From the Research
A patient with olecranon bursitis that is not improving should be referred to an orthopedic specialist. The orthopedic specialist is typically the primary referral choice as they specialize in musculoskeletal conditions and can provide comprehensive evaluation and treatment options for persistent bursitis. Rheumatologists may be appropriate if there is suspicion of an underlying inflammatory or autoimmune condition contributing to the bursitis, however, the most recent evidence suggests that orthopedic specialists are better equipped to handle the condition 1. The specialist will likely perform additional diagnostic tests such as fluid aspiration to rule out infection, ultrasound or MRI to assess the extent of inflammation, and possibly blood tests to identify systemic causes. They can offer advanced treatment options including therapeutic aspiration under sterile conditions, prescription-strength anti-inflammatory medications, or surgical intervention such as bursectomy if conservative measures fail. Referral should be considered when the patient has failed 2-3 weeks of conservative treatment including rest, ice, compression, elevation, NSAIDs, and activity modification, or if there are concerning features such as fever, significant erythema, rapid onset of symptoms, or history of immunocompromise that might suggest septic bursitis requiring urgent care 2. Some key points to consider when referring a patient with olecranon bursitis include:
- The patient's overall health and medical history
- The severity of symptoms and impact on daily activities
- The presence of any underlying conditions that may be contributing to the bursitis
- The effectiveness of previous treatments and any potential side effects 3. It's also important to note that corticosteroid injections are not recommended as a first-line treatment due to the potential for adverse effects 1. Ultimately, the decision to refer a patient with olecranon bursitis to an orthopedic specialist should be based on the individual patient's needs and circumstances, and should take into account the most recent and highest quality evidence available 4, 5.