What Is the Best Treatment for Bursitis?

Reviewed on 8/11/2021

Bursitis treatment depends on its cause and location. Treatment can include the RICE method, home remedies, nonsteroidal anti-inflammatory drugs (NSAIDs), steroid injections, physical therapy, antibiotics, and surgery.
Bursitis treatment depends on its cause and location. Treatment can include the RICE method, home remedies, nonsteroidal anti-inflammatory drugs (NSAIDs), steroid injections, physical therapy, antibiotics, and surgery.

Bursitis is inflammation or irritation of the bursae (plural of “bursa”), which are fluid-filled sacs around joints and tendons that function to reduce friction from movement and to provide cushioning between bones, tendons, muscles, and skin.

Bursitis can involve nearly any joint in the body, but some joints are affected more often than others. Common locations for bursitis include: 

  • Shoulder (subacromial bursitis)  
  • Upper back (scapulothoracic bursitis) 
  • Elbow (olecranon bursitis) 
  • Pelvis (ischial bursitis
  • Hip
    • Greater trochanteric pain syndrome (formerly called trochanteric bursitis) 
    • Iliopsoas bursitis 
  • Knee
    • Prepatellar and infrapatellar bursitis 
    • MCL bursitis 
    • Pes anserinus pain syndrome 
  • Heel (retrocalcaneal bursitis) 

Bursitis Treatment

Treatment depends on the cause and the location of the bursitis. The best way to treat bursitis involves rest and protecting the joints, relieving inflammation and pain, treating any infection, preserving range of motion, avoiding complications, and preventing recurrence.

Lifestyle modifications to protect the joints include: 

  • The RICE method:
    • Rest
    • Ice the affected area
    • Compression with a compression bandage or stocking
    • Elevation of affected area
  • Heat (e.g., a heating pad) 
    • More effective for deeper forms of bursitis, such as the hip, shoulder, or inner knee
  • Avoid or modify activities that cause pain
  • Use pads or cushions for kneeling or sitting
  • Use splints or braces to limit movement of the affected joint
  • Modify footwear to reduce pressure on the back of the heel (e.g., using a pad inside the shoe to lift the heel or cutting a “V”-shaped groove into the back of a shoe)
  • Custom-fitted devices to wear over the elbows to protect them and prevent fluid build-up

Medications used to treat bursitis include: 

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain and inflammation
  • Steroid injections for pain and inflammation 
    • Used when the affected area is deep under the skin but not for superficial types of bursitis
    • Only provides short-term pain relief for several weeks

Other measures to treat bursitis include: 

  • Physical therapy
    • Exercises depend on the type and severity of bursitis but may include: 
      • Stretching
      • Strengthening
      • Range of motion
  • Treating infection
    • Septic bursitis is a serious condition that needs to be treated right away with antibiotics and draining infected fluid from the bursa
  • Surgery
    • Rarely, surgery is performed to remove all or part of the affected bursa (bursectomy)

What Are Symptoms of Bursitis?

Symptoms of bursitis can come on rapidly (acute) or develop slowly over time (chronic). 

Symptoms of bursitis include: 

  • Pain in the affected area 
  • Pain when moving or bending the joint 
  • Visible swelling, redness, and warmth of the affected area 
    • More common in acute bursitis of a superficial bursa closer to the surface of the skin, such as those around the elbows, kneecaps, and heels
  • Limited range of motion and deterioration of muscles due to pain in chronic bursitis 
  • If an infection is present (“septic bursitis”) symptoms may include: 
    • Pain, swelling, warmth, and redness around the affected joint
    • Fever 

What Causes Bursitis?

Causes of acute bursitis include:

  • Injury, such as from a fall or hit
    • People who take anticoagulants (blood thinners) are at increased risk 
  • Infection from bacteria entering the body through a cut or scrape in the skin
  • Gout or other crystal diseases
  • Certain types of arthritis, such as rheumatoid arthritis or psoriatic arthritis
  • Tendonitis
  • Diabetes
  • Thyroid disease

Causes of chronic bursitis include: 

  • Kneeling, sitting, or leaning on a particular joint that for a long period
  • Strain or overuse from repetitive motion
  • Joint stress from an abnormal gait; for example, walking unevenly because one leg is shorter than the other

How Is Bursitis Diagnosed?

Bursitis is diagnosed with a physical examination, a patient history of symptoms, and sometimes tests.

Tests to determine the cause of bursitis include: 

  • If infection or crystal disease (for example, gout) is suspected, fluid is removed from the affected bursa using a syringe (aspiration) to be examined under a microscope  
  • Blood tests
  • Imaging tests to rule out other problems, such as tears in cartilage or ligaments

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Reviewed on 8/11/2021
References
https://www.uptodate.com/contents/bursitis-beyond-the-basics?search=bursitis&source=search_result&selectedTitle=3~150&usage_type=default&display_rank=3

https://www.hopkinsmedicine.org/health/conditions-and-diseases/bursitis