Bursitis Treatment & Management

  • Author: Alita Gonsalves, MD; Chief Editor: Harris Gellman, MD   more...
 
Updated: Feb 7, 2012
 

Medical Therapy

The PRICEMM eponym can be used for pain control. Patients should let pain be their guide with regard to activities.

  • P rotect - with padding, braces, changes in technique
  • R est - avoid activities that exacerbate pain
  • I ce - cryotherapy can relieve pain and decrease inflammation
  • C ompression - elastic dressings can ease pain, as in olecranon bursitis
  • E levation - raise affected limb above level of heart
  • M odalities - electrical stimulation, ultrasound, phonophoresis
  • M edications - nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, corticosteroid injection

Corticosteroid injection can be helpful if the patient does not respond to other treatment. A 1.5- to 4-inch 20-gauge spinal needle may be used as a probe to determine the points of maximal tenderness in the affected bursa. A mix of corticosteroid and local anesthetic is injected into each tender site. An injection of 20 mg or less of corticosteroid should be used per lesion, and no more than a total of 40 mg of corticosteroid should be used.[10, 17, 25]

An 8-week placebo-controlled study demonstrated a decrease in pain and an improvement in function with use of steroids compared with placebo. Furthermore, the study showed no significant differences between higher (40 mg) and lower (20 mg) doses of triamcinolone acetonide. Therefore, in general, lower doses of steroids should be used initially.[26]

In cases in which septic bursitis is suspected, the bursa should be aspirated. The skin over the bursa is sterilized, and the area is anesthetized with lidocaine using a 27-gauge needle. A 20- or 22-gauge needle is then introduced sterilely into the bursa. Fluid is aspirated and sent for analysis to look for an infectious organism or crystals.

If bursitis is found to be secondary to infection following aspiration and fluid analysis, treatment should be initiated with antibiotics.[6] Outpatient treatment is effective in 40-50% of patients with mild to moderate infections. A 4-week course is advisable using high doses of sensitivity-directed antibiotics. In more severe cases, hospitalization is required with 1 week of parenteral antibiotics followed by 30 days of oral antibiotics.

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Surgical Therapy

In general, bursitis is not treated surgically. However, surgical release may be indicated when adhesive bursitis develops, severely limiting joint motion. During surgery, the adhered bursa is removed and the contiguous tissues are released.[27, 28, 23]

In the upper extremity, subscapular bursitis can be caused by bony exostoses, and surgery may be needed to reduce these structures. In addition, the association of subacromial bursitis with rotator cuff impingement and tears is high, and surgical repair of the tear may be indicated.

In the lower extremity, Baker's cysts (popliteal bursitis) are often removed surgically. Before open excision, arthroscopy should be performed to evaluate for intra-articular conditions. Most cysts are approached posteromedially through a hockey-stick incision.

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Follow-up

Most patients respond well to conservative management. Patients who do not respond to nonoperative treatment or who have signs of tendinous or ligamentous injury require further evaluation.

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Contributor Information and Disclosures
Author

Alita Gonsalves, MD  Physiatry, Private Practice, Vero Orthopaedics and Neurology; Former Staff Physician, Department of Physical Medicine and Rehabilitation, New York Presbyterian Hospital-Columbia and Cornell

Alita Gonsalves, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation and Physiatric Association of Spine, Sports and Occupational Rehabilitation

Disclosure: Nothing to disclose.

Coauthor(s)

Leon Root, MD  Professor of Clinical Surgery, Department of Orthopedics, Weill Medical College of Cornell University; Founder and Director, Pediatric Outreach Program; Emeritus Chief of Osteogenesis Imperfecta Clinic, Attending Orthopaedic Surgeon, Medical Director of Rehabilitation , Emeritus Chief of Pediatric Orthopaedics at The Hospital for Special Surgery

Leon Root, MD is a member of the following medical societies: American Academy of Cerebral Palsy and Developmental Medicine, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, New York Academy of Medicine, and Pediatric Orthopaedic Society of North America

Disclosure: Nothing to disclose.

