What is the recommended treatment for olecranon bursa issues, including the use of a splint?

Treatment of Olecranon Bursitis: Splinting Recommendations

Splinting is generally not recommended as a primary treatment for olecranon bursitis due to potential complications including increased attention to the area, accessory muscle use, compensatory movement patterns, muscle deconditioning, and increased pain.

Assessment of Olecranon Bursitis

When evaluating olecranon bursitis, determine:

• Whether it is septic or aseptic (non-infectious)
• Duration and severity of symptoms
• Presence of skin breakdown or fistula
• Associated pain and functional limitations

Treatment Algorithm

First-Line Treatment for Aseptic Olecranon Bursitis:

1. Conservative management:

   • PRICE protocol (Protection, Rest, Ice, Compression, Elevation)
   • Activity modification to reduce pressure on the elbow
   • Open-backed elbow protection to avoid direct pressure
   • NSAIDs for pain and inflammation 1

2. Aspiration considerations:

   • May be performed for significant fluid collection causing discomfort
   • Does not increase infection risk in aseptic cases 2
   • Avoid corticosteroid injection as it increases complications including skin atrophy 2

For Septic Olecranon Bursitis:

1. Antibiotics and drainage:

   • Systemic antibiotics based on culture results (common pathogens: Staphylococcus aureus, beta-hemolytic Streptococcus) 3
   • Aspiration or incision and drainage for purulent collections

2. For refractory cases:

   • Complete bursectomy with debridement 4
   • Consider vacuum-assisted closure therapy for severe cases 5

Role of Splinting in Olecranon Bursitis

Splinting should be used with caution and only in specific circumstances:

• Short-term immobilization: May be considered for 2-3 days post-procedure (aspiration or surgical intervention) 4
• Avoid prolonged splinting: Extended immobilization can lead to muscle deconditioning and compensatory movement patterns 1
• Removable splints: If used, should be monitored regularly with clear instructions to discontinue if pain increases or skin breakdown occurs 1

Important Caveats and Pitfalls

1. Surgical vs. Nonsurgical Management:

   • Nonsurgical management is significantly more effective and safer than surgical management 2
   • Surgery has higher rates of complications including persistent drainage and infection 2

2. Complications of Bursectomy:

   • Wound healing problems (27%)
   • Recurrence (22%)
   • Potential need for soft tissue coverage in some cases 6

3. Splinting Risks:

   • May increase focus and attention on the affected area
   • Can promote accessory muscle use and compensatory movements
   • May lead to muscle deconditioning
   • Can increase pain in some cases 1

Follow-up Recommendations

• Regular monitoring for symptom improvement
• Assess for signs of infection (increasing pain, erythema, warmth)
• Early functional rehabilitation once acute symptoms resolve
• Gradual return to normal activities with protection of the elbow

For most cases of olecranon bursitis, encouraging normal movement patterns and proper resting postures is more beneficial than splinting. If conservative measures fail after 6-8 weeks, referral to a specialist may be warranted 1.