What are the treatment options for bursitis (inflammation of the bursae)?

From the Guidelines

Bursitis treatment should initially focus on nonpharmacological approaches, such as physical therapy, heat/cold, and orthotics, as recommended by the American Heart Association 1. When considering pharmacological treatments, it's essential to prioritize safety and efficacy. The treatment options may include:

• Over-the-counter NSAIDs like ibuprofen or naproxen to manage pain and inflammation
• Acetaminophen as an alternative for those who cannot take NSAIDs
• Corticosteroid injections for more severe cases, providing rapid relief that can last several months
• Physical therapy exercises to strengthen surrounding muscles and improve joint flexibility Applying ice for 15-20 minutes several times daily during acute phases, then transitioning to heat therapy for chronic cases can provide comfort. If infection is suspected, antibiotics may be necessary. Most cases resolve within a few weeks with proper treatment, but severe or recurrent bursitis may require surgical intervention to remove the affected bursa. It's crucial to note that the American College of Foot and Ankle Surgeons recommends avoiding corticosteroid injections in the Achilles tendon 2, 3. The primary goal of treatment is to reduce inflammation, alleviate pain, and improve quality of life, with the most recent and highest quality study guiding the recommendation 1.

From the FDA Drug Label

Management of Pain, Primary Dysmenorrhea, and Acute Tendonitis and Bursitis Because the sodium salt of naproxen is more rapidly absorbed, naproxen sodium is recommended for the management of acute painful conditions when prompt onset of pain relief is desired. Naproxen may also be used 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: Naproxen may be used for the management of acute bursitis. The recommended starting dose 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, and thereafter, the total daily dose should not exceed 1000 mg of naproxen 4. Alternatively, triamcinolone injection can be used as adjunctive therapy for short-term administration in acute bursitis 5.

From the Research

Bursitis Treatment Options

• Conservative measures are often the first line of treatment, including rest, nonsteroidal anti-inflammatory drugs (NSAIDs), and stretching exercises 6, 7, 8, 9
• Ice, compression, and elevation (RICE) may also be used to reduce swelling and promote healing 10
• In some cases, corticosteroid injections may be used to reduce inflammation and relieve pain 6, 7, 9
• Surgical intervention may be necessary in cases of recalcitrant or septic bursitis, such as open excisional procedures or arthroscopy 7, 8

Specific Treatment Approaches

• For trochanteric bursitis, conservative therapy followed by corticosteroid injection if necessary is recommended 6
• For olecranon bursitis, conservative management including ice, rest, and anti-inflammatory drugs is often effective, with arthroscopy or open excisional procedures considered for unresponsive patients 8, 9
• For nonseptic olecranon bursitis, noninvasive management such as rest, ice, compression, and orthosis wear may be preferred over intrabursal injections or surgery 9

Additional Considerations

• The use of negative pressure therapy (RICE+) may be explored to stimulate lymphatic flow and reduce postoperative swelling 10
• The choice of treatment should be tailored to the individual patient and the specific type of bursitis, with consideration of the potential benefits and risks of each approach 6, 7, 8, 9