Specialty Editor Board

Heidi M Stephens, MD, MBA  Associate Professor, Department of Surgery, Division of Orthopedic Surgery, University of South Florida College of Medicine; Courtesy Joint Associate Professor, Department of Environmental and Occupational Health, University of South Florida College of Public Health

Heidi M Stephens, MD, MBA is a member of the following medical societies: Alpha Omega Alpha, American Academy of Orthopaedic Surgeons, American Medical Association, American Orthopaedic Foot and Ankle Society, and Florida Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Ian D Dickey, MD, FRCSC  Adjunct Professor, Department of Chemical and Biological Engineering, University of Maine; Consulting Staff, Adult Reconstruction, Orthopedic Oncology, Department of Orthopedics, Eastern Maine Medical Center

Ian D Dickey, MD, FRCSC is a member of the following medical societies: American Academy of Orthopaedic Surgeons, British Columbia Medical Association, Canadian Medical Association, and Royal College of Physicians and Surgeons of Canada

Disclosure: Stryker Orthopaedics Consulting fee Consulting; Cadence Honoraria Speaking and teaching

Dinesh Patel, MD, FACS  Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital

Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Harris Gellman, MD  Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami, Leonard M Miller School of Medicine

Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, and Arkansas Medical Society

Disclosure: Nothing to disclose.

References

  1. Crenshaw AH, Canale ST. Nontraumatic disorders. In: Canale ST, ed. Campbell's Operative Orthopaedics. 9th ed. St Louis, Mo:. Mosby; 1998:776-85.

  2. DeLee JC, Drez D. Imaging effusions, cysts, and ganglia. In: DeLee JC, Drez D, Miller MD, eds. DeLee and Drez's Orthopaedic Sports Medicine: Principles and Practice. Philadelphia, Pa: WB Saunders;. 2003: 1646-8.

  3. Sheon RP, Moskowitz RW, Goldberg VM. Soft Tissue Rheumatic Pain: Recognition, Management, Prevention. 3rd ed. Baltimore, Md: Williams and Wilkins;. 1996.

  4. Farmer KW, Jones LC, Brownson KE, Khanuja HS, Hungerford MW. Trochanteric Bursitis After Total Hip Arthroplasty Incidence and Evaluation of Response to Treatment. J Arthroplasty. Mar 3 2009;[Medline].

  5. Pretell J, Ortega J, García-Rayo R, Resines C. Distal fascia lata lengthening: an alternative surgical technique for recalcitrant trochanteric bursitis. Int Orthop. Oct 2009;33(5):1223-7. [Medline].

  6. Martinez-Taboada VM, Cabeza R, Cacho PM, Blanco R, Rodriguez-Valverde V. Cloxacillin-based therapy in severe septic bursitis: Retrospective study of 82 cases. Joint Bone Spine. Jul 1 2009;[Medline].

  7. Reilly JP, Nicholas JA. The chronically inflamed bursa. Clin Sports Med. Apr 1987;6(2):345-70. [Medline].

  8. Hirji Z, Hunjun JS, Choudur HN. Imaging of the bursae. J Clin Imaging Sci. 2011;1:22. [Medline]. [Full Text].

  9. Salzman KL, Lillegard WA, Butcher JD. Upper extremity bursitis. Am Fam Physician. Nov 1 1997;56(7):1797-806, 1811-2. [Medline].

  10. Chen MJ, Lew HL, Hsu TC, Tsai WC, Lin WC, Tang SF. Ultrasound-guided shoulder injections in the treatment of subacromial bursitis. Am J Phys Med Rehabil. Jan 2006;85(1):31-5. [Medline].

  11. Blankstein A, Ganel A, Givon U, Mirovski Y, Chechick A. Ultrasonographic findings in patients with olecranon bursitis. Ultraschall Med. Dec 2006;27(6):568-71. [Medline].

  12. Turan H, Serefhanoglu K, Karadeli E, Timurkaynak F, Arslan H. A case of brucellosis with abscess of the iliacus muscle, olecranon bursitis, and sacroiliitis. Int J Infect Dis. Apr 23 2009;[Medline].

