What is the treatment for olecranon (elbow) bursitis?

Treatment of Olecranon Bursitis

For olecranon bursitis, initial treatment should be conservative with rest, ice, NSAIDs, and activity modification, followed by aspiration for persistent cases, while avoiding corticosteroid injections due to their association with complications.

Diagnosis and Classification

Before initiating treatment, it's essential to determine whether the olecranon bursitis is:

1. Septic (infectious) - characterized by:

   • Fever
   • Significant warmth and erythema
   • Rapid onset
   • History of skin break/puncture
   • Systemic symptoms

2. Non-septic (aseptic) - characterized by:

   • Gradual onset
   • Minimal erythema
   • History of repetitive trauma or pressure
   • Absence of systemic symptoms

Treatment Algorithm

First-Line Treatment for Non-Septic Olecranon Bursitis

1. Conservative Management 1:

   • Rest and activity modification
   • Ice application (15-20 minutes several times daily)
   • NSAIDs for pain and inflammation 1
   • Padding or protection of the elbow
   • Avoidance of direct pressure on the olecranon

2. If symptoms persist (after 2-3 weeks):

   • Aspiration of bursal fluid 2, 3
   • Continue NSAIDs and protective measures

For Septic Olecranon Bursitis

1. Diagnostic aspiration to confirm infection 3
2. Antibiotic therapy based on culture results or empirically 4
   • Coverage for Staphylococcus aureus is essential
   • Duration typically 10-14 days
3. Repeated aspiration may be necessary to drain purulent fluid 3
4. Consider hospitalization for:
   • Systemic symptoms
   • Immunocompromised patients
   • Failed outpatient management

Important Considerations and Cautions

Corticosteroid Injections

• AVOID intrabursal corticosteroid injections as they are associated with:
  • Increased overall complications 2
  • Skin atrophy 5
  • Risk of infection 5
  • Chronic local pain 5

Surgical Management

• Reserve for cases that fail conservative management
• Surgery has higher rates of:
  • Overall complications 2
  • Persistent drainage 2
  • Bursal infection 2

Follow-up Recommendations

• Non-septic cases: Re-evaluate in 1-2 weeks
• Septic cases: More frequent follow-up (2-3 days initially)
• Full recovery may take weeks to months, particularly for septic bursitis 3

Special Populations

Athletes/Active Individuals

• May require more aggressive initial treatment to expedite return to activities
• Protective padding for return to activities

Patients with Inflammatory Arthritis

• Evaluate for underlying joint disease that may contribute to bursitis
• Coordinate management with rheumatology if appropriate 1

When to Consider Referral

• Failure to improve after 4-6 weeks of conservative treatment
• Recurrent episodes of bursitis
• Suspicion of septic bursitis with poor response to antibiotics
• Need for surgical intervention

Remember that non-surgical management is significantly more effective and safer than surgical management for olecranon bursitis 2, and that corticosteroid injections should be avoided due to their association with complications despite their rapid symptomatic relief 5.