Treating bursitis

Most cases of bursitis can be treated at homewith self-care techniques and over-the-counter painkillers.

The pain usually improves within a few weeks, but the swelling may take longer to completely disappear.

Exactly how long it takes to recover may depend on where the bursitis is and whether it is caused by an infection ( septic bursitis ).

Self-care

There are a number of things you cando yourselfto reduce the swelling in the affected joint. Rest the joint until your symptoms improve and avoid strenuous activities that are likely to cause additional pain, such as running.

Wearing padding may help protect the joint from further injury. For example, knee pads may help if you have bursitis in your knee joints.

Ice packs are also a good way of reducing inflammation and pain. Wrap an ice pack (or a bag of frozen vegetables) in a towel and apply itto the affected area for 10-20 minutes. Repeat this every few hours.

While sleeping, avoid lying on the side that has bursitis. If possible, raising the body part above the level of your heart may help reduce the inflammation. For example, you can prop your foot up on a pillow to raise your ankle.

If your knees, ankles or hips are affected, try to avoid long periods of standing up. Standing on a soft surface can help, as can placing a pillow between your knees when lying on your side. Being overweight can also cause bursitis, so losing weight may help.

Painkillers such asaspirin, paracetamol or Painkillers, ibuprofen can help to relieve the pain. Ibuprofen, or other non-steroidal anti-inflammatory drugs (NSAIDs) such as naproxen or diclofenac, can also be used to help reduce swelling.

Always read the patient information leaflet that comes with the medicine to check that it issuitable for you and that you are taking the correct dose.

Aspiration

If the swelling caused by bursitis is particularly severe, youmay want to consider having the fluid drained out. This procedure, known as aspiration,can relieve thepain and improve the range of movement in your joint.

During aspiration, a needle is used to draw out the fluid before the area is coveredwith a dressing. You'll need to avoid strenuous activity for about two days afterwards.

Corticosteroids

If your bursitissymptoms are severe or they do not respond to treatment, corticosteroid injections are another possible treatment option. Corticosteroids contain steroids, a type of hormone, and can be used to reduce inflammation.

Your GP can inject corticosteroids directly into the affected area. Possible side effects include the surrounding tissue wasting away and discolouration of the skin around the injection site.

You will not be able to have a corticosteroid injection if you have septic bursitis, and cannot havemore than three corticosteroid injections a year in the same area.

Antibiotics

Your GP will prescribe antibiotics if tests confirm thatyou have septicbursitis. These may include:

• flucloxacillin
• erythromycin
• clarithromycin

These will usually be taken as tablets or capsules two or four times a day for seven days. After seven days, your GP should check how well you're responding to the antibiotics. If you still have signs of infection, you may need to take antibiotics for another seven days.

If you'represcribed antibiotics, it's important that you finish the entire course, even if your symptoms improve. This will help to prevent the infection returning.

Referral

If your symptoms do notimprove with treatmentafter a couple of months, your GP may refer you to a specialist. This may be:

• a rheumatologist a specialist in conditions that affect the bones, muscles and joints
• an orthopaedic surgeon a specialist in the surgical treatment of conditions that affect the bones, muscles and joints

You may also be referred if you have infected bursitis that does not get better or reoccurs.

Surgery

In some cases, surgery may be recommendedto remove the affected bursa,particularly whereseptic bursitis does not respond to antibiotics.

Surgery either involves removing the bursa completely, or making an incision in your skin and draining the fluid out of the bursa (incision and drainage).