Bursitis medical therapy: Difference between revisions
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==Overview== | ==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.<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 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> | |||
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*[[antibiotics|Systemic antibiotics]] | *[[antibiotics|Systemic antibiotics]] | ||
*''[[Staphylococcus aureus]]'' bursitis often resolves with antibiotics alone | *''[[Staphylococcus aureus]]'' bursitis often resolves with [[antibiotics]] alone | ||
*''[[Sporothrix schenckii]]'' bursitis often requires [[bursectomy]] | *''[[Sporothrix schenckii]]'' bursitis often requires [[bursectomy]] | ||
*Most patients respond to oral antibiotics alone although some require intravenous therapy | *Most patients respond to [[oral antibiotics]] alone, although some require [[intravenous therapy]] | ||
| style="padding: 5px 5px; background: #F5F5F5" | | | style="padding: 5px 5px; background: #F5F5F5" | | ||
*Usually managed with rest, | *Usually managed with [[RICE]] regimen (rest, ice, compression, elevation) | ||
*[[nonsteroidal anti-inflammatory drugs|Nonsteroidal anti-inflammatory drugs (NSAIDs]]) | *[[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 | *Local [[corticosteroid]] injections may be used in some patients who do not respond to initial therapy | ||
|} | |} | ||
===Subacromial Bursitis=== | ===Subacromial Bursitis=== | ||
Conservative measures | 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)]] | *[[Physical therapy|Physical therapy (PT)]] | ||
**Scapular strengthening and postural reeducation | **Scapular strengthening and postural reeducation | ||
*Shoulder exercise | *Shoulder exercise | ||
*[[Corticosteroid|Corticosteroid injection]] | *[[Corticosteroid|Corticosteroid injection]] | ||
*[[NSAIDs|Nonsteroidal anti-inflammatory medications (NSAIDs) | *[[NSAIDs|Nonsteroidal anti-inflammatory medications (NSAIDs)]] | ||
===Prepatellar Bursitis=== | ===Prepatellar Bursitis=== | ||
Conservative measures | 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> | ||
*[[NSAIDs|Nonsteroidal anti-inflammatory medications (NSAIDs)]] is often | *[[NSAIDs|Nonsteroidal anti-inflammatory medications (NSAIDs)]] is often used as a first choice | ||
* | *Reduce physical activity | ||
*RICE regimen in the first 72 hours after the injury (rest, ice, compression, elevation) | *[[RICE]] regimen in the first 72 hours after the injury (rest, ice, compression, elevation) | ||
*[[Physical therapy|Physical therapy (PT)]] | *[[Physical therapy|Physical therapy (PT)]] | ||
*Local [[corticosteroid]] injections may be used in some patients who do not respond to initial therapy | *Local [[corticosteroid]] injections may be used in some patients who do not respond to initial therapy | ||
===Olecranon Bursitis=== | ===Olecranon Bursitis=== | ||
Conservative measures | 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> | ||
*RICE regimen in the first 72 hours after the injury (rest, ice, compression, elevation) | *[[RICE]] regimen in the first 72 hours after the injury (rest, ice, compression, elevation) | ||
*Avoidance of aggravating activity | *Avoidance of aggravating physical activity | ||
*Most patients improve significantly with these measures | *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 | *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 rule out possible infection | *Diagnostic aspiration should be performed among patients who do not respond to treatment in order to rule out possible [[infection]] | ||
===Trochanteric Bursitis=== | ===Trochanteric Bursitis=== | ||
Conservative measures | 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> | ||
* | *Modification of physical activity | ||
*Weight loss | *Weight loss | ||
*[[Physical therapy|Physical therapy (PT)]] | *[[Physical therapy|Physical therapy (PT)]] | ||
*[[NSAIDs|Nonsteroidal anti-inflammatory medications (NSAIDs)]] | *[[NSAIDs|Nonsteroidal anti-inflammatory medications (NSAIDs)]] | ||
*Local glucocorticoid injections are reserved for patients with refractory symptoms | *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 | |||
[[Physical therapy]] and [[NSAIDs]] are the most effective therapies for [[trochanteric bursitis]]. Most patients do not require any surgical intervention. | |||
===Retrocalcaneal Bursitis=== | ===Retrocalcaneal Bursitis=== | ||
Conservative measures | 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> | ||
*RICE regimen in the first 72 hours after the injury (rest, ice, compression, elevation) | *[[RICE]] regimen in the first 72 hours after the injury (rest, ice, compression, elevation) | ||
*Maneuvers that stretch the [[Achilles tendon]] may be helpful | *Maneuvers that stretch the [[Achilles tendon]] may be helpful | ||
*Limitation of activity and modification of footwear to avoid posterior heel irritation | *Limitation of activity and modification of footwear to avoid posterior heel irritation | ||
*[[NSAIDs|Nonsteroidal anti-inflammatory medications (NSAIDs)]] and [[Orthotics|orthoses]] | *[[NSAIDs|Nonsteroidal anti-inflammatory medications (NSAIDs)]] and [[Orthotics|orthoses]] | ||
*[[Physical therapy|Physical therapy (PT)]] | *[[Physical therapy|Physical therapy (PT)]] | ||
[[Corticosteroid]] injections are not recommended as they may have adverse effects on the [[Achilles tendon]]. | |||
===Antimicrobial Regimens=== | ===Antimicrobial Regimens=== | ||
* | *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}} | ||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
[[Category:Disease]] | |||
[[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]
- Physical therapy (PT)
- Scapular strengthening and postural reeducation
- Shoulder exercise
- Corticosteroid injection
- Nonsteroidal anti-inflammatory medications (NSAIDs)
Prepatellar Bursitis
Conservative measures that are recommended among all patients who develop prepatellar bursitis include: [3][6]
- Nonsteroidal anti-inflammatory medications (NSAIDs) is often used as a first choice
- Reduce physical activity
- RICE regimen in the first 72 hours after the injury (rest, ice, compression, elevation)
- Physical therapy (PT)
- Local corticosteroid injections may be used in some patients who do not respond to initial therapy
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]
- Modification of physical activity
- Weight loss
- Physical therapy (PT)
- 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
Conservative measures that are recommended among all patients who develop retrocalcaneal bursitis include:[3][9]
- RICE regimen in the first 72 hours after the injury (rest, ice, compression, elevation)
- Maneuvers that stretch the Achilles tendon may be helpful
- Limitation of activity and modification of footwear to avoid posterior heel irritation
- Nonsteroidal anti-inflammatory medications (NSAIDs) and orthoses
- Physical therapy (PT)
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)
- Preferred regimen (1): Nafcillin 2 g IV q4h
- Preferred regimen (2): Oxacillin 2 g IV q4h
- Preferred regimen (3): Dicloxacillin 500 mg PO qid
- 2. Staphylococcus aureus, methicillin-resistant (MRSA)
- Preferred regimen (1): Vancomycin 1 g IV q12h
- Preferred regimen (2): Linezolid 600 mg PO qd
References
- ↑ 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.
- ↑ 2.0 2.1 2.2 Zimmermann B, Mikolich DJ, Ho G (1995). "Septic bursitis". Semin Arthritis Rheum. 24 (6): 391–410. PMID 7667644.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ Wilson-MacDonald J (1987). "Management and outcome of infective prepatellar bursitis". Postgrad Med J. 63 (744): 851–3. PMC 2428634. PMID 3447109.
- ↑ Lockman, Leonard. "Treating nonseptic olecranon bursitis A 3-step technique." Canadian Family Physician 56.11 (2010): 1157-1157.
- ↑ 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.
- ↑ 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.
- ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.