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, NSAIDs, and activity modification to reduce pressure on the affected elbow for 1-2 weeks. 1

Diagnostic Approach

Before initiating treatment, proper diagnosis is essential:

1. Clinical Assessment:