From the Guidelines
Oral steroids are not recommended for the treatment of chronic complex prepatellar bursitis due to their potential negative effects and lack of proven benefit in reducing inflammation in similar conditions, as seen in the treatment of Guillain-Barré Syndrome 1. When considering treatment options for chronic complex prepatellar bursitis, it's essential to prioritize approaches that directly address the inflammation and underlying causes of the condition.
- Initial management should focus on conservative measures including rest, ice, compression, elevation (RICE), activity modification, and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen for 1-2 weeks.
- If these measures fail, a corticosteroid injection directly into the bursa may be more effective than oral steroids, as it delivers medication directly to the site of inflammation.
- Oral steroids would only be considered in severe cases where other treatments have failed and systemic inflammation is present, but their use is cautioned against due to significant side effects including fluid retention, elevated blood pressure, mood changes, and blood sugar abnormalities, as noted in the context of other inflammatory conditions 1.
- For chronic cases, addressing underlying causes such as repetitive kneeling or trauma is essential, and patients may benefit from wearing protective knee pads.
- If conservative treatment fails, surgical intervention (bursectomy) may be necessary, especially if infection is present or the condition is severely limiting function.
From the Research
Treatment Options for Chronic Complex Prepatellar Bursitis
- The use of oral steroids for chronic complex prepatellar bursitis is not explicitly mentioned in the provided studies as a primary treatment option 2, 3, 4, 5.
- However, the studies suggest that chronic, nonseptic bursitis can usually be treated with conservative therapy, and occasionally, aspiration or corticosteroid injection may be used 2, 3.
- In cases of non-septic bursitis, intrabursal steroid injection may be performed for patients with high athletic or occupational demands 3.
- Other treatment options for prepatellar bursitis include: + Aspiration and compression 2, 3 + Nonsteroidal anti-inflammatory agents (NSAIDs) 3, 5 + Physical therapy and activity modification 5 + Surgical treatment, such as incision, drainage, or bursectomy, which should be restricted to severe, refractory, or chronic/recurrent cases 2, 3, 4 + Endoscopic treatment, which has been shown to be effective in treating prepatellar bursitis with minimal complications 4 + Sclerotherapy, which has been reported as a novel treatment option for recurrent non-septic prepatellar bursitis 5