# Bursitis (prepatellar / olecranon / subacromial) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: Egyptian National Drug Formulary - Cardiovascular 2024 · Naproxen 500 mg Tablets SmPC section 4.2 (eMC product 2639) · Meloxicam 15 mg Tablets SmPC sections 4.2 and 4.4 (eMC product 101306) · Bursitis - StatPearls - NCBI Bookshelf - disease-level clinical article (bursitis-full.txt) · Williams CH, Jamal Z, Sternard BT. Bursitis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Updated 2023 Jul 24. Bookshelf ID: NBK513340; PMID: 30020712. · MSF Essential Drugs 2024 (paracetamol oral monograph, mild pain) - Verified date: 2026-08 ## Verified against - Naproxen 500 mg Tablets SmPC section 4.2 (eMC product 2639) - Meloxicam 15 mg Tablets SmPC sections 4.2 and 4.4 (eMC product 101306) - Egyptian National Drug Formulary - Endocrine - No dose - referral pathway, no medicine given in primary care - Bursitis - StatPearls - NCBI Bookshelf - disease-level clinical article (bursitis-full.txt) - MSF Essential Drugs 2024 (paracetamol oral monograph, mild pain) ## Treatment metadata - Naproxen — 500 mg — oral.solid - Referral & safety-netting (no drug therapy) - Paracetamol — 500 mg — oral.solid - Triamcinolone — injection ## Complete treatment card ```text BURSITIS (PREPATELLAR / OLECRANON / SUBACROMIAL) Sources: Egyptian National Drug Formulary - Cardiovascular 2024 · Naproxen 500 mg Tablets SmPC section 4.2 (eMC product 2639) · Meloxicam 15 mg Tablets SmPC sections 4.2 and 4.4 (eMC product 101306) · Bursitis - StatPearls - NCBI Bookshelf - disease-level clinical article (bursitis-full.txt) · Williams CH, Jamal Z, Sternard BT. Bursitis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Updated 2023 Jul 24. Bookshelf ID: NBK513340; PMID: 30020712. · MSF Essential Drugs 2024 (paracetamol oral monograph, mild pain) Review status: REVIEWED against Naproxen 500 mg Tablets SmPC section 4.2 (eMC product 2639), Meloxicam 15 mg Tablets SmPC sections 4.2 and 4.4 (eMC product 101306), Egyptian National Drug Formulary - Endocrine, No dose - referral pathway, no medicine given in primary care, Bursitis - StatPearls - NCBI Bookshelf - disease-level clinical article (bursitis-full.txt), MSF Essential Drugs 2024 (paracetamol oral monograph, mild pain) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (3) - The sudden form follows injury, infection or crystal disease, while the long-standing form follows inflammatory arthritis or repeated pressure at work - Many report pain when they move the joint themselves, yet the same movement done for them hurts little - Ischial bursitis can give shooting pain that is worse on sitting [burning pain] SIGNS - what you find (8) - Pressing directly over the bursa reproduces the pain in the sudden form - The joint moves through a reduced arc, and it is the pain that limits it - At the kneecap and the elbow, bending the joint hurts while straightening it does not - Long-standing bursitis is frequently painless on examination - Given time the sac enlarges to hold the extra fluid, so what you see is a bulky, thickened swelling - A rise of 2.2 °C in skin temperature over the affected side, against the opposite side, was both sensitive and specific for a septic bursa in one study [fever · sepsis] - A deep bursa can be acutely inflamed and still give neither tenderness on pressing nor any visible skin change - At the knee an effusion is not typical, so finding one points away from a bursa TESTS (6) - Take a plain radiograph where there has been an injury, or where a retained foreign body or a break in the bone could explain the swelling - Deep bursae need MRI or ultrasound; the latter images live and can be watched while the joint is moved - A cobblestone pattern in the fat above the bursa on ultrasound separates cellulitis from an infected bursa - Colour Doppler shows hyperaemia of the bursa and nearby tissue when it is infected - Aspirate the bursa where sepsis or crystal disease is in question, and send the fluid for a cell count, Gram stain with