What is the treatment for olecranon bursitis?

From the Guidelines

Treatment for olecranon bursitis should prioritize conservative measures, including rest, ice, compression, and elevation, along with NSAIDs for pain and inflammation management, as these approaches are crucial for reducing morbidity and improving quality of life. When considering the management of olecranon bursitis, it's essential to focus on the most recent and highest quality evidence available, although the provided study 1 does not directly address olecranon bursitis but rather heel pain, the principles of initial treatment with NSAIDs and consideration of corticosteroid injections can be broadly applied to bursitis conditions.

Key Considerations

• Rest, ice application for 15-20 minutes several times daily, compression with an elastic bandage, and elevation of the affected elbow are fundamental in the initial management of olecranon bursitis.
• Over-the-counter NSAIDs like ibuprofen or naproxen can help reduce pain and inflammation, thus improving the patient's quality of life and reducing morbidity.
• Activity modification, including avoiding leaning on the elbow and protecting it with an elbow pad during recovery, is crucial for preventing further irritation and allowing the bursa to heal.
• For more severe cases, aspiration of the bursal fluid followed by a corticosteroid injection may be considered, as these interventions can significantly reduce inflammation and pain, thereby improving outcomes in terms of morbidity and mortality.

Management of Complications

• In cases of infection, identified by signs such as warmth, redness, fever, or purulent drainage, antibiotics like cephalexin or clindamycin are necessary to prevent further complications and improve patient outcomes.
• Surgery (bursectomy) is typically reserved for cases that do not respond to conservative treatment or recur frequently, as it carries inherent risks and should be balanced against the potential benefits in reducing morbidity and improving quality of life. Given the indirect nature of the provided evidence 1 regarding olecranon bursitis treatment, the approach should prioritize general principles of bursitis management, focusing on reducing inflammation, relieving pain, and preventing infection to minimize morbidity and mortality while enhancing the patient's quality of life.

From the FDA Drug Label

For relief of the signs and symptoms of tendonitis For relief of the signs and symptoms of bursitis The recommended starting dose of naproxen is 500 mg, followed by 500 mg every 12 hours or 250 mg every 6 to 8 hours as required.

Olecranon bursitis treatment with naproxen involves taking the medication to relieve the signs and symptoms of bursitis.

• The recommended starting dose is 500 mg, followed by 500 mg every 12 hours or 250 mg every 6 to 8 hours as required.
• The initial total daily dose should not exceed 1250 mg of naproxen.
• Thereafter, the total daily dose should not exceed 1000 mg of naproxen 2.

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 3
• Arthroscopy is being considered as a suitable new modality of management for unresponsive patients, as it is a minimally invasive procedure that avoids wound problems often occurring following open excision 3
• For septic olecranon bursitis, antibiotic therapy should be initiated, while for non-septic cases, intrabursal steroid injection may be performed for patients with high athletic or occupational demands 4

Surgical Treatment

• Surgical treatment, such as incision, drainage, or bursectomy, should be restricted to severe, refractory, or chronic/recurrent cases 4
• Open excisional procedures allow for the complete removal of pathological bursal tissue, but arthroscopy is a viable alternative with fewer complications 3
• Surgical management is less likely to clinically resolve septic or aseptic bursitis and demonstrates higher rates of overall complications, persistent drainage, and bursal infection compared to nonsurgical management 5

Non-Surgical Treatment

• Non-surgical management of olecranon bursitis is significantly more effective and safer than surgical management, based primarily on level IV evidence 5
• Corticosteroid injection for aseptic bursitis is associated with increased overall complications and skin atrophy, but may be considered for refractory cases 6, 5
• Aspiration does not increase the risk of bursal infection for aseptic bursitis, and empiric antibiotic therapy without bursal aspiration may be a reasonable initial approach for select patients with suspected septic olecranon bursitis 5, 7

Treatment Algorithm

• The initial differentiation between septic and non-septic bursitis is based on clinical presentation, bursal aspirate, and blood sampling analysis 4
• A treatment algorithm for olecranon bursitis should consider the type of bursitis, patient characteristics, and treatment outcomes to guide management decisions 4