What are the recommended first-line treatments for acute bursitis in adults?

First-line treatments for acute bursitis in adults focus on conservative management when the bursitis is non-septic. These include:

• Rest to reduce mechanical stress on the inflamed bursa.
• Application of ice to the affected area for 10 minutes at a time every few hours, ensuring a barrier such as a thin towel is placed between the ice and skin to reduce swelling.
• Activity modification to avoid actions that worsen symptoms (e.g., kneeling) and protect the area (e.g., using kneepads).
• Simple analgesia such as paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs) for pain relief. Topical NSAIDs may be preferred initially if paracetamol is insufficient.

These conservative measures are recommended until symptoms improve, with reassurance that most people respond well to this approach.

If symptoms worsen or there is suspicion of infection (septic bursitis), further assessment including bursal aspiration and antibiotic treatment is indicated.