What is the evaluation and treatment of olecranon (elbow) bursitis?

From the Guidelines

Olecranon bursitis evaluation and treatment should prioritize distinguishing between septic and non-septic cases, with initial treatment for non-septic cases including rest, ice, compression, elevation, and NSAIDs, while septic cases require antibiotic therapy and potential surgical intervention. The evaluation of olecranon bursitis should begin with a thorough history and physical examination to determine the nature of the condition 1. For non-septic olecranon bursitis, initial treatment includes rest, ice application for 15-20 minutes several times daily, compression with an elastic bandage, and elevation of the affected arm. NSAIDs such as ibuprofen 400-600mg three times daily or naproxen 500mg twice daily for 7-10 days can help reduce inflammation and pain. Activity modification to avoid pressure on the elbow is essential.

If these conservative measures fail after 2-3 weeks, aspiration of the bursa fluid may be performed, potentially followed by a corticosteroid injection (such as methylprednisolone 20-40mg) 2. For septic bursitis, antibiotic therapy is necessary, typically with coverage for Staphylococcus aureus using cephalexin 500mg four times daily or clindamycin 300mg four times daily for 7-10 days, along with bursal drainage. Surgical intervention (bursectomy) may be required for recurrent or refractory cases. The distinction between septic and non-septic bursitis is crucial as treatment differs significantly, with septic cases requiring more aggressive intervention to prevent spread of infection to adjacent structures and potential systemic complications.

Key considerations in the management of olecranon bursitis include:

• Distinguishing between septic and non-septic cases
• Initial conservative treatment for non-septic cases
• Prompt antibiotic therapy and potential surgical intervention for septic cases
• Activity modification to avoid pressure on the elbow
• Potential use of corticosteroid injections for non-septic cases that do not respond to initial treatment. The most recent and highest quality study 1 provides guidance on the evaluation and treatment of acute elbow and forearm pain, including olecranon bursitis, emphasizing the importance of distinguishing between septic and non-septic cases and tailoring treatment accordingly.

From the FDA Drug Label

Management of Pain, Primary Dysmenorrhea, and Acute Tendonitis and Bursitis Because the sodium salt of naproxen is more rapidly absorbed, naproxen sodium is recommended for the management of acute painful conditions when prompt onset of pain relief is desired. 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.

The evaluation of olecranon bursitis involves assessing the patient's symptoms and medical history. The treatment of olecranon bursitis with naproxen may involve a starting dose of 500 mg, followed by 500 mg every 12 hours or 250 mg every 6 to 8 hours as required 3. Key considerations for treatment include:

• The initial total daily dose should not exceed 1250 mg of naproxen.
• Thereafter, the total daily dose should not exceed 1000 mg of naproxen. Alternatively, prednisone may be used as an adjunctive therapy for short-term administration to tide the patient over an acute episode or exacerbation of bursitis 4.

From the Research

Evaluation of Olecranon Bursitis

• The evaluation of olecranon bursitis involves distinguishing between septic and aseptic bursitis, which can be difficult due to overlapping physical and laboratory data 5.
• Physical examination findings for septic olecranon bursitis include tenderness, erythema/cellulitis, warmth, report of trauma or evidence of a skin lesion, and fever, while aseptic bursitis may present with similar findings, but to a lesser extent 5.
• Laboratory data ranges for septic and aseptic olecranon bursitis have been summarized in the literature, but the optimum length and route of antibiotic treatment for septic cases remains unclear 5.

Treatment of Olecranon Bursitis

• The first line of treatment for olecranon bursitis is conservative, including ice, rest, anti-inflammatory and analgesic drugs, and occasionally, bursal fluid aspiration 6.
• Nonsurgical management of olecranon bursitis is significantly more effective and safer than surgical management, with a lower risk of complications such as persistent drainage and bursal infection 7.
• Corticosteroid injection for aseptic bursitis is associated with increased overall complications, including skin atrophy, and does not improve the outcome of aseptic bursitis 7, 8.
• Arthroscopy is a suitable new modality of management for olecranon bursitis, allowing for minimally invasive procedures that avoid wound problems often occurring following open excision 6.
• Conservative methods, such as rest, ice, compression, orthosis wear, and nonsteroidal anti-inflammatory medications, can resolve symptoms of nonseptic olecranon bursitis, and are recommended as the initial treatment 9.