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{{Bursitis}}
{{Bursitis}}
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==Overview==
==Overview==
Medical therapy for traumatic bursitis includes the RICE regimen (rest, ice, compression, elevation), [[anti-inflammatory]] agents such as [[Aspirin]], [[Naproxen]], or [[Ibuprofen]], [[ultrasound]] therapy, and/or [[corticosteroid]] injections. Restriction of activity is encouraged to prevent further injury and promote healing.  Antimicrobial therapy is administered for infectious bursitis.
Medical therapy for non-septic bursitis depends on the involved [[bursa]] and includes the [[RICE]] regimen (rest, ice, compression, elevation), [[NSAIDs]], and/or [[corticosteroid]] injections. Restriction of activity is encouraged to prevent further injury and promote healing.  [[Antimicrobials]] are the mainstay of therapy for septic bursitis. Surgical management is often reserved for non-responders.<ref name="pmid26577126">{{cite journal| author=Reilly D, Kamineni S| title=Olecranon bursitis. | journal=J Shoulder Elbow Surg | year= 2016 | volume= 25 | issue= 1 | pages= 158-67 | pmid=26577126 | doi=10.1016/j.jse.2015.08.032 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26577126  }} </ref><ref name="pmid7667644">{{cite journal| author=Zimmermann B, Mikolich DJ, Ho G| title=Septic bursitis. | journal=Semin Arthritis Rheum | year= 1995 | volume= 24 | issue= 6 | pages= 391-410 | pmid=7667644 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7667644  }} </ref><ref name="pmid21628647">{{cite journal| author=Aaron DL, Patel A, Kayiaros S, Calfee R| title=Four common types of bursitis: diagnosis and management. | journal=J Am Acad Orthop Surg | year= 2011 | volume= 19 | issue= 6 | pages= 359-67 | pmid=21628647 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21628647  }} </ref>


