What criteria should I use to decide whether to refer a patient with chronic bursitis to a specialist?

Criteria for referral of a patient with chronic bursitis to a specialist include:

• Refer urgently or seek specialist advice if the patient has septic bursitis that does not respond or inadequately responds to antibiotic treatment, as they may require a change in antibiotic, intravenous antibiotics, or surgical intervention such as incision and drainage ¹,²,³.
• Refer if aspiration of the bursa is needed but there is no expertise available in primary care ¹,².
• Refer patients with recurrent septic bursitis for consideration of surgical excision of the bursa, but only after infection has cleared ¹,².
• Consider referral if a patient with non-septic bursitis, in whom septic bursitis has been excluded, does not respond to conservative management after 2 months, or sooner if symptoms are severe (e.g., significant discomfort), as corticosteroid injection or surgical management may be beneficial ¹,²,³.
• Refer patients with systemic signs of infection or inflammation, immunocompromise, severe septic bursitis with necrosis of overlying skin, or severe soft tissue infection for hospital admission and specialist care ¹,²,³.
• Refer patients with persistent infection despite appropriate antibiotic treatment, infection with difficult-to-treat organisms (e.g., environmental fungi), sepsis, underlying osteomyelitis, abscess, fistula, skin necrosis, foreign body, or chronic/refractory non-septic bursitis for specialist assessment ¹,²,³.
• Referral should be made sooner than 2 months if there are symptoms suggestive of septic bursitis ¹,²,³.