culture, glucose and crystal analysis - Fewer than 500 white cells per mm3 in the aspirate fits a bursitis that is neither infected nor crystal driven IF NOT THIS - what else fits (9) - Osteoarthritis - Rheumatoid arthritis and other inflammatory joint disease - Rotator cuff or labral tear and shoulder impingement, where the pain is at the shoulder - Gout or pseudogout, particularly around the elbow and the knee - Sciatica, though ischial bursitis is the one that hurts more on sitting - Iliotibial band syndrome, whose tenderness lies further down the thigh than the trochanteric bursa - MCL strain or tear, meniscal injury and tibial plateau fracture at the knee - Achilles tendinitis, bone spur pain or plantar fasciitis at the heel - Septic joint, or plain cellulitis of the skin lying over the bursa Source StatPearls "Bursitis" - disease-level clinical article Status traced to the source above Rx: Main treatment | Analgesia - non-NSAID first-line option MAIN TREATMENT - choose one 1. NAPROXEN [1st line] Adult 500 mg initially followed by 250 mg at 6-8 hour intervals up to a maximum daily dose after the first day of 1250 mg Peds Not recommended under 16 years for this indication - the product label restricts paediatric naproxen to juvenile idiopathic arthritis (10 mg/kg/day in two divided doses, child over 5 years). Use paracetamol or ibuprofen instead. Choice Alternatives. Both are non-selective NSAIDs; naproxen is the cheaper by a wide margin (8-24 EGP against 7-142) and dosed twice daily. Source Naproxen 500 mg Tablets SmPC section 4.2 (eMC product 2639) Why Non-selective NSAID that blocks cyclooxygenase and prostaglandin synthesis, reducing the inflammatory pain and swelling of an aseptic bursitis. Caution Rule out septic bursitis (fever, severe erythema, warmth, purulent aspirate) before starting anti-inflammatory monotherapy. Co-prescribe PPI in elderly or ulcer-prone patients. Contraindicated in active or history of recurrent peptic ulcer or GI haemorrhage. Contraindicated in active or history of recurrent peptic ulcer/haemorrhage. Contraindicated in severe hepatic, renal and cardiac failure. Egypt ORGOPROXEN 500 MG 20 TAB. ORGANOPHARMA ... 16.00 EGP (0.80/unit) NAPROSYN 500 MG 10 TAB. MISR > F.HOFF... 8.05 EGP (0.81/unit) NAPROFEN 500MG 10 TAB. EL NILE. 12.00 EGP (1.20/unit) NAPROFEN 500MG 20 TAB. EL NILE. 24.00 EGP (1.20/unit) 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source No dose - referral pathway, no medicine given in primary care Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - Septic bursitis needs systemic antibiotics (gram-positive coverage) as first- line therapy, not NSAIDs alone. RED FLAG - The admission criteria for septic bursitis are systemic or whole-joint involvement and an unstable patient. RED FLAG - Corticosteroid injection is for deep bursae only. Injecting a superficial one - prepatellar, olecranon - risks seeding infection into the bursa, injuring the tendon under it, thinning the skin above it, and leaving a sinus that will not close. A corticosteroid injection can relieve pain well enough to delay the diagnosis of a rotator cuff tear, which has an optimal window for surgical repair. Evidence for corticosteroid injection in chronic bursitis is weak, and a recent study found no benefit. RED FLAG - Skin over the affected bursa that is 2.2 degrees C warmer than the same bursa on the other side is highly sensitive and specific for septic bursitis. RED FLAG - Aspirate the bursa whenever septic bursitis or crystal disease is in question; an aspirate white cell count under 500/mm3 fits non-infective, non-crystalline bursitis. RED FLAG - A septic bursa can be mistaken for a septic joint or for simple cellulitis; missing an infected joint carries significant morbidity and mortality. RED FLAG - Diabetes, HIV, rheumatological disease and alcohol dependence all raise the risk that a bursitis is septic. RED FLAG - In subacromial bursitis, do not immobilise the shoulder - immobilisation can cause atrophy, retraction and a frozen shoulder. When bursitis is driven by a systemic inflammatory disease, treat the underlying condition rather than the bursa alone. 