Management of Traumatic Olecranon Bursitis
The first-line treatment for traumatic olecranon bursitis is conservative management with ice, rest, anti-inflammatory medications, and analgesics, with aspiration reserved for specific cases and surgical intervention only for refractory cases. 1
Clinical Assessment
- Evaluate for signs of infection (fever, significant erythema, warmth, severe pain)
- Distinguish septic from non-septic bursitis
- Check for skin integrity over the bursa
- Assess for underlying conditions (gout, rheumatoid arthritis)
Diagnostic Approach
- Aspiration is indicated when:
- Infection is suspected
- Significant pain or functional limitation exists
- Large fluid collection causes discomfort
- Aspirated fluid should be examined for:
- Gram stain and culture
- Cell count (WBC >2000/mm³ suggests infection)
- Crystal analysis (to rule out gout)
- Glucose measurement (lower in septic bursitis)
Treatment Algorithm
Step 1: Conservative Management (First-Line)
- Rest and activity modification to avoid pressure on the elbow
- Ice application for 15-20 minutes several times daily
- Compression with elastic bandage
- Elevation of the affected arm
- NSAIDs for pain and inflammation
- Protective padding during healing phase
Step 2: Aspiration (For Selected Cases)
- Indicated for:
- Large, symptomatic effusions
- Diagnostic purposes when infection is suspected
- Technique:
- Use sterile technique
- Avoid multiple needle punctures
- Consider leaving a pressure dressing afterward
- Note: Aspiration alone (without steroids) is preferred for traumatic cases 2
Step 3: Antibiotics (For Septic Bursitis)
- Empiric therapy should cover Staphylococcus aureus
- Outpatient oral antibiotics for mild cases:
- Dicloxacillin, cephalexin, or clindamycin
- Inpatient IV antibiotics for severe cases or systemic symptoms
- Duration: 10-14 days 3, 4
Step 4: Management of Refractory Cases
- For persistent non-septic bursitis:
- Continued conservative measures
- Repeated aspiration may be considered
- Avoid corticosteroid injections due to risk of complications 2
- For persistent septic bursitis:
- Repeated aspiration
- Consider surgical intervention
Step 5: Surgical Management (Last Resort)
- Indications:
- Failed conservative treatment
- Recurrent septic bursitis
- Chronic symptomatic bursitis unresponsive to other measures
- Options:
- Open bursectomy (complete removal of bursal tissue)
- Arthroscopic bursectomy (minimally invasive alternative) 1
Important Considerations and Cautions
Corticosteroid Injections
- Not recommended for traumatic olecranon bursitis due to:
- Risk of infection (3 cases in 25 patients)
- Skin atrophy (5 cases in 25 patients)
- Chronic local pain (7 cases in 25 patients) 2
- Long-term follow-up shows delayed recovery and complications with steroid injections compared to aspiration alone
Complications to Monitor
- Infection (septic bursitis)
- Skin breakdown
- Chronic pain
- Recurrence
- Wound healing problems after surgical intervention 5
Follow-up Care
- Regular reassessment until resolution
- Patient education about avoiding direct pressure on the elbow
- Consider protective padding for activities that may cause recurrence
- Complete recovery may take weeks to months, particularly for septic cases 4
By following this structured approach, most cases of traumatic olecranon bursitis can be effectively managed with conservative measures, reserving more invasive interventions for specific indications.