From the Guidelines
Olecranon bursitis should be managed based on whether it is septic or non-septic, with initial treatment for non-septic cases including rest, ice, compression, and elevation, as well as over-the-counter NSAIDs like ibuprofen or naproxen, as recommended by recent guidelines 1. The management of olecranon bursitis involves a step-wise approach, starting with conservative measures for non-septic cases.
- Rest, ice application for 15-20 minutes several times daily, compression with an elastic bandage, and elevation of the affected arm are essential initial steps.
- Over-the-counter NSAIDs like ibuprofen (400-600mg three times daily) or naproxen (250-500mg twice daily) can help reduce pain and inflammation, as supported by the American College of Radiology guidelines 1.
- Activity modification to avoid pressure on the elbow is crucial to prevent further irritation and inflammation. If these conservative measures fail after 2-3 weeks, aspiration of the bursa fluid may be performed, sometimes followed by a corticosteroid injection (such as methylprednisolone 20-40mg). For septic bursitis, oral antibiotics targeting Staphylococcus aureus (like cephalexin 500mg four times daily for 7-10 days) are prescribed, along with aspiration of the infected fluid, as septic bursitis requires prompt treatment to prevent spread of infection to adjacent structures 1. Severe cases may require intravenous antibiotics or surgical intervention (bursectomy), and recurrent cases might benefit from surgical removal of the bursa. The condition occurs due to direct trauma, prolonged pressure on the elbow, inflammatory conditions like gout, or infection through breaks in the skin, highlighting the importance of proper diagnosis and management to improve patient outcomes, as emphasized in recent studies 1.
From the Research
Diagnosis and Management of Olecranon Bursitis
- Olecranon bursitis is a condition characterized by inflammation and fluid collection in the olecranon bursa, and its management is often conservative, including ice, rest, anti-inflammatory and analgesic drugs, and occasionally, bursal fluid aspiration 2.
- The optimal management of olecranon bursitis is ill-defined, and a systematic review of clinical outcomes for aseptic versus septic bursitis, comparing surgical versus nonsurgical management, and examining the roles of corticosteroid injection and aspiration in aseptic bursitis has been conducted 3.
Treatment Options
- Nonsurgical management of olecranon bursitis is significantly more effective and safer than surgical management, based primarily on level IV evidence 3.
- Corticosteroid injection for aseptic bursitis is associated with increased overall complications and skin atrophy, and aspiration does not increase the risk of bursal infection for aseptic bursitis 3, 4.
- Conservative methods, such as rest, ice, compression, orthosis wear, and nonsteroidal anti-inflammatory medications, can lead to clinical resolution of aseptic olecranon bursitis if implemented earlier in the disease course 4, 5.
Complications and Risks
- Surgical management is less likely to clinically resolve septic or aseptic bursitis and demonstrates higher rates of overall complications, persistent drainage, and bursal infection than nonsurgical management 3.
- Corticosteroid injection is associated with a higher number of complications, including bursal infection and skin atrophy, and should be reserved for refractory cases 4.
- Intrabursal injections and surgery have been shown to have adverse effects compared with noninvasive management for initial treatment of nonseptic olecranon bursitis 5.