What is the treatment for olecranon bursitis?

Treatment of Olecranon Bursitis

The first-line treatment for olecranon bursitis is conservative management with rest, ice application, and NSAIDs such as naproxen 500 mg twice daily, with aspiration reserved for symptomatic relief in moderate to severe cases. 1, 2

Diagnosis and Classification

Before initiating treatment, it's important to distinguish between septic and non-septic olecranon bursitis:

• Non-septic bursitis: Usually caused by trauma, repetitive pressure, or inflammatory conditions
• Septic bursitis: Caused by bacterial infection, typically Staphylococcus aureus

Key diagnostic features:

• Swelling over the olecranon process
• Pain with direct pressure or elbow movement
• Erythema (may be present in both septic and non-septic cases)
• Fever and systemic symptoms (more suggestive of septic bursitis)

When diagnosis is uncertain, bursal aspiration with fluid analysis (cell count, Gram stain, culture) is essential to differentiate between septic and non-septic bursitis 3.

Treatment Algorithm

1. Non-septic Olecranon Bursitis

Initial Conservative Management (1-2 weeks):

• Rest and activity modification to avoid pressure on the affected elbow 4
• Ice application for 10-minute periods through a wet towel to reduce inflammation 4
• NSAIDs such as naproxen 500 mg twice daily (maximum 1000 mg/day) 1
• Protective padding to prevent further trauma

For Moderate to Severe Cases:

• Aspiration of bursal fluid for symptomatic relief 2
  • Should be performed under sterile conditions
  • May need to be repeated if fluid reaccumulates
  • Avoid corticosteroid injection as it's associated with significant complications including skin atrophy and infection 5, 2, 6

For Persistent Cases (>3-4 weeks despite conservative treatment):

• Consider referral for surgical management if conservative measures fail
• Surgical options include open bursectomy or arthroscopic bursectomy 7

2. Septic Olecranon Bursitis

• Immediate aspiration of bursal fluid for diagnostic purposes 3
• Empiric antibiotic therapy targeting Staphylococcus aureus pending culture results
• May require repeated aspirations to drain purulent material
• More severe cases may require hospital admission for IV antibiotics
• Surgical drainage if not responding to aspiration and antibiotics 3

Complications and Pitfalls

1. Corticosteroid injections: Despite providing rapid symptom relief, they carry significant risks including:

   • Skin atrophy (reported in up to 20% of cases) 5
   • Increased risk of infection 2
   • Chronic local pain 5

2. Surgical management: Associated with higher complication rates than non-surgical approaches:

   • Persistent drainage
   • Wound healing problems
   • Bursal infection 2

3. Recurrence: Common with both septic and non-septic bursitis if underlying causes are not addressed

Follow-up and Monitoring

• Regular follow-up until resolution of symptoms
• Monitor for signs of infection if aspiration was performed
• Assess for recurrence and consider preventive measures (elbow pads, activity modification)
• Complete recovery from septic bursitis may take months 3

Special Considerations

• In patients with recurrent olecranon bursitis, address underlying causes such as occupational factors or anatomical predisposition
• For patients with inflammatory arthritis, management of the underlying condition is essential
• Patients with diabetes or immunocompromised states require closer monitoring for infection

Remember that non-septic olecranon bursitis typically resolves with conservative management within 2-3 weeks 4, though some cases may take longer. Surgical intervention should be reserved for cases that fail to respond to appropriate conservative management.