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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- Systemic oral antibiotics
- Bursectomy (depending on the patient's response to the treatments and the involved organism
- Staphylococcus aureus bursitis often resolves with antibiotics alone
- Sporothrix schenckii bursitis often requires bursectomy
- Most patients respond to oral antibiotics alone although some require intravenous therapy
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- Usually managed with rest, compression,
- nonsteroidal anti-inflammatory drugs (NSAIDs)
- Local corticosteroid injections may be used in some patients who do not respond to initial therapy
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Subacromial Bursitis
(procaine injection, roentgenotherapy and physical therapy
- Conservative measures which are recommended among all patients who developed subacromial bursitis include:
- Physical therapy (PT)
- Scapular strengthening, postural reeducation, and core strength endurance
- Shoulder exercise
- Corticosteroid injection
- Nonsteroidal anti-inflammatory medications (NSAIDs)
- Physical therapy (PT)
- Physical therapy and NSAIDs are the most effective therapies for trochanteric 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.
- 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
- Conservative measures which are recommended among all patients who developed trochanteric bursitis include:
- Activity modification
- Physical therapy (PT)
- Weight loss
- Corticosteroid injection
- Nonsteroidal anti-inflammatory medications (NSAIDs)
- 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.