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148 Bursitis and periarticular inflammation
n Summary and recommendations
First line: NSAID (e.g. naproxen 500 mg PO BID)
Reasonable: aspiration and intrabursal injection (e.g. with methylprednisolone
20 mg plus 1–4 mL 1% lidocaine)
Pregnancy:
n NSAIDs should generally be avoided; therefore, injection therapy would be
appropriate in cases of failure of acetaminophen (1000 mg PO q4–6 h);
n corticosteroid can be used with clinician discretion injection; injection of
corticosteroids for bursitis treatment in pregnant patients is standard practice
at the Massachusetts General Hospital; the low-range dose of steroids
is recommended (e.g. betamethasone 6 mg plus 4 mL 1% lidocaine)
Pediatric: NSAIDs (e.g. ibuprofen 5–10 mg/kg PO q6–8h)
Special cases:
n calcaneal bursitis: avoid intrabursal infiltration
n possible septic bursitis: corticosteroid injection contraindicated
n subacromial inflammation in patients taking protease inhibitors (e.g. indinavir,
lamivudine): consult longitudinal care physician regarding medication
alteration
n favorable GI/cardiovascular risk profile: COX-2 selective NSAID (e.g. celecoxib
200 mg PO BID)
References
1. Zuinan C. Diclofenac/misoprostol vs diclofenac/placebo in treating acute
episodes of tendinitis/bursitis of the shoulder. Drug. 1993;45:12–23.
2. Heller B, Tarricone R. Oxaprozin versus diclofenac in NSAID-refractory periarthritis
pain of the shoulder. Curr Med Res Opin. 2004;20:1279–1290.
3. Green S, Buchbinder R, Barnsley L, et al. Non-steroidal anti-inflammatory
drugs (NSAIDs) for treating lateral elbow pain in adults. Cochrane Database
Syst Rev. 2002(4):CD003686.
4. Heintjes E, Berger MY, Bierma-Zeinstra SM, et al. Pharmacotherapy for patellofemoral
pain syndrome. Cochrane Database Syst Rev. 2004(3):CD003470.