==Medical Therapy==
==Medical Therapy==
Medical therapy for non-septic bursitis depends on the involved [[bursa]] and includes the [[RICE]] regimen (rest, ice, compression, elevation), [[NSAIDs]], and/or [[corticosteroid]] injections. Restriction of activity is encouraged to prevent further injury and promote healing.  [[Antimicrobials]] are the mainstay of therapy for septic bursitis. Surgical management is often reserved for non-responders.<ref name="pmid26577126">{{cite journal| author=Reilly D, Kamineni S| title=Olecranon bursitis. | journal=J Shoulder Elbow Surg | year= 2016 | volume= 25 | issue= 1 | pages= 158-67 | pmid=26577126 | doi=10.1016/j.jse.2015.08.032 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26577126  }} </ref><ref name="pmid7667644">{{cite journal| author=Zimmermann B, Mikolich DJ, Ho G| title=Septic bursitis. | journal=Semin Arthritis Rheum | year= 1995 | volume= 24 | issue= 6 | pages= 391-410 | pmid=7667644 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7667644  }} </ref><ref name="pmid21628647">{{cite journal| author=Aaron DL, Patel A, Kayiaros S, Calfee R| title=Four common types of bursitis: diagnosis and management. | journal=J Am Acad Orthop Surg | year= 2011 | volume= 19 | issue= 6 | pages= 359-67 | pmid=21628647 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21628647  }} </ref>
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
|+
! style="background: #4479BA; width: 450px;" | {{fontcolor|#FFF|Septic}}<ref name="pmid26577126">{{cite journal| author=Reilly D, Kamineni S| title=Olecranon bursitis. | journal=J Shoulder Elbow Surg | year= 2016 | volume= 25 | issue= 1 | pages= 158-67 | pmid=26577126 | doi=10.1016/j.jse.2015.08.032 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26577126  }} </ref><ref name="pmid7667644">{{cite journal| author=Zimmermann B, Mikolich DJ, Ho G| title=Septic bursitis. | journal=Semin Arthritis Rheum | year= 1995 | volume= 24 | issue= 6 | pages= 391-410 | pmid=7667644 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7667644  }} </ref>
! style="background: #4479BA; width: 450px;" | {{fontcolor|#FFF|Aseptic}}
|-
| style="padding: 5px 5px; background: #F5F5F5" |
*[[antibiotics|Systemic antibiotics]]
*''[[Staphylococcus aureus]]'' bursitis often resolves with [[antibiotics]] alone
*''[[Sporothrix schenckii]]'' bursitis often requires [[bursectomy]]
*Most patients respond to [[oral antibiotics]] alone, although some require [[intravenous therapy]]
| style="padding: 5px 5px; background: #F5F5F5" |
*Usually managed with [[RICE]] regimen (rest, ice, compression, elevation)
*[[nonsteroidal anti-inflammatory drugs|Nonsteroidal anti-inflammatory drugs (NSAIDs]])
*Local [[corticosteroid]] injections may be used in some patients who do not respond to initial therapy
|}
===Subacromial Bursitis===
Conservative measures that are recommended among all patients who develop subacromial bursitis include:<ref>Van der Windt, D. A., et al. "Shoulder disorders in general practice: incidence, patient characteristics, and management." Annals of the rheumatic diseases 54.12 (1995): 959-964.</ref><ref>Chang, Won Hyuk, et al. "Comparison of the therapeutic effects of intramuscular subscapularis and scapulothoracic bursa injections in patients with scapular pain: a randomized controlled trial." Rheumatology international 34.9 (2014): 1203-1209. </ref>
*[[Physical therapy|Physical therapy (PT)]]
**Scapular strengthening and postural reeducation
*Shoulder exercise
*[[Corticosteroid|Corticosteroid injection]]
*[[NSAIDs|Nonsteroidal anti-inflammatory medications (NSAIDs)]]
===Prepatellar Bursitis===
===Prepatellar Bursitis===
* '''Septic prepatellar bursitis''' requires oral antibiotics with or without surgical excision of the bursal sac (bursectomy) depending on the patient's response and the organism involved.
Conservative measures that are recommended among all patients who develop prepatellar bursitis include: <ref name="pmid21628647">{{cite journal| author=Aaron DL, Patel A, Kayiaros S, Calfee R| title=Four common types of bursitis: diagnosis and management. | journal=J Am Acad Orthop Surg | year= 2011 | volume= 19 | issue= 6 | pages= 359-67 | pmid=21628647 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21628647  }} </ref><ref name="pmid3447109">{{cite journal| author=Wilson-MacDonald J| title=Management and outcome of infective prepatellar bursitis. | journal=Postgrad Med J | year= 1987 | volume= 63 | issue= 744 | pages= 851-3 | pmid=3447109 | doi= | pmc=2428634 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3447109  }} </ref>
* ''Staphylococcus aureus'' bursitis often resolves with antibiotics alone, while ''Sporotrix schenckii'' bursitis often requires bursectomy.
*[[NSAIDs|Nonsteroidal anti-inflammatory medications (NSAIDs)]] is often used as a first choice
* Most patients respond to oral antibiotics alone although some require intravenous therapy.
*Reduce physical activity
* '''Aseptic prepatellar bursitis''' is usually managed with rest, compression, and nonsteroidal anti-inflammatory drugs (NSAIDs). Iee is not helpful except in the acute setting. 
*[[RICE]] regimen in the first 72 hours after the injury (rest, ice, compression, elevation)
* Local corticosteroid injections may be used in some patients who do not respond to initial therapy. <ref name="pmid21628647">{{cite journal| author=Aaron DL, Patel A, Kayiaros S, Calfee R| title=Four common types of bursitis: diagnosis and management. | journal=J Am Acad Orthop Surg | year= 2011 | volume= 19 | issue= 6 | pages= 359-67 | pmid=21628647 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21628647  }} </ref>
*[[Physical therapy|Physical therapy (PT)]]
*Local [[corticosteroid]] injections may be used in some patients who do not respond to initial therapy


===Olecranon Bursitis===
===Olecranon Bursitis===
* The mainstay of therapy for '''acute traumatic''' or '''idiopathic olecranon bursitis''' is nonsurgical measures including ice, compressive dressings, and avoidance of aggravating activity.
Conservative measures that are recommended among all patients who develop olecranon bursitis include:<ref name="pmid21628647">{{cite journal| author=Aaron DL, Patel A, Kayiaros S, Calfee R| title=Four common types of bursitis: diagnosis and management. | journal=J Am Acad Orthop Surg | year= 2011 | volume= 19 | issue= 6 | pages= 359-67 | pmid=21628647 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21628647  }} </ref><ref>Lockman, Leonard. "Treating nonseptic olecranon bursitis A 3-step technique." Canadian Family Physician 56.11 (2010): 1157-1157.</ref>
* Most patients improve significantly with these measures.
*[[RICE]] regimen in the first 72 hours after the injury (rest, ice, compression, elevation)
* Aspiration should be performed among patients who do not respond to rule out possible infection.
*Avoidance of aggravating physical activity
* Early aspiration (with or without corticosteroid injection) may be helpful among patients with bothersome fluid collections.
*Most patients improve significantly with these measures, so physical and occupational therapy are not usually necessary
* The mainstay of therapy for '''septic olecranon bursitis''' is fluid drainage, rest, and intravenous antibiotics.<ref name="pmid21628647">{{cite journal| author=Aaron DL, Patel A, Kayiaros S, Calfee R| title=Four common types of bursitis: diagnosis and management. | journal=J Am Acad Orthop Surg | year= 2011 | volume= 19 | issue= 6 | pages= 359-67 | pmid=21628647 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21628647  }} </ref>
*Early aspiration (with or without [[corticosteroid]] injection) may be helpful among patients with bothersome fluid collections
*Diagnostic aspiration should be performed among patients who do not respond to treatment in order to rule out possible [[infection]]


