From the Guidelines
Treatment for mild adventitial bursitis of the patellar tendon should begin with conservative measures, prioritizing rest, ice, and non-steroidal anti-inflammatory drugs (NSAIDs) to manage pain and inflammation, as recommended by the American Family Physician in 2005 1. The initial approach should focus on reducing inflammation and alleviating pain.
- Rest the affected knee and avoid activities that worsen pain for 1-2 weeks.
- Apply ice to the area for 15-20 minutes every 2-3 hours during the acute phase to reduce inflammation, as cryotherapy is effective for short-term pain relief 1.
- Take non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen 400-600mg three times daily with food or naproxen 220-440mg twice daily for 7-10 days to manage pain and inflammation, as NSAIDs effectively relieve tendinopathy pain and may offer additional benefit in acute inflammatory tendonitis 1. Gentle stretching and strengthening exercises for the quadriceps and hamstrings can begin once acute pain subsides, with eccentric exercise recommended to reduce symptoms, increase strength, and promote tendon healing 1. Physical therapy may be beneficial, focusing on proper knee mechanics and gradual return to activities, and compression with an elastic bandage or patellar strap can provide support during recovery. If symptoms persist beyond 4-6 weeks despite these measures, consider seeking further medical evaluation for possible corticosteroid injection or other interventions, as most patients with overuse tendinopathies fully recover within three to six months with outpatient treatment consisting of relative rest, icing, and eccentric strengthening exercises 1.
From the Research
Treatment Options for Adventitial Bursitis
The treatment for adventitial bursitis, as seen in the right knee MRI, can be managed through various methods.
- Nonsurgical management, including ice, activity modification, and nonsteroidal anti-inflammatory drugs, is often effective 2.
- Local corticosteroid injection may be used in the management of bursitis; however, the use of steroid injection should be considered carefully, as it may adversely affect the biomechanical properties of surrounding tissues 2.
- In some cases, surgical intervention may be required, such as marginal resection, to achieve optimal outcomes 3.
- Conservative treatment, including aspiration of fluid from the bursa, rest, ice, immobilization, and injection of a corticosteroid and analgesic combination, can also be effective 4.
- Physical therapy modalities can be applied as an alternative to corticosteroid injections, with both treatments resulting in significant improvements in pain and functionality 5.
Considerations for Treatment
When considering treatment options, it is essential to distinguish adventitial bursitis from other conditions, such as arthritis, fracture, tendinitis, and nerve pathology 2.
- A thorough diagnostic assessment, including imaging studies such as MRI, can help confirm the diagnosis and guide treatment decisions 3, 6.
- The location and severity of the bursitis, as well as the patient's overall health and medical history, should be taken into account when selecting a treatment approach.