From the Research
The management of olecranon bursitis should prioritize conservative measures, including rest, ice application, compression, and elevation (RICE) of the affected elbow, as well as the use of nonsteroidal anti-inflammatory drugs (NSAIDs) for pain and inflammation, with empiric antibiotic therapy without bursal aspiration being a reasonable initial approach for suspected septic cases, as supported by the most recent study 1.
Conservative Management
Conservative measures are the first line of treatment for olecranon bursitis, aiming to reduce pain and inflammation. This includes:
- Rest, ice, compression, and elevation (RICE) of the affected elbow
- Avoiding activities that put pressure on the elbow
- Using an elbow pad to protect the area
- Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) for 7-10 days to reduce pain and inflammation
Management of Septic Bursitis
For cases where infection is suspected, based on signs such as warmth, redness, fever, or rapid onset, the approach has evolved. Recent studies suggest that empiric antibiotic therapy without bursal aspiration can be an effective and reasonable initial approach for uncomplicated septic olecranon bursitis 1, 2. Common empiric antibiotic choices include cephalexin (500mg four times daily) or dicloxacillin (500mg four times daily) for 7-10 days to cover Staphylococcus aureus, the most common pathogen.
Surgical Intervention
Surgical intervention, such as bursectomy, is typically reserved for cases that fail conservative management or have recurrent infections. The decision for surgery should be made on a case-by-case basis, considering the severity of symptoms, the presence of complications, and the patient's overall health status.
Considerations
It's essential to differentiate between aseptic (inflammatory) and septic (infectious) bursitis, as the treatment approach varies significantly between the two. Aseptic bursitis may be managed with conservative measures and, in some cases, corticosteroid injections, though the latter carries a risk of infection. Septic bursitis, on the other hand, requires prompt antibiotic therapy, and the recent evidence supports the use of empiric antibiotics without initial aspiration in uncomplicated cases 1, 2.