Bursitis — regenerative treatment

What is bursitis

The body has more than 150 synovial bursae — small synovial-fluid filled sacs that reduce friction between tendons and bones, and between muscles. Overload, trauma or infection cause the bursa to inflame, accumulate fluid and thicken.

Overload and repetitive movement

Working on knees (prepatellar), with arms overhead (subdeltoid), prolonged sitting (ischial). Microtrauma triggers aseptic inflammation.

Direct trauma

Bruise with hematoma in the bursa. A common scenario — olecranon bursitis ("student's elbow") after striking a desk.

Infection

Septic bursitis. Bacterial penetration through the skin (overlying abrasion) or from a distant focus. Requires urgent aspiration, culture and antibiotics.

Systemic disease

Rheumatoid arthritis, gout, tuberculosis. Bursitis is part of the wider process and is treated alongside the underlying disease.

Common locations

Shoulder (subacromial)

The most common. Pain on arm abduction, night pain. Often accompanies rotator cuff tendinitis. → More

Trochanteric (hip)

Pain over the greater trochanter on the lateral hip. Worsens lying on the affected side. → More

Olecranon (elbow)

Swelling and tenderness on the back of the elbow ("student's elbow"). Septic form — redness and fever.

Prepatellar and infrapatellar

Bursae in front of and below the kneecap. "Housemaid's knee." Fluctuant swelling above the knee.

Heel (retrocalcaneal)

Between the Achilles tendon and the calcaneus. Often coexists with Achilles tendinopathy.

Ischial, iliopsoas

Deep pelvic bursae. Diagnosed only with ultrasound and MRI. Common cause of "unexplained" buttock or groin pain.

Bursitis diagnosis

Clinical examination

Palpation over the bursa, provocation tests, range-of-motion assessment. Superficial bursae present visible, palpable swelling.

Ultrasound

Method of choice. Accurately measures fluid volume, wall thickness, septations. Used for image-guided aspiration and injection.

MRI

For deep bursae and ambiguous cases. Excludes coexisting pathology: rotator cuff tears, fractures, tumors.

Bursitis: treatment options and what is known about them

The treatment plan is made by the clinic doctor after an examination and a review of your images. The table shows the options usually discussed for this diagnosis and how well they have been studied.

Option	What to expect	How well studied
Load management, weight loss	Takes load off the affected area; if overweight, losing 5–10% noticeably reduces pain	Well studied, recommended
Exercise therapy and physiotherapy	Reduces pain, strengthens muscles, improves function; the basis of treatment	Well studied, recommended
Painkillers and NSAIDs	Ease pain during flare-ups; long-term use is limited by side effects	Moderate evidence
Corticosteroid injection	Quickly reduces inflammation and pain, the effect is often temporary; frequent injections are undesirable	Moderate evidence
PRP / CGF	Concentrate from your own blood; may reduce pain, growth of new tissue has not been shown	Little data
Bursa removal (bursectomy) — rarely	If conservative treatment does not help or there is an indication	When indicated — the doctor decides

We send your request to several partner clinics. Some will suggest conservative treatment or injections, others surgery; each clinic quotes its own conditions and price. We help you compare the options.

Regenerative methods: realistic expectations

Bursitis usually settles with offloading, exercise therapy and painkillers. A corticosteroid injection reduces inflammation quickly, but the effect may be temporary. A tendon problem often lies behind “bursitis” — then that is what is treated. PRP has been little studied in bursitis and is rarely used.

When surgery is discussed. Surgery (removal of the bursa) is rarely done — for frequent recurrences, infection or if conservative treatment has not helped for months.

If an injection helps, the effect usually builds up over 6–12 weeks, and the result is assessed after 2–3 months. No clinic can guarantee a result.

Who it is not suitable for and possible risks

Contraindications

Active infection — at the injection site or systemic, with fever.
Active cancer or ongoing chemotherapy.
Blood clotting disorders or a low platelet count. Anticoagulants are discussed with the physician.
Pregnancy and breastfeeding — the procedure is usually postponed.
A corticosteroid injection into the same area in recent weeks.
A complete tendon or ligament rupture with loss of function — surgical repair is usually needed.

Possible risks

Pain and swelling at the injection site for 1–3 days.
Bruising where blood or fat tissue is taken.
Rarely, infection. The procedure is therefore performed under sterile conditions with ultrasound or X-ray guidance.
The effect may be absent or smaller than expected.

If any of these apply to you, mention it in your request. The coordinator will check with the clinic physician whether treatment is possible. Contact a coordinator.

Scientific evidence

Studies of regenerative methods show mixed results. Clinic physicians rely on research including the following:

Sheth U et al. Efficacy of autologous platelet-rich plasma use for orthopaedic indications: a meta-analysis. J Bone Joint Surg Am, 2012.
Andia I et al. Platelet-rich plasma for muscle injury and tendinopathy. Sports Med Arthrosc Rev, 2013.

Next steps: Treatment methods · Treatment cost · How treatment in Germany is organised

Frequently asked questions

Bursitis: can surgery be avoided?

Almost always: bursitis is treated with offloading, exercise, painkillers and sometimes aspiration or an injection. Surgery is rarely needed.

Bursitis: do PRP and cell-based methods help?

There is little data. Offloading, exercise and, if needed, a corticosteroid injection usually come first; PRP is discussed if the cause is tendon damage.

When can I expect a result after an injection?

If an injection helps, relief usually builds up over 6–12 weeks. The result is assessed after 2–3 months; not everyone needs a repeat procedure. No clinic can guarantee a result.

Bursitis: when is surgery needed?

Surgery (removal of the bursa) is rarely done — for frequent recurrences, infection or if conservative treatment has not helped for months. The decision is made by the clinic doctor.

How does RegenPAS help organise treatment?

RegenPAS is a patient service centre in Munich, not a clinic. We review your images and symptoms and send a request to several partner clinics at once. Clinics that can accept you send their own conditions and price; prices differ between clinics, and you choose the option that suits you. The coordinator replies within 24 hours, and a clinic physician’s preliminary opinion follows in 1–3 business days. We then arrange the appointment, visa invitation, interpreter, transfers and accommodation. Treatment decisions are made by the clinic physician. Contact a coordinator.

What is needed for a preliminary assessment?

Your MRI (or CT, X-ray) report and the images if you have them, plus a short description of your symptoms and previous treatment. Send them via the form on the website — the assessment is free and without obligation: the coordinator replies within 24 hours, and the clinic physician’s preliminary opinion follows in 1–3 business days.

How much does treatment cost and how long do I need to stay in Munich?

The cost depends on the method, the diagnostics needed and the clinic itself: prices differ between clinics. We request offers from several clinics and send you their conditions and quotes so you can compare. Price guidance is on the treatment cost page. For an outpatient procedure, 2–3 days in Munich are usually enough: examination, procedure and follow-up visit.