What is the recommended treatment for olecranon bursitis?

Treatment of Olecranon Bursitis

The first-line treatment for olecranon bursitis should be conservative management including rest, ice, compression, and NSAIDs, with aspiration reserved for symptomatic relief in cases with significant swelling. 1, 2

Classification and Diagnosis

• Septic vs. Non-septic: Differentiate based on clinical parameters:

  • Septic: Fever, significant erythema, warmth, rapidly developing symptoms
  • Non-septic: Gradual onset, minimal erythema, history of repetitive trauma

• Diagnostic considerations:

  • Plain radiography may be useful to rule out bony abnormalities, calcific tendinosis, or fractures 1
  • Aspiration for diagnostic purposes if infection is suspected (analyze fluid for cell count, culture)

Treatment Algorithm

1. Non-septic Olecranon Bursitis

Initial Management (First 1-2 weeks):

• Rest and activity modification to prevent ongoing damage 1
• Ice application for 10-minute periods through a wet towel to reduce swelling and pain 1
• Compression bandaging to limit fluid reaccumulation 3
• NSAIDs (oral or topical) for pain relief and anti-inflammatory effects 1, 4
  • Naproxen 500mg twice daily is specifically indicated for bursitis 4
  • Lower doses should be considered in elderly patients or those with renal/hepatic impairment 4

If No Improvement After 2 Weeks:

• Aspiration may be considered for symptomatic relief of large, painful bursal effusions 2, 3
  • Caution: Aspiration alone has been associated with delayed recovery compared to other treatments 3
  • Does not increase risk of infection in aseptic bursitis 2

Corticosteroid Injections:

• Not recommended as first-line treatment due to significant risks without improved outcomes 2
• Associated with complications including skin atrophy (5 cases), infection (3 cases), and chronic local pain (7 cases) in long-term follow-up 5
• If used, should be reserved for recalcitrant cases after failure of other conservative measures 1

2. Septic Olecranon Bursitis

• Immediate aspiration for diagnosis and drainage 6
• Antibiotics based on Gram stain and culture results
• Incision and drainage or bursectomy for purulent bursitis 6

3. Surgical Management

• Reserved for cases that fail conservative management after 4-6 weeks 2
• Higher complication rates than non-surgical management, including persistent drainage and bursal infection 2
• Options include:
  • Open bursectomy (complete removal of pathological bursal tissue)
  • Arthroscopic bursectomy (minimally invasive alternative) 7

Outcomes and Prognosis

• Non-surgical management is significantly more effective and safer than surgical management 2
• Compression bandaging with NSAIDs has shown 83% resolution rate by 4 weeks 3
• Aspiration with steroid injection provides fastest resolution (average 2.3 weeks) but with higher complication rates 3, 5
• Longer duration of symptoms before treatment is associated with treatment failure 3

Important Considerations

• Aseptic bursitis may have a more complicated clinical course than septic bursitis 2
• Avoid complete immobilization to prevent muscular atrophy and deconditioning 1
• For patients with increased gastrointestinal risk (age ≥60 years, history of peptic ulcer disease or GI bleeding), consider acetaminophen, topical NSAIDs, or oral NSAIDs with gastroprotective agents 1