What is the treatment for olecranon bursitis (elbow bursitis)?

From the Guidelines

Treatment of elbow bursitis should begin with conservative measures, including rest, ice application, compression, and elevation, as well as over-the-counter NSAIDs like ibuprofen or naproxen to reduce pain and inflammation. The primary goal of treatment is to reduce inflammation, relieve pain, and prevent further irritation of the olecranon bursa. According to the most recent study 1, diagnostic imaging plays a key role in assessing acute elbow pain, but in the case of elbow bursitis, initial treatment is often focused on symptom management rather than imaging.

Conservative Measures

• Rest and avoidance of activities that aggravate symptoms
• Ice application for 15-20 minutes several times daily
• Compression with an elastic bandage
• Elevation of the affected arm
• Over-the-counter NSAIDs like ibuprofen (400-800mg three times daily with food) or naproxen (220-440mg twice daily)

Further Treatment

For more severe cases, a healthcare provider may perform aspiration followed by a corticosteroid injection such as methylprednisolone or triamcinolone to reduce inflammation 1. If the bursitis is infected, recognizable by warmth, redness, and fever, antibiotics like cephalexin (500mg four times daily for 7-10 days) are necessary. Physical therapy exercises to maintain range of motion and strengthen surrounding muscles may be recommended during recovery. Surgery is rarely needed but may be considered for chronic cases that don't respond to other treatments.

Prevention of Recurrence

Preventing recurrence is crucial and involves avoiding repetitive pressure on the elbow, using elbow pads for protection during activities that involve leaning on the elbow, and maintaining a healthy weight to reduce pressure on the joints. Regular exercise to strengthen the muscles around the elbow can also help prevent future episodes of bursitis.

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 of Elbow Bursitis:

• The recommended dose of naproxen for the relief of signs and symptoms of bursitis is 500 mg, followed by 500 mg every 12 hours or 250 mg every 6 to 8 hours as required 2, 2.
• The initial total daily dose should not exceed 1250 mg of naproxen, and thereafter, the total daily dose should not exceed 1000 mg of naproxen 2.
• Key Considerations:
  • Use the lowest effective dose for the shortest duration consistent with individual patient treatment goals.
  • Naproxen may be used for the relief of signs and symptoms of bursitis, but the dose and frequency should be adjusted to suit an individual patient's needs 2, 2.

From the Research

Treatment Options for Elbow Bursitis

• Conservative management is often the first line of treatment, including ice, rest, anti-inflammatory and analgesic drugs, and occasionally, bursal fluid aspiration 3
• Nonsteroidal anti-inflammatory drugs (NSAIDs) may be used to manage symptoms 4, 3
• Local corticosteroid injection may be used in the management of olecranon bursitis, but its use in retrocalcaneal bursitis may adversely affect the biomechanical properties of the Achilles tendon 4
• Surgical intervention may be required for recalcitrant bursitis, such as refractory trochanteric bursitis 4
• Arthroscopy is increasingly being considered as a suitable new modality of management for olecranon bursitis, as it avoids the wound problems often occurring following open excision 3

Treatment of Septic Bursitis

• Septic bursitis requires prompt treatment with antibiotics, and in some cases, surgical wash-out of the affected bursa may be necessary 5, 6
• Oral antibiotics may be administered for septic bursitis, but in severe cases, parenteral antibiotics may be required 5, 6
• The most common organism isolated from bursal fluid in septic bursitis is Staphylococcus aureus 5, 6

Comparative Efficacies of Treatment Options

• Recent literature has demonstrated adverse effects of intrabursal injections and surgery compared with noninvasive management for initial treatment of nonseptic olecranon bursitis 7
• More research is needed to identify the comparative efficacies of each option for management of nonseptic olecranon bursitis and to tailor decision-making for individual patients 7