What is the treatment for olecranon bursitis?

Management of Olecranon Bursitis

For olecranon bursitis, conservative treatment with NSAIDs, ice application, activity modification, and rest is the first-line approach, as nonsurgical management is significantly more effective and safer than surgical intervention. 1

What is Olecranon Bursitis?

Olecranon bursitis is inflammation of the bursal sac superficial to the olecranon process of the elbow. It can be:

• Non-septic (aseptic): Caused by trauma, repetitive pressure, or inflammatory conditions
• Septic: Caused by infection, typically through direct inoculation from puncture wounds or spread from adjacent infections

Causes

• Direct trauma or repetitive pressure on the elbow ("student's elbow," "miner's elbow")
• Direct inoculation through wounds or injuries 2
• Spread from adjacent soft tissue infections 2
• Crystal deposition diseases (gout, calcium pyrophosphate deposition) 2
• Biomechanical factors 2

Diagnosis

1. Clinical presentation:

   • Swelling over the olecranon process
   • Pain with movement or direct pressure
   • Erythema (may be present in both septic and non-septic cases)
   • Warmth

2. Imaging:

   • Plain radiographs to rule out fractures or other bony abnormalities 2
   • Ultrasound to confirm fluid collection and evaluate bursal wall thickening 2
   • MRI for cases with suspected associated conditions 2

3. Aspiration (when infection is suspected):

   • Fluid analysis including cell count, Gram stain, and culture

Treatment Algorithm

1. Non-septic Olecranon Bursitis

First-line treatment:

• NSAIDs such as naproxen (500mg twice daily) 3
• Ice application for 10-minute periods through a wet towel 2
• Activity modification to avoid pressure on the elbow 2
• Rest and protection of the affected area

For persistent cases:

• Aspiration of the bursa may provide symptomatic relief 1
• Avoid corticosteroid injection as it is associated with significant complications including skin atrophy, infection, and chronic local pain without improving outcomes 1, 4

2. Septic Olecranon Bursitis

First-line treatment:

• Aspiration of the bursa to obtain fluid for analysis
• Empiric antibiotic therapy targeting common skin pathogens (Staphylococcus aureus, Streptococcus species)
• Recent evidence suggests that empiric antibiotics without aspiration may be reasonable in select patients, with 88% resolving without complications 5

For severe or refractory cases:

• Repeated aspiration may be necessary
• Intravenous antibiotics for severe infections
• Surgical intervention (bursectomy) for cases that fail conservative management

Expected Outcomes

• Non-septic bursitis typically resolves within 2-3 weeks with conservative treatment 2
• Septic bursitis may take months for complete recovery 6
• Non-septic bursitis paradoxically has a higher overall complication rate compared to septic bursitis 1

Important Considerations

1. Avoid surgical management when possible, as it is associated with higher rates of complications including persistent drainage and bursal infection 1

2. Avoid corticosteroid injections for aseptic bursitis, as they are associated with significant risks including skin atrophy without improving outcomes 1, 4

3. Monitor for red flags that may indicate more serious conditions:

   • Fever or systemic symptoms
   • Rapidly worsening pain or swelling
   • Spreading erythema or lymphangitis
   • Immunocompromised status

4. Prevention strategies:

   • Protective padding for those engaged in activities with risk of elbow trauma
   • Strengthening exercises for supporting muscles 2
   • Avoiding prolonged pressure on the elbow

By following this treatment approach, most cases of olecranon bursitis can be effectively managed without the need for invasive interventions.