What is the efficacy of intrabursal injections for the treatment of bursitis?

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

In a randomized study of 42 patients with olecranon bursitis who were assigned after bursal aspiration to 1 of 4 treatment groups (intrabursal methylprednisolone 20 mg plus naproxen 1 g/day for 10 days, intrabursal methylprednisolone without naproxen, naproxen only, or placebo), steroid injection was more successful in decreasing edema and preventing recurrence than naproxen or placebo was. [36]

In a systematic review of 29 studies involving a total of 1278 patients with olecranon bursitis, Sayegh and Strauch found that treatment of aseptic bursitis with corticosteroids was associated with significantly increased rates of overall complications and skin atrophy. Compared with patients with septic bursitis, those with aseptic bursitis had a significantly higher overall complication rate. Compared with nonsurgical management, surgical management was significantly less likely to clinically resolve septic or aseptic bursitis, and it was associated with significantly higher rates of overall complications, persistent drainage, and bursal infection. [37]

A study comparing the short- and long-term effectiveness of betamethasone injections (6, 12, or 24 mg with 4 mL of 1% lidocaine) for trochanteric bursitis reported that improvement of pain was achieved at 1, 6, and 26 weeks in 77%, 69%, and 61% of patients, respectively. [38] Higher doses of steroids were significantly more effective.

Ultrasound (US) can be used to guide aspiration and injection. [39] However, Mitchell et al reported that US-guided injection of the trochanteric bursa provides 2-week and 6-month outcomes similar to those of injection guided by anatomic landmarks, but is considerably more expensive. These authors advise that anatomic landmark-guided injection remains the method of choice, but should be routinely performed using a sufficiently long needle (at least 2 in [50.8 mm]), with US guidance reserved for cases of extreme obesity or injection failure. [28]

In a study of 25 cases of postarthroplasty trochanteric bursitis requiring corticosteroid injection, Farmer et al found that corticosteroid injections were effective therapy and that nonoperative management may be more likely to fail in young patients and patients with leg-length discrepancies. [40] Of the 25 hips, 11 required multiple corticosteroid injections, and symptoms resolved in 20 cases.

An 8-week placebo-controlled study of acromial injections demonstrated that steroids brought about a decrease in pain and an improvement in function as compared with placebo. [41] Furthermore, the study showed no significant differences between higher (40 mg) and lower (20 mg) doses of triamcinolone acetonide. Therefore, in general, lower doses of steroids should be used initially.

Other injected agents

Experiences with platelet-rich therapy (PRT) injections of soft-tissue injuries (ligament, muscle, and tendon tears; tendinopathies) are increasingly being published. [42] A Cochrane review cited insufficient evidence to support the use PRT and a need for standardization of platelet-rich plasma preparations. [43]

Isolated case reports describe management of recurrent non-septic bursitis.with aspiration followed by injection of a sclerosing agent (eg, polidocanol). [44]


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