===Trochanteric Bursitis===
===Trochanteric Bursitis===
* Physical therapy and NSAIDs are the most effective therapies for trochanteric bursitis.
Conservative measures that are recommended among all patients who develop trochanteric bursitis include:<ref name="pmid21628647">{{cite journal| author=Aaron DL, Patel A, Kayiaros S, Calfee R| title=Four common types of bursitis: diagnosis and management. | journal=J Am Acad Orthop Surg | year= 2011 | volume= 19 | issue= 6 | pages= 359-67 | pmid=21628647 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21628647  }} </ref><ref>Farmer, Kevin W., et al. "Trochanteric bursitis after total hip arthroplasty: incidence and evaluation of response to treatment." The Journal of arthroplasty 25.2 (2010): 208-212.</ref>
* Local glucocorticoid injections are reserved for patients with refractory symptoms.
*Modification of physical activity
* Most patients do not require any surgical intervention.<ref name="pmid21628647">{{cite journal| author=Aaron DL, Patel A, Kayiaros S, Calfee R| title=Four common types of bursitis: diagnosis and management. | journal=J Am Acad Orthop Surg | year= 2011 | volume= 19 | issue= 6 | pages= 359-67 | pmid=21628647 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21628647  }} </ref>
*Weight loss
*[[Physical therapy|Physical therapy (PT)]]
*[[NSAIDs|Nonsteroidal anti-inflammatory medications (NSAIDs)]]
*Local [[glucocorticoid]] injections are reserved for patients with refractory symptoms
 
[[Physical therapy]] and [[NSAIDs]] are the most effective therapies for [[trochanteric bursitis]]. Most patients do not require any surgical intervention.


===Retrocalcaneal Bursitis===
===Retrocalcaneal Bursitis===
* Management of retrocalcaneal bursitis involves supportive measures such as ice, limitation of activity, NSAIDs, and orthoses.
Conservative measures that are recommended among all patients who develop retrocalcaneal bursitis include:<ref name="pmid21628647">{{cite journal| author=Aaron DL, Patel A, Kayiaros S, Calfee R| title=Four common types of bursitis: diagnosis and management. | journal=J Am Acad Orthop Surg | year= 2011 | volume= 19 | issue= 6 | pages= 359-67 | pmid=21628647 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21628647  }} </ref><ref name="pmid24883139">{{cite journal| author=Vallone G, Vittorio T| title=Complete Achilles tendon rupture after local infiltration of corticosteroids in the treatment of deep retrocalcaneal bursitis. | journal=J Ultrasound | year= 2014 | volume= 17 | issue= 2 | pages= 165-7 | pmid=24883139 | doi=10.1007/s40477-014-0066-9 | pmc=4033727 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24883139  }} </ref>
* Modification of footwear to avoid posterior heel irritation and use of maneuvers that stretch the Achilles tendon may be helpful.
*[[RICE]] regimen in the first 72 hours after the injury (rest, ice, compression, elevation)
* Corticosteroid injections are not recommended as they may have adverse effects on the Achilles tendon.<ref name="pmid21628647">{{cite journal| author=Aaron DL, Patel A, Kayiaros S, Calfee R| title=Four common types of bursitis: diagnosis and management. | journal=J Am Acad Orthop Surg | year= 2011 | volume= 19 | issue= 6 | pages= 359-67 | pmid=21628647 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21628647  }} </ref>
*Maneuvers that stretch the [[Achilles tendon]] may be helpful
*Limitation of activity and modification of footwear to avoid posterior heel irritation
*[[NSAIDs|Nonsteroidal anti-inflammatory medications (NSAIDs)]] and [[Orthotics|orthoses]]
*[[Physical therapy|Physical therapy (PT)]]
 
[[Corticosteroid]] injections are not recommended as they may have adverse effects on the [[Achilles tendon]].


