How can bursitis be treated?

Photo of a woman holding a cold pack against her elbow (PantherMedia / imagepointfr)

Signs of bursitis include swelling and pain – in an elbow or knee, for example. There are various ways to treat this inflammation, depending on the cause and how it develops over time.

Bursitis often arises when a bursa is constantly irritated – for example during work that requires a lot of kneeling. Bursae are small, fluid-filled sacs that act as protective cushions in the body, often near to joints. Resting the affected area and using bandages and anti-inflammatory medications usually helps to make the inflammation go away.

Antibiotics are used if bacteria are involved. If the symptoms don’t improve, surgery to remove the inflamed bursa is considered.

What are the conservative (non-surgical) treatment options?

The acronym P.R.I.C.E. can be used to remember an approach to treating muscle and joint injuries, especially sports-related injuries like strains and sprains. But this approach is also helpful for bursitis. P.R.I.C.E. stands for:

  • P as in protection: This means protecting the affected area from pressure or bumps. A splint might be useful for this purpose. Walking aids are sometimes a good idea too, to help relieve the pressure on a leg or foot.
  • R as in rest: Make sure to rest the joint. Particularly if the bursitis is work-related, you may need a note from the doctor to take some time off. Physiotherapists and occupational therapists can offer more tips on what to be careful of at home or at work also in the long term, to prevent bursitis from coming back.
  • I as in ice: Cool packs or a moist, cooling wrap can relieve the symptoms. It’s important to wrap the ice or cool pack in a towel or cloth first. Never put it directly on your skin – it could harm the skin otherwise.
  • C as in compression: An elastic compression bandage that’s not too tight can prevent the inflamed area from becoming more swollen. Putting a tightly wrapped bandage or a special cuff around a joint such as an elbow or a knee will also automatically keep the joint from moving too much.
  • E as in elevate: If your knee or lower leg is affected, it can be helpful to put your feet up (elevate) several times a day to keep the swelling down.

Medication

Non-steroidal anti-inflammatory drugs (NSAIDs) can relieve pain, reduce inflammation and help keep swelling down. For this reason, some people take them in addition to following the P.R.I.C.E. treatment approach.

Antibiotics are only necessary if bacteria have caused the bursitis or are making an existing inflammation worse.

Draining the bursa

The more the fluid builds up in the bursa, the more it swells up, and the more painful it becomes. A doctor can puncture the bursa with a hollow needle (cannula) to draw out the excess fluid. But this technique is usually not a permanent solution – even when repeated several times: The fluid quickly fills up again, and each time it is drained there is a risk that bacteria could infect the bursa. This procedure can also be done to find out whether bacteria are involved: The fluid that is taken is then tested for germs in a lab.

Steroid injections

If a bursa has become inflamed following overuse and doctors are certain that bacteria are not involved, steroids can be used to treat the inflammation. The drug is injected right into the bursa. Usually, these steroid injections are only given if other treatments haven’t led to an improvement after about ten days. They may cause an infection or loss of tissue.

When is surgery a good idea?

There is hardly any research on when an inflamed bursa should be surgically removed, so there aren’t currently any general recommendations.

If the bursa is also infected with bacteria, surgery is often recommended right away in order to drain pus or remove the entire bursa. But if you don't have an increased risk of complications, you can wait: Then the bursa is only removed if it's still inflamed after several days of treatment with antibiotics. The risk of complications is higher in people who have a weakened immune system, for example due to a chronic disease such as diabetes.

If there is no bacterial infection, doctors often wait even longer. The bursa is typically not removed unless other treatments haven't improved the symptoms enough after several weeks – or the bursitis keeps returning at short intervals (chronic bursitis).

What does the surgery involve?

The surgery is typically done as an outpatient procedure (in other words, you go home on the same day). General anesthesia isn't usually needed – if the bursitis affects the elbow, for instance, only that arm is anesthetized. The surgeon makes an incision (cut) into the skin to drain the pus or removes the entire inflamed bursa. Especially if there is also a bacterial infection, the cavity of the wound is rinsed thoroughly, and the surgeon inserts a tube to drain fluid from the wound. Then the incision is closed with stitches. The drainage tube can usually be taken out after 1 or 2 days. The arm is kept still (immobilized) in a splint until the stitches can be removed, typically after 7 to 12 days.

Like any type of surgery, this procedure may have adverse effects, including poorly healing wounds and infections. Although the affected joint is less protected without a bursa, it is typically just as flexible as before.

Labels: Bursitis, Bursitis, M70, Muscles, bones and joints