From the Guidelines
The treatment of olecranon bursitis typically begins with conservative measures, including rest, ice, compression, and elevation, as well as over-the-counter NSAIDs like ibuprofen or naproxen to reduce pain and inflammation. The goal of these measures is to reduce morbidity and improve quality of life by minimizing pain and inflammation. According to the principles outlined in 1, most patients with overuse tendinopathies, which can include olecranon bursitis, fully recover within three to six months with relative rest, icing, and eccentric strengthening exercises.
Conservative Treatment
- Rest the affected elbow to avoid further irritation
- Apply ice for 15-20 minutes several times daily to reduce inflammation
- Use compression with an elastic bandage to help reduce swelling
- Elevate the arm when possible to reduce inflammation
- Over-the-counter NSAIDs like ibuprofen (400-600mg three times daily) or naproxen (250-500mg twice daily) can help reduce pain and inflammation
Further Treatment Options
For more severe cases, aspiration of the bursa fluid may be necessary, performed by a healthcare provider using sterile technique, sometimes followed by a corticosteroid injection such as methylprednisolone (20-40mg) or triamcinolone (10-40mg) 1. Antibiotics are required if infection is present, commonly cephalexin (500mg four times daily) or clindamycin (300-450mg four times daily) for 7-10 days. Surgical intervention (bursectomy) is reserved for cases that don't respond to conservative treatment or recur frequently, as it is a more invasive option with potential risks and should only be considered when the benefits outweigh these risks, prioritizing the reduction of morbidity and improvement of quality of life. Prevention strategies include wearing elbow pads during activities that put pressure on the elbow and avoiding leaning on hard surfaces. These treatments work by reducing inflammation in the bursa, a fluid-filled sac that normally allows smooth movement between the olecranon process and the skin.
From the Research
Treatment Options for Olecranon Bursitis
- Conservative treatment is often the first line of treatment, including ice, rest, anti-inflammatory and analgesic drugs, and occasionally, bursal fluid aspiration 2
- For unresponsive patients, arthroscopy is increasingly being considered as a suitable new modality of management, avoiding the wound problems often occurring following open excision 2
- A treatment algorithm for olecranon bursitis can be developed based on a systematic review of the literature, including differentiation between septic and non-septic bursitis, and treatment with bursal aspiration, NSAIDs, and PRICE 3
- Surgical treatment, such as incision, drainage, or bursectomy, should be restricted to severe, refractory, or chronic/recurrent cases 3, 4
Septic vs. Aseptic Bursitis
- Septic bursitis is often treated with antibiotic therapy, while aseptic bursitis may be treated with intrabursal steroid injection, although this is associated with significant risks without improving the outcome 3, 4, 5
- Aseptic bursitis appears to have a more complicated clinical course than septic bursitis, with a higher overall complication rate 4
Non-Surgical Treatment
- Non-surgical management of olecranon bursitis is significantly more effective and safer than surgical management, based on level IV evidence 4
- Conservative methods, such as rest, ice, and compression, can lead to clinical resolution of aseptic olecranon bursitis if implemented earlier in the disease course 5
- Empirical treatment of uncomplicated septic olecranon bursitis without aspiration may be effective, with fewer chronic draining sinuses and less progression to bursectomy 6