===Antimicrobial Regimens===
===Antimicrobial Regimens===
* Septic bursitis <ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
*Standard antimicrobial regimens for septic bursitis are as follows:<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
:*1. '''Staphylococcus aureus, methicillin-susceptible (MSSA)'''
:*1. '''Staphylococcus aureus, methicillin-susceptible (MSSA)'''
::* Preferred regimen (1): [[Nafcillin]] 2 g IV q4h   
::* Preferred regimen (1): [[Nafcillin]] 2 g IV q4h   
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==References==
==References==
{{reflist|2}}
{{reflist|2}}
[[Category:Orthopedics]]
[[Category:Inflammations]]
[[Category:Rheumatology]]
[[Category:Primary care]]


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[[Category:Up-To-Date]]
[[Category:Rheumatology]]
[[Category:Orthopedics]]
[[Category:Surgery]]
[[Category:Emergency medicine]]
[[Category:Infectious disease]]

Latest revision as of 20:46, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Mehrsefat, M.D. [2]

Overview

Medical therapy for non-septic bursitis depends on the involved bursa and includes the RICE regimen (rest, ice, compression, elevation), NSAIDs, and/or corticosteroid injections. Restriction of activity is encouraged to prevent further injury and promote healing. Antimicrobials are the mainstay of therapy for septic bursitis. Surgical management is often reserved for non-responders.[1][2][3]

Medical Therapy

Medical therapy for non-septic bursitis depends on the involved bursa and includes the RICE regimen (rest, ice, compression, elevation), NSAIDs, and/or corticosteroid injections. Restriction of activity is encouraged to prevent further injury and promote healing. Antimicrobials are the mainstay of therapy for septic bursitis. Surgical management is often reserved for non-responders.[1][2][3]

Septic[1][2] Aseptic

Subacromial Bursitis

Conservative measures that are recommended among all patients who develop subacromial bursitis include:[4][5]

Prepatellar Bursitis

Conservative measures that are recommended among all patients who develop prepatellar bursitis include: [3][6]

Olecranon Bursitis

Conservative measures that are recommended among all patients who develop olecranon bursitis include:[3][7]

  • RICE regimen in the first 72 hours after the injury (rest, ice, compression, elevation)
  • Avoidance of aggravating physical activity
  • Most patients improve significantly with these measures, so physical and occupational therapy are not usually necessary
  • Early aspiration (with or without corticosteroid injection) may be helpful among patients with bothersome fluid collections
  • Diagnostic aspiration should be performed among patients who do not respond to treatment in order to rule out possible infection

Trochanteric Bursitis

Conservative measures that are recommended among all patients who develop trochanteric bursitis include:[3][8]

Physical therapy and NSAIDs are the most effective therapies for trochanteric bursitis. Most patients do not require any surgical intervention.

Retrocalcaneal Bursitis

Conservative measures that are recommended among all patients who develop retrocalcaneal bursitis include:[3][9]

Corticosteroid injections are not recommended as they may have adverse effects on the Achilles tendon.

Antimicrobial Regimens

  • Standard antimicrobial regimens for septic bursitis are as follows:[10]
  • 1. Staphylococcus aureus, methicillin-susceptible (MSSA)
  • 2. Staphylococcus aureus, methicillin-resistant (MRSA)

References

  1. ↑ 1.0 1.1 1.2 Reilly D, Kamineni S (2016). "Olecranon bursitis". J Shoulder Elbow Surg. 25 (1): 158–67. doi:10.1016/j.jse.2015.08.032. PMID 26577126.
  2. ↑ 2.0 2.1 2.2 Zimmermann B, Mikolich DJ, Ho G (1995). "Septic bursitis". Semin Arthritis Rheum. 24 (6): 391–410. PMID 7667644.
  3. ↑ 3.0 3.1 3.2 3.3 3.4 3.5 Aaron DL, Patel A, Kayiaros S, Calfee R (2011). "Four common types of bursitis: diagnosis and management". J Am Acad Orthop Surg. 19 (6): 359–67. PMID 21628647.
  4. ↑ Van der Windt, D. A., et al. "Shoulder disorders in general practice: incidence, patient characteristics, and management." Annals of the rheumatic diseases 54.12 (1995): 959-964.
  5. ↑ Chang, Won Hyuk, et al. "Comparison of the therapeutic effects of intramuscular subscapularis and scapulothoracic bursa injections in patients with scapular pain: a randomized controlled trial." Rheumatology international 34.9 (2014): 1203-1209.
  6. ↑ Wilson-MacDonald J (1987). "Management and outcome of infective prepatellar bursitis". Postgrad Med J. 63 (744): 851–3. PMC 2428634. PMID 3447109.
  7. ↑ Lockman, Leonard. "Treating nonseptic olecranon bursitis A 3-step technique." Canadian Family Physician 56.11 (2010): 1157-1157.
  8. ↑ Farmer, Kevin W., et al. "Trochanteric bursitis after total hip arthroplasty: incidence and evaluation of response to treatment." The Journal of arthroplasty 25.2 (2010): 208-212.
  9. ↑ Vallone G, Vittorio T (2014). "Complete Achilles tendon rupture after local infiltration of corticosteroids in the treatment of deep retrocalcaneal bursitis". J Ultrasound. 17 (2): 165–7. doi:10.1007/s40477-014-0066-9. PMC 4033727. PMID 24883139.
  10. ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.

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