Bursitis
Treatment
Non-operative treatment is the primary route for management of bursitis. Historically bursitis treated managed with intrabursal injection and temporary drainage cathether, but have not been proven to be successful. Additionally, management of septic prepatellar bursitis is controversial. For septic prepatellar bursitis, it is recommended that oral antibiotics be taken along with surgical excision. The treatment of aseptic prepatellar bursitis consists of rest, compression, NSAIDs and may include local corticosteroid injection.
Surgery may be required for recalcitrant bursitis. Surgical option includes open bursectomy (complications include wound healing issues, atrophic skin changes, subcutaneous hematoma, and severe tenderness), arthroscopic bursal excision, and partial excision of involved bony processes.
For septic prepatellar bursitis, it is recommended that oral antibiotics be taken along with surgical excision. The treatment of aseptic prepatellar bursitis consists of rest, compressive wrapping, elevation, NSAIDs and may include local corticosteroid injection.
Conservative Management:
Surgery may be required for recalcitrant bursitis. Surgical option includes open bursectomy (complications include wound healing issues, atrophic skin changes, subcutaneous hematoma, and severe tenderness), arthroscopic bursal excision, and partial excision of involved bony processes.
For septic prepatellar bursitis, it is recommended that oral antibiotics be taken along with surgical excision. The treatment of aseptic prepatellar bursitis consists of rest, compressive wrapping, elevation, NSAIDs and may include local corticosteroid injection.
Conservative Management:
- Reduce pain/edema
- Increase and restore pain-free ROM
- Increase/maintain LE strength to promote joint stability
- Restore ability to resume regular activities
- Propiceptive and balance reactions
Prevention
Maintain the integrity of the knee joint and musculature by continuing with therapeutic exercises after discharge, and progress LE strengthening. Avoid excessive repetitive knee activities prone to trauma and extreme prolonged knee flexion positions.
Education
Most patients respond well to nonsurgical treatment including ice, activity modification, and NSAIDs. Local corticosteroid injection may be used to manage the symptoms, but it may effect biomechanical properties of the knee. In addition, injections increases the risk of infection, skin atrophy, and chronic pain. It is important to protect the knee in the early phases and avoid activities that may aggravate the knee.
References
Aaron DL, Patel A, Kayiaros S, Calfee R. Four common types of bursitis: diagnosis and management. J Am Acad Orthop Surg. 2011;19(6):359-367.
Huang YC, Yeh WL. Endoscopic treatment of prepatellar bursitis. Int Orthop. 2011;35(3):355-358. Epub 2010 Jun 2014.
Dressendorfer R. Knee pain: unspecified site—conservative management. CINAHL Rehab Guide. Mar 20, 2012.
Huang YC, Yeh WL. Endoscopic treatment of prepatellar bursitis. Int Orthop. 2011;35(3):355-358. Epub 2010 Jun 2014.
Dressendorfer R. Knee pain: unspecified site—conservative management. CINAHL Rehab Guide. Mar 20, 2012.