From the Guidelines
Treatment for olecranon bursitis should begin with conservative measures, including rest, ice application, compression, and elevation of the affected elbow, as well as over-the-counter NSAIDs such as ibuprofen or naproxen to reduce pain and inflammation. The provided evidence does not directly address olecranon bursitis, but general principles of treating bursitis and other inflammatory conditions can be applied.
- Conservative measures are essential in the initial treatment phase, aiming to reduce inflammation and protect the bursa from further irritation.
- Activity modification is crucial, with patients advised to avoid leaning on the elbow and considering the use of an elbow pad for protection.
- If conservative measures do not provide relief within 2-3 weeks or if the bursitis is severe, medical intervention may be necessary, which could include aspiration of the bursa or corticosteroid injection 1.
- For infected bursitis, treatment with oral antibiotics such as cephalexin may be prescribed, with severe cases potentially requiring intravenous antibiotics or surgical drainage.
- Chronic or recurrent cases may ultimately require surgical removal of the bursa (bursectomy), although this is typically considered a last resort. The most recent and highest quality study provided is from 2007 1, which, although focused on hand osteoarthritis, supports the use of conservative measures and individualized treatment approaches for inflammatory conditions affecting joints and surrounding tissues.
From the FDA Drug Label
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. The initial total daily dose should not exceed 1250 mg of naproxen. Thereafter, the total daily dose should not exceed 1000 mg of naproxen.
Treatment for olecranon bursitis may include naproxen.
- The recommended dose is 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.
- The total daily dose should not exceed 1000 mg of naproxen thereafter 2, 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
- For unresponsive patients, arthroscopy is increasingly being considered as a suitable new modality of management, avoiding the wound problems often occurring following open excision 3
- Differentiation between septic and non-septic bursitis is crucial, with septic bursitis requiring antibiotic therapy and non-septic bursitis potentially benefiting from intrabursal steroid injection 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 complete removal of the pathological bursal tissue, but may result in wound problems 3
- Arthroscopy is a minimally invasive alternative to open excision, with fewer complications 3
Empiric Antibiotic Management
- Empiric antibiotic therapy without bursal aspiration may be a reasonable initial approach to ED management of select patients with suspected septic olecranon bursitis 5
- A study found that 88% of ED patients with suspected septic olecranon bursitis treated with empiric antibiotics without aspiration had resolution without need for subsequent bursal aspiration, hospitalization, or surgery 5
- Another study found that empirical management without aspiration was effective in treating uncomplicated septic olecranon bursitis, with no patients requiring bursectomy 6
Comparison of Treatment Outcomes
- A systematic review found that nonsurgical management of olecranon bursitis is significantly more effective and safer than surgical management 7
- The review also found that corticosteroid injection for aseptic bursitis is associated with increased overall complications and skin atrophy, without improving the outcome of aseptic bursitis 7