Can bursitis be drained?

Can Bursitis Be Drained?

Yes, bursitis can and should be drained when it is septic (infected), severe, or unresponsive to initial conservative treatment, but drainage is generally not recommended for chronic non-septic bursitis due to the risk of introducing infection. 1

Septic Bursitis: Drainage is Essential

For septic bursitis, drainage is a cornerstone of treatment alongside antibiotics. 1 The Infectious Diseases Society of America specifically recommends drainage for septic bursitis that is severe or fails to respond to initial aspiration and antibiotics. 1

Key indicators that drainage is needed:

• Positive signs of infection: warmth, erythema, fluctuance, fever, or systemic symptoms 2
• Failure to improve with initial aspiration and antibiotics 1
• Severe presentation with surrounding cellulitis or systemic inflammatory response 1

Methods of drainage for septic bursitis:

• Simple aspiration is the first-line approach for most cases 3, 2
• Percutaneous suction-irrigation systems are highly effective for severe cases, with studies showing no complications or recurrences when combined with antibiotics 4
• Incision and drainage is rarely needed but may be indicated for refractory cases that don't respond to aspiration and antibiotics 3, 5

Critical pitfall: Delaying drainage in severe septic cases can lead to extensive tissue damage, making prompt intervention essential. 1

Acute Traumatic/Hemorrhagic Bursitis: Aspiration May Help

For acute bursitis following trauma with significant swelling, aspiration may shorten the duration of symptoms, though conservative treatment with ice, compression, and padding is often sufficient. 3, 2

Chronic Non-Septic Bursitis: Avoid Routine Drainage

Bursal aspiration of chronic microtraumatic bursitis is generally NOT recommended because of the significant risk of introducing iatrogenic septic bursitis. 2 This is a critical distinction—draining non-infected chronic bursitis can convert a benign condition into a serious infection.

Conservative management is preferred:

• Activity modification and addressing underlying causes 2, 6
• Ice, compression, elevation, and NSAIDs 5, 6
• Relative rest and structured rehabilitation 6

Corticosteroid injections are sometimes used for chronic inflammatory bursitis (such as from gout or rheumatoid arthritis), but high-quality evidence for benefit in microtraumatic bursitis is lacking. 2

Diagnostic Approach Before Drainage

If infection is suspected, bursal aspiration should be performed with fluid analysis including: 2

• Gram stain and culture
• White blood cell count
• Crystal analysis
• Glucose measurement

Ultrasonography can help distinguish bursitis from cellulitis and guide aspiration. 2

Treatment Algorithm

1. Assess for septic bursitis: Look for warmth, erythema, fever, systemic symptoms 2
2. If septic: Aspirate for diagnosis and drainage, start antibiotics effective against Staphylococcus aureus, consider hospitalization if acutely ill 2
3. If severe or unresponsive: Use percutaneous suction-irrigation or consider incision and drainage 1, 4
4. If chronic non-septic: Treat conservatively, avoid aspiration to prevent iatrogenic infection 2
5. If acute traumatic: Consider aspiration to shorten symptoms, but conservative treatment is often adequate 2