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. | 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. | ||
==Medical Therapy== | ==Medical Therapy== | ||
===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. | * '''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. | ||
* ''Staphylococcus aureus'' bursitis often resolves with antibiotics alone, while '' | * ''[[Staphylococcus aureus]]'' bursitis often resolves with antibiotics alone, while ''[[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. | ||
* '''Aseptic prepatellar bursitis''' is usually managed with rest, compression, and nonsteroidal anti-inflammatory drugs (NSAIDs). | * '''Aseptic [[prepatellar bursitis]]''' is usually managed with rest, compression, and [[nonsteroidal anti-inflammatory drugs]] (NSAIDs). Ice is not helpful except in the acute setting. | ||
* 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> | * 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> | ||
===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. | * The mainstay of therapy for '''acute traumatic''' or '''idiopathic [[olecranon bursitis]]''' is nonsurgical measures including ice, compressive dressings, and avoidance of aggravating activity. | ||
* Most patients improve significantly with these measures. | * Most patients improve significantly with these measures. | ||
* Aspiration should be performed among patients who do not respond to rule out possible infection. | * Aspiration should be performed among patients who do not respond to rule out possible infection. | ||
* 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. | ||
* 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> | * 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> | ||
===Trochanteric Bursitis=== | ===Trochanteric Bursitis=== | ||
* Physical therapy and NSAIDs are the most effective therapies for trochanteric bursitis. | * [[Physical therapy]] and [[NSAIDs]] are the most effective therapies for [[trochanteric bursitis]]. | ||
* Local glucocorticoid injections are reserved for patients with refractory symptoms. | * Local glucocorticoid injections are reserved for patients with refractory symptoms. | ||
* 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> | * 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> | ||
===Retrocalcaneal Bursitis=== | ===Retrocalcaneal Bursitis=== | ||
* Management of retrocalcaneal bursitis involves supportive measures such as ice, limitation of activity, NSAIDs, and orthoses. | * Management of retrocalcaneal bursitis involves supportive measures such as ice, limitation of activity, [[NSAIDs]], and [[Orthotics|orthoses]]. | ||
* Modification of footwear to avoid posterior heel irritation and use of maneuvers that stretch the Achilles tendon may be helpful. | * Modification of footwear to avoid posterior heel irritation and use of maneuvers that stretch the [[Achilles tendon]] may be helpful. | ||
* 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> | * [[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> | ||
===Antimicrobial Regimens=== | ===Antimicrobial Regimens=== | ||
Revision as of 15:12, 24 September 2015
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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.
Medical Therapy
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.
- Staphylococcus aureus bursitis often resolves with antibiotics alone, while Sporothrix schenckii bursitis often requires bursectomy.
- Most patients respond to oral antibiotics alone although some require intravenous therapy.
- Aseptic prepatellar bursitis is usually managed with rest, compression, and nonsteroidal anti-inflammatory drugs (NSAIDs). Ice is not helpful except in the acute setting.
- Local corticosteroid injections may be used in some patients who do not respond to initial therapy. [1]
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.
- Most patients improve significantly with these measures.
- Aspiration should be performed among patients who do not respond to rule out possible infection.
- Early aspiration (with or without corticosteroid injection) may be helpful among patients with bothersome fluid collections.
- The mainstay of therapy for septic olecranon bursitis is fluid drainage, rest, and intravenous antibiotics.[1]
Trochanteric Bursitis
- Physical therapy and NSAIDs are the most effective therapies for trochanteric bursitis.
- Local glucocorticoid injections are reserved for patients with refractory symptoms.
- Most patients do not require any surgical intervention.[1]
Retrocalcaneal Bursitis
- Management of retrocalcaneal bursitis involves supportive measures such as ice, limitation of activity, NSAIDs, and orthoses.
- Modification of footwear to avoid posterior heel irritation and use of maneuvers that stretch the Achilles tendon may be helpful.
- Corticosteroid injections are not recommended as they may have adverse effects on the Achilles tendon.[1]
Antimicrobial Regimens
- Septic bursitis [2]
- 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 1.3 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.
- ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.