Bursitis medical therapy
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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
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Subacromial Bursitis
Conservative measures which are recommended among all patients who developed subacromial bursitis include:
- Physical therapy (PT)
- Scapular strengthening and postural reeducation
- Shoulder exercise
- Corticosteroid injection
- Nonsteroidal anti-inflammatory medications (NSAIDs)
Physical therapy and NSAIDs are the most effective therapies for trochanteric bursitis
Prepatellar Bursitis
Conservative measures which are recommended among all patients who developed prepatellar bursitis include: [1]
- Nonsteroidal anti-inflammatory medications (NSAIDs) is often use as a first chose
- Decrease physical activities
- 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 which are recommended among all patients who developed olecranon bursitis include:[1]
- RICE regimen in the first 72 hours after the injury (rest, ice, compression, elevation)
- Avoidance of aggravating activity
- Most patients improve significantly with these measures and most of the time physical and occupational therapy are not 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 rule out possible infection
Trochanteric Bursitis
Conservative measures which are recommended among all patients who developed trochanteric bursitis include:[1]
- Activity modification
- 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
- 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 1.4 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.