From the Guidelines
Olecranon bursitis is best treated with a combination of rest, ice, compression, and elevation (RICE therapy) for 1-2 weeks, as this approach has been shown to reduce pain and inflammation, and promote healing 1. The treatment of olecranon bursitis should prioritize reducing pain and inflammation, while also promoting healing and preventing further injury.
- Rest and reduced activity are essential to prevent further damage and promote healing, although the optimal duration of rest is not well established 1.
- Cryotherapy, such as applying ice for 15-20 minutes every 2-3 hours, can provide acute relief of pain and is widely accepted as a treatment for tendinopathy 1.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (400-600mg three times daily with food) or naproxen (500mg twice daily) can be used to reduce pain and inflammation, but their effect on long-term outcomes is unclear 1.
- It is also important to avoid activities that put pressure on the elbow and consider using an elbow pad for protection.
- If the area is red, warm, or extremely painful, medical attention should be sought as these may indicate infection requiring antibiotics.
- For severe or infected cases, aspiration to drain fluid or injection of corticosteroids like methylprednisolone or triamcinolone may be necessary, and surgery may be considered for recurrent cases. The goal of treatment is to reduce pain and inflammation, promote healing, and prevent further injury, with the ultimate goal of improving morbidity, mortality, and quality of life for patients with olecranon bursitis.
From the Research
Diagnosis and Treatment of Olecranon Bursitis
- Olecranon bursitis is a common cause of musculoskeletal pain and often prompts orthopaedic consultation, it must be distinguished from arthritis, fracture, tendinitis, and nerve pathology 2.
- The first treatment line for olecranon bursitis is conservative, including ice, rest, anti-inflammatory and analgesic drugs and, occasionally, bursal fluid aspiration 3.
- Most patients respond to nonsurgical management, including ice, activity modification, and nonsteroidal anti-inflammatory drugs 2.
- Local corticosteroid injection may be used in the management of olecranon bursitis; however, steroid injection may adversely affect the treatment outcome and is associated with a higher number of complications including bursal infection and skin atrophy 4, 5.
Surgical Intervention
- Surgical intervention may be required for recalcitrant bursitis, such as refractory trochanteric bursitis 2.
- Open excisional procedures allow for the complete removal of the pathological bursal tissue, but arthroscopy is increasingly being considered as a suitable new modality of management 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 than nonsurgical management 5.
Non-Surgical Treatment
- Non-surgical management of olecranon bursitis is significantly more effective and safer than surgical management 5, 6.
- The clinical resolution of aseptic olecranon bursitis can occur with conservative methods if implemented earlier in the disease course 4.
- Corticosteroid injection is associated with significant risks without improving the outcome of aseptic bursitis, and should be reserved for refractory cases 4, 5.