musculoskeletal and connective tissue disorders
Bursitis
Treatment of Bursitis
Rest followed by physical therapy High-dose nonsteroidal anti-inflammatory drugs (NSAIDs) Treatment of crystal-induced disease or infection Sometimes, corticosteroid injection For crystal-induced disease, see Treatment and should be given initially (see Treatment ). Subsequent choice of antibiotic is determined by results of Gram stain and culture. Infectious bursitis requires drainage or occasionally excision in addition to antibiotics. Acute nonseptic bursitis is treated with temporary rest or immobilization and high-dose Nonopioid Analgesics and sometimes with other analgesics. Physical therapy and voluntary movement should be increased as pain subsides. This may accelerate restoration of range of motion. Pendulum exercises are helpful for the shoulder joint. In one study, corticosteroid injections relieved short-term (< 6 weeks) pain more than placebo (in patients with concurrent adhesive capsulitis), but they showed no benefit long term ( Treatment reference ). Corticosteroid injection should be considered if the bursal effusion is recurrent, infection has been excluded, and oral drugs and rest are inadequate. Aspiration and intrabursal injection of depot corticosteroids 0.5 to 1 mL (eg, Chronic bursitis is treated the same as acute bursitis, except that splinting and rest are less likely to help, and range-of-motion exercises are especially important. Rarely, the bursa needs to be excised. 1.Challoumas D, Biddle M, McLean M, et al: Comparison of treatments for frozen shoulder: A systematic review and meta-analysis.JAMA Netw Open. 3(12):e2029581, 2020. doi: 10.1001/jamanetworkopen.2020.29581. PMID: 33326025; PMCID: PMC7745103. 