Bursitis

For a nonseptic bursitis, advice may be given on activity modification and rest. If the subacromial bursa is affected, avoiding overhead lifting is advised, but gentle mobilization of the joint should be encouraged after 24 to 48 hours. The importance of attending physical therapy should be emphasized. If a joint is injected, the patient should be aware of the signs of developing infection (erythema, increasing tenderness, increasing swelling) and the need to seek urgent medical advice.

Patients with septic bursitis should be advised to avoid activities that worsen symptoms and to rest the affected area. Ice can be used to reduce swelling in the first 24 hours by topical application every few hours. Patients with trochanteric and infrapatellar bursitis may find crutches or a cane useful. Gentle mobilization exercise is important to maintain range of movement in a joint, particularly in the shoulder. Simple analgesia such as acetaminophen or nonsteroidal anti-inflammatory drugs can be taken for pain relief, used in combination if necessary. Any patient discharged with oral antibiotic therapy should be aware of the need to seek medical assistance if symptoms do not improve or they worsen.

All patients should be advised the following to help reduce the risk of future episodes of bursitis:

• maintain a healthy weight to reduce pressure on joints

• ensure a proper posture and/or technique for sports and work activities

• use padding and take regular breaks when putting a lot of pressure on joints (e.g., kneeling) or when doing repetitive tasks

• try to avoid knocking or banging joints

• promptly clean and dress any cuts near joints.