  3. Failing to address underlying biomechanical issues
  4. Missing infection as the underlying cause of bursitis

For chronic or recurrent bursitis that fails to respond to conservative measures and corticosteroid injections, consider referral for surgical intervention such as bursectomy 3.