Symptomatic Management for Right Wrist Bursitis
Initial treatment should focus on conservative measures including rest, ice application, activity modification, and NSAIDs, with acetaminophen as an alternative first-line option for patients with cardiovascular risk factors. 1
Initial Conservative Management
Begin with non-pharmacological interventions as the foundation of treatment:
- Activity modification and relative rest to reduce repetitive loading and mechanical stress on the affected bursa 2, 3
- Cryotherapy using melting ice water through a wet towel for 10-minute periods to reduce inflammation and provide acute pain relief 4
- Elevation and compression when applicable to minimize swelling 5
- Avoid prolonged positioning of the wrist at end ranges, as this exacerbates symptoms 2
Pharmacological Management
For patients without cardiovascular disease or risk factors:
- NSAIDs are the primary pharmacological treatment for bursitis, effective at reducing both pain and inflammation 6, 3
- Naproxen can be initiated at 500 mg twice daily for acute bursitis, with the initial total daily dose not exceeding 1250 mg 7
- For acute tendonitis and bursitis specifically, naproxen sodium is recommended for more rapid absorption when prompt pain relief is desired 7
- Prescribe at the lowest effective dose for the shortest duration with periodic reassessment 1, 8
For patients with known cardiovascular disease or risk factors:
- Acetaminophen up to 4g/day should be the first-line oral analgesic due to its superior safety profile 1, 8
- If acetaminophen is insufficient, consider topical NSAIDs which have equivalent efficacy to oral NSAIDs without gastrointestinal or cardiovascular risks 8
- Only progress to oral NSAIDs if topical agents and acetaminophen fail, using the lowest dose required and considering adding aspirin 81 mg with a proton-pump inhibitor for gastroprotection 1
Important Caveats
Avoid corticosteroid injections in wrist bursitis. While intrabursal corticosteroid injections are sometimes used for bursitis in other locations, high-quality evidence demonstrating benefit for microtraumatic bursitis is unavailable, and there is risk of iatrogenic septic bursitis 3. Additionally, steroid injection near tendons may adversely affect their biomechanical properties 6.
Rule out septic bursitis before initiating treatment. If there is fever, erythema, warmth, or other signs of infection, bursal aspiration should be performed immediately with fluid analysis including Gram stain, culture, cell count, and crystal analysis 4, 3. Septic bursitis requires antibiotics effective against Staphylococcus aureus rather than conservative management 3.
Rehabilitation and Recovery
- Structured rehabilitation should be implemented once acute inflammation subsides, focusing on range-of-motion and strengthening exercises 8, 5
- Joint protection education to avoid adverse mechanical factors during daily activities 8
- Most patients with non-septic bursitis respond to conservative management within several weeks 6, 3
When Conservative Management Fails
If symptoms persist despite 3-6 months of appropriate conservative treatment, consider advanced imaging (MRI without contrast) to evaluate for alternative diagnoses or complications, and surgical consultation may be warranted 2, 4.