From the Guidelines
Treatment for olecranon bursitis typically begins with conservative measures, including rest, ice application, compression, and elevation of the affected elbow, as well as NSAIDs like ibuprofen or naproxen to reduce pain and inflammation 1. The initial approach to managing olecranon bursitis involves a combination of non-pharmacological and pharmacological interventions.
- Rest and avoidance of activities that aggravate the condition
- Ice application for 15-20 minutes several times daily to reduce inflammation
- Compression with an elastic bandage to help reduce swelling
- Elevation of the affected elbow to decrease inflammation
- Over-the-counter NSAIDs, such as ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily), can help alleviate pain and inflammation 1. Activity modification is crucial, including avoiding leaning on the elbow and protecting it with an elbow pad during recovery. For more severe cases, aspiration of fluid from the bursa may be performed by a healthcare provider, sometimes followed by a corticosteroid injection to reduce inflammation. However, the provided evidence does not directly address olecranon bursitis treatment but rather discusses heel pain and overuse tendon problems 1. Given the context of real-life clinical medicine and prioritizing morbidity, mortality, and quality of life, the recommended treatment approach focuses on conservative management, with surgery reserved for cases that do not respond to conservative treatment or recur frequently. It is essential to note that while the evidence provided does not specifically focus on olecranon bursitis, the principles of managing inflammation and reducing pain can be applied, emphasizing the importance of a thorough clinical evaluation to guide treatment decisions.
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. The treatment for olcraneon bursitis is naproxen.
- The recommended 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
- Nonsurgical management of olecranon bursitis is significantly more effective and safer than surgical management, with a lower overall complication rate 4
- Corticosteroid injection for aseptic bursitis is associated with increased overall complications and skin atrophy, and does not improve the outcome of aseptic bursitis 4, 5
- Aspiration does not increase the risk of bursal infection for aseptic bursitis 4
Surgical Management
- Surgical management is less likely to clinically resolve septic or aseptic bursitis, and demonstrates higher rates of overall complications, persistent drainage, and bursal infection 4
- Open excisional procedures allow for complete removal of the pathological bursal tissue, but are associated with wound problems 3
- Arthroscopy is a minimally invasive alternative to open excision, with fewer complications 3
Management of Septic Bursitis
- Empiric antibiotic therapy without bursal aspiration may be a reasonable initial approach to ED management of select patients with suspected septic olecranon bursitis 6
- Adjuvant antibiotic therapy might be limited to 7 days in non-immunosuppressed patients with severe infectious bursitis requiring hospitalization 7
- Immunosuppression is a risk factor for recurrence of septic bursitis 7