Bursitis medical therapy: Difference between revisions

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Revision as of 13:31, 24 September 2015

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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

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. For instance, Staphylococcus aureus bursitis often resolves with antibiotics alone, while Sporotrix 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). Iee is not helpful except in the acute setting.
Local corticosteroid injections may be used in some patients who do not respond to initial therapy.

Olecranon Bursitis

Trochanteric Bursitis

Retrocalcaneal Bursitis

Antimicrobial Regimen

Olecranon bursitis or prepatellar bursitis ^[1]

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

↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.

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[1] Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.

[1]

@@ Line 6: / Line 6: @@
 ==Medical Therapy==
-Treatment focuses on healing the injured [[bursa]]. The first step is to reduce pain and inflammation with rest, compression, elevation, and [[anti-inflammatory]] medicines such as [[Aspirin]], [[Naproxen]], or [[Ibuprofen]]. Ice may also be used in acute injuries, but many cases of bursitis are considered [[chronic]], and ice is not helpful. When ice is needed, an ice pack can be applied to the affected area for 15–20 minutes every 4–6 hours for 3–5 days. Longer use of ice and a stretching program may be recommended by a [[health care provider]].
+===Prepatellar Bursitis===
-Activity involving the affected [[joint]] is also restricted to encourage healing and prevent further [[injury]].
+* '''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. For instance, ''Staphylococcus aureus'' bursitis often resolves with antibiotics alone, while ''Sporotrix 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). Iee is not helpful except in the acute setting.
+* Local corticosteroid injections may be used in some patients who do not respond to initial therapy.
-The doctor or [[physical therapist]] may use [[ultrasound]] (gentle sound-wave vibrations) to warm deep tissues and improve [[blood flow]]. [[Iontophoresis]] may also be used. This involves using an electrical current to push a [[corticosteroid]] medication through the skin directly over the inflamed [[bursa]]. Gentle stretching and strengthening exercises are added gradually. Massage of the soft tissue may be helpful. These may be preceded or followed by use of an ice pack. The type of exercises recommended may vary depending on the location of the affected bursa.
+===Olecranon Bursitis===
+===Trochanteric Bursitis===
+===Retrocalcaneal Bursitis===
-If there is no improvement, the doctor may inject a [[corticosteroid]] medicine into the area surrounding the inflamed [[bursa]]. While [[corticosteroid]] injections are a common treatment, they must be used with caution because they may lead to weakening or rupture of the [[tendon]] (especially weight-bearing tendons such as the [[Achilles tendon|Achilles]] [ankle], posterior tibial [arch of the foot], and patellar [knee] tendons). If there is still no improvement after 6-12 months, the doctor may perform either [[arthroscopic]] or open [[surgery]] to relieve pressure on the bursae, although this is rare.
-If the bursitis is caused by an [[infection]], the doctor will prescribe [[antibiotics]].
 ===Antimicrobial Regimen===