What is included in conservative treatment in bursitis?

Updated: Dec 11, 2020
  • Author: Kristine M Lohr, MD, MS; Chief Editor: Herbert S Diamond, MD  more...
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Answer

Conservative treatment involves control of pain and inflammation, which may be guided by the PRICEMM acronym, as follows:

  • P rotect - Use padding, braces, or changes in technique
  • R est - Avoid activities that exacerbate pain
  • I ce - Cryotherapy can relieve pain and decrease inflammation
  • C ompression - Elastic dressings can ease pain, as in olecranon bursitis
  • E levation - Raise the affected limb above the level of the heart
  • M odalities – Employ electrical stimulation, ultrasonography, or phonophoresis
  • M edications – Administer nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, or corticosteroid injections

Physical measures

The affected area should be placed at rest. Because of the risk of adhesive capsulitis, shoulders should not be immobilized for more than a few days. After immobilization, patients should begin graduated range-of-motion exercises. Patients who have bursitis secondary to overuse should be educated about the importance of regular periods of rest and possible alternative activities to prevent recurrence.

Applying cold treatments for 20 minutes every several hours may be of value in the first 24-48 hours. Such treatments may be followed by heat treatments. Elevation is useful, particularly in lower-limb bursitis. Consider site-specific therapy (eg, cushions for ischial bursitis, well-fitting padded shoes for calcaneal bursitis).

A randomized comparative clinical trial by Homayouni and colleagues in 56 patients with pes anserinus tendino-bursitis concluded that kinesiotaping of the tender area is more effective than 10 days of naproxen (250 mg three times daily) plus daily physical therapy for reducing pain and swelling. Kinesiotaping, using space-correction (lifting) technique, was repeated three times in 1 week. [30]


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