Management: Acute
Assessment:
- Is the patient unwell?
- In acute bursitis it is no longer advised to aspirate the bursa as commonly it will introduce infection and cause a larger problem.
- Instead it is better to assess the patient and control the symptoms (ie pain, swelling) before moving onto trying to treat the acute bursitis itself.
Cause:
- Some acute bursitis isn't caused by infection, is this person leaning too hard on a desk, have they passed out in a funny position after drinking too much?
- In both of these cases eliminating the cause (ie Pressure) is the best treatment so taking some ibuprofen, ice packs and elevating away from surfaces are good conservative measures that provide relief to the patient.
Exacerbating Factors:
- Managing your lifestyle and augmenting your environment can be good ways of eliminating and preventing Acute Bursitis in the future, using pillows or gel pads under your elbows when typing or reducing workload will help prevent both repeated episodes and the worsening of the condition.
Antibiotics:
- Odds on your patient will need antibiotics. NICE guidance says to start empirical therapy for 7 days, typically meaning 7 days of amoxicillin / flucloxacillin depending on local policy. It is useful to consult the NHS Grampian Abx guidelines as as an FY1 you will be referring to them on a daily basis.
