From the Guidelines
Bursitis treatment should initially focus on nonpharmacological approaches, including physical therapy, heat/cold, and orthotics, with pharmacological treatments considered if symptoms persist, prioritizing the least risky medication first, such as acetaminophen or aspirin, before escalating to NSAIDs like ibuprofen or naproxen, and potentially corticosteroid injections for more severe cases 1.
Initial Treatment Approaches
- Nonpharmacological methods: physical therapy, heat/cold therapy, orthotics
- Pharmacological treatments: acetaminophen, aspirin, NSAIDs (ibuprofen, naproxen)
Considerations for Treatment
- Safety and efficacy of medications should be considered, with the least risky option tried first
- Potential toxicity, including tendon rupture, must be considered with corticosteroid injections 1
- For septic bursitis, antibiotics are necessary, often starting with oral options like cephalexin, but potentially requiring intravenous antibiotics for severe cases
Additional Treatment Options
- Corticosteroid injections may be considered for local site of musculoskeletal inflammation, with evidence supporting their use in sacroiliitis and potential benefit in enthesitis 1
- Aspiration of the bursa fluid may be performed to relieve pressure and obtain samples for diagnosis
Key Principles
- Reduce inflammation in the fluid-filled sacs (bursae) to allow the affected area to heal and restore normal function
- Prioritize treatments that minimize risk while effectively managing symptoms, considering the potential for abuse with narcotic medications 1
From the FDA Drug Label
For relief of the signs and symptoms of tendonitis For relief of the signs and symptoms of bursitis The recommended starting dose of naproxen is 500 mg, followed by 500 mg every 12 hours or 250 mg every 6 to 8 hours as required. The initial total daily dose should not exceed 1250 mg of naproxen. Thereafter, the total daily dose should not exceed 1000 mg of naproxen.
Bursitis treatment with naproxen involves taking a starting dose of 500 mg, followed by 500 mg every 12 hours or 250 mg every 6 to 8 hours as needed. The total daily dose should not exceed 1250 mg initially and 1000 mg thereafter.
- Key considerations:
- Dose adjustment: may be necessary based on patient response and adverse events
- Maximum daily dose: should not exceed 1000 mg after the initial period
- Formulation: naproxen sodium may be preferred for acute painful conditions due to its faster absorption 2
- Concomitant use: with other medications, such as gold salts or corticosteroids, may be safe, but the combination with salicylates is not recommended 2
From the Research
Bursitis Treatment Options
- The first line of treatment for bursitis is conservative, including:
- Ice
- Rest
- Anti-inflammatory drugs
- Analgesic drugs
- Occasional bursal fluid aspiration 3
- For patients who do not respond to conservative treatment, other options are available:
- Open excisional procedures to completely remove the pathological bursal tissue
- Arthroscopy, a minimally invasive procedure that is increasingly being considered as a suitable management modality 3