3. TRIAMCINOLONE [2nd line] Adult Smaller joints: 2.5-15 mg; larger joints up to 40 mg Peds Indicated for intra-articular/intrabursal use in adults and children over 6 years. Source Egyptian National Drug Formulary - Endocrine Why Intrabursal corticosteroid injection for symptomatic relief of a deep bursitis, such as subacromial. The source restricts the injection to the deeper bursa and advises against the superficial prepatellar and olecranon bursae. Caution DEEP BURSAE ONLY, such as the subacromial bursa. Do not inject a corticosteroid into a superficial bursa - prepatellar or olecranon. Doing so raises the risk of septic bursitis introduced by the needle, of damage to the tendon beneath, of skin thinning over it, and of sinus tracts that go on draining. Hypersensitivity to Triamcinolone or any component of the formulation. The site of injection and volume of injection should be carefully considered due to the potential for cutaneous atrophy. Egypt PHARCOCINOLONE 40MG/ML I.M AMP. CHEMIPHARM > ... 8.00 EGP AMCINOL 40MG/ML I.M AMP. SIGMA TEC 11.00 EGP EPIRELEFAN 40MG/ML I.M AMP. EIPICO 38.00 EGP SYNTHECORTIN 40MG/ML I.M AMP. MUP 54.00 EGP ANALGESIA - NON-NSAID FIRST-LINE OPTION 4. PARACETAMOL [1st line] Adult 1 g 3 or 4 times daily (maximum 4 g daily) Peds 15 mg/kg/dose [child max 500 mg] (MSF: child 1 month and over, 15 mg/kg 3 or 4 times daily (maximum 60 mg/kg daily); child under 1 month, 10 mg/kg 3 or 4 times daily (maximum 40 mg/kg daily).) 3kg -> 45 mg/dose 4kg -> 60 mg/dose 5kg -> 75 mg/dose 6kg -> 90 mg/dose 7kg -> 105 mg/dose 8kg -> 120 mg/dose 9kg -> 135 mg/dose 10kg -> 150 mg/dose 11kg -> 165 mg/dose 12kg -> 180 mg/dose 13kg -> 195 mg/dose 14kg -> 210 mg/dose 15kg -> 225 mg/dose 16kg -> 240 mg/dose 17kg -> 255 mg/dose 18kg -> 270 mg/dose 19kg -> 285 mg/dose 20kg -> 300 mg/dose 21kg -> 315 mg/dose 22kg -> 330 mg/dose 23kg -> 345 mg/dose 24kg -> 360 mg/dose 25kg -> 375 mg/dose 26kg -> 390 mg/dose 27kg -> 405 mg/dose 28kg -> 420 mg/dose 29kg -> 435 mg/dose 30kg -> 450 mg/dose 31kg -> 465 mg/dose 32kg -> 480 mg/dose 33kg -> 495 mg/dose 34kg -> 500 mg/dose (capped) 35kg -> 500 mg/dose (capped) 36kg -> 500 mg/dose (capped) 37kg -> 500 mg/dose (capped) 38kg -> 500 mg/dose (capped) 39kg -> 500 mg/dose (capped) 40kg -> 500 mg/dose (capped) 41kg -> 500 mg/dose (capped) 42kg -> 500 mg/dose (capped) 43kg -> 500 mg/dose (capped) 44kg -> 500 mg/dose (capped) 45kg -> 500 mg/dose (capped) 46kg -> 500 mg/dose (capped) 47kg -> 500 mg/dose (capped) 48kg -> 500 mg/dose (capped) 49kg -> 500 mg/dose (capped) 50kg -> 500 mg/dose (capped) Source MSF Essential Drugs 2024 (paracetamol oral monograph, mild pain) Why The disease article names NSAIDs and paracetamol together as the first-line analgesics for bursitis; the card offered only naproxen, so a patient in whom an NSAID is unsuitable - peptic ulcer, renal impairment, anticoagulation - had no analgesic option at all. MSF Essential Drugs gives paracetamol an explicit mild-pain indication with an adult and a paediatric dose. Caution Do not exceed indicated doses, especially in children and older patients. Paracetamol intoxications are severe (hepatic cytolysis). Administer with caution to patients with hepatic impairment. Paracetamol has no anti-inflammatory properties. Egypt FEBRIMOL 500 MG 20 TAB. PHARCO 3.50 EGP (0.17/unit) CETAMOL 500 MG 20 TABS. MEMPHIS 8.00 EGP (0.40/unit) PARACETAMOL-MUP 500MG B.P. 20 TABS. MUP 13.00 EGP (0.65/unit) CETAL 500 MG 20 TABS. EIPICO 24.00 EGP (1.20/unit) ARKADOLOW 500 MG 30 F.C. TABS. UTOPIA 42.00 EGP (1.40/unit) PARAMOL 500MG 20 TAB. MISR 38.00 EGP (1.90/unit) ADOL 500MG 24 CAPLETS JULPHAR 32.00 EGP AUGICETAMIDE 500 MG 20 SACHETS AUG PHARMA 50.00 EGP FEBRIMOL ORAL DROPS 20 ML PHARCO 4.00 EGP -> ? strength differs, ? different route - not oral solid THERA-LO 3.2G/100ML ORAL SUSP. 100 ML PHAROPHARMA 5.00 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)