  13. Malkin J, Shrimpton A, Wiselka M, Barer MR, Duddridge M, Perera N. Olecranon bursitis secondary to Mycobacterium kansasii infection in a patient receiving infliximab for Behcet's disease. J Med Microbiol. Mar 2009;58:371-3. [Medline].

  14. Butcher JD, Salzman KL, Lillegard WA. Lower extremity bursitis. Am Fam Physician. May 15 1996;53(7):2317-24. [Medline].

  15. Keplinger FS, Gupta N. Knee bursitis. In: Frontera WR, Silver JK, eds. Essentials of Physical Medicine and Rehabilitation. Philadelphia, Pa: Hanley & Belfus;2002: 340-4.

  16. McAfee JH, Smith DL. Olecranon and prepatellar bursitis. Diagnosis and treatment. West J Med. Nov 1988;149(5):607-10. [Medline].

  17. Brinks A, van Rijn RM, Bohnen AM, Slee GL, Verhaar JA, Koes BW. Effect of corticosteroid injection for trochanter pain syndrome: design of a randomised clinical trial in general practice. BMC Musculoskelet Disord. Sep 19 2007;8(1):95. [Medline].

  18. Alvarez-Nemegyei J, Canoso JJ. Evidence-Based Soft Tissue Rheumatology: III: Trochanteric Bursitis. J Clin Rheumatol. Jun 2004;10(3):123-124. [Medline].

  19. Rowand M, Chambliss ML, Mackler L. Clinical inquiries. How should you treat trochanteric bursitis?. J Fam Pract. Sep 2009;58(9):494-500. [Medline].

  20. Viradia NK, Berger AA, Dahners LE. Relationship between width of greater trochanters and width of iliac wings in tronchanteric bursitis. Am J Orthop (Belle Mead NJ). Sep 2011;40(9):E159-62. [Medline].

  21. Alvarez-Nemegyei J. Risk factors for pes anserinus tendinitis/bursitis syndrome: a case control study. J Clin Rheumatol. Apr 2007;13(2):63-5. [Medline].

  22. Alvarez-Nemegyei J, Canoso JJ. Evidence-Based Soft Tissue Rheumatology IV: Anserine Bursitis. J Clin Rheumatol. Aug 2004;10(4):205-206. [Medline].

  23. Wiegerinck JI, Kok AC, van Dijk CN. Surgical treatment of chronic retrocalcaneal bursitis. Arthroscopy. Feb 2012;28(2):283-93. [Medline].

  24. Tsai YH, Huang TJ, Hsu WH, Huang KC, Li YY, Peng KT. Detection of subacromial bursa thickening by sonography in shoulder impingement syndrome. Chang Gung Med J. Mar-Apr 2007;30(2):135-41. [Medline].

  25. Buchbinder R, Green S, Youd JM, Johnston RV. Oral steroids for adhesive capsulitis. Cochrane Database Syst Rev. 2006;(4):CD006189. [Medline].

  26. Hong JY, Yoon SH, Moon do J, Kwack KS, Joen B, Lee HY. Comparison of high- and low-dose corticosteroid in subacromial injection for periarticular shoulder disorder: a randomized, triple-blind, placebo-controlled trial. Arch Phys Med Rehabil. Dec 2011;92(12):1951-60. [Medline].

  27. Baker CL Jr, Massie RV, Hurt WG, Savory CG. Arthroscopic bursectomy for recalcitrant trochanteric bursitis. Arthroscopy. Aug 2007;23(8):827-32. [Medline].

  28. Baums MH, Spahn G, Nozaki M, Steckel H, Schultz W, Klinger HM. Functional outcome and general health status in patients after arthroscopic release in adhesive capsulitis. Knee Surg Sports Traumatol Arthrosc. May 2007;15(5):638-44. [Medline].

 
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Olecranon bursitis, shown here with the elbow flexed. Image courtesy of UMDNJ-New Jersey Medical School, www.DoctorFoye.com, and www.TailboneDoctor.com.
Olecranon bursitis aspiration of a hemorrhagic effusion. Image courtesy of UMDNJ-New Jersey Medical School, www.DoctorFoye.com, and www.TailboneDoctor.com.
Location of pes anserine bursa on the medial knee. MCL is medial collateral ligament.
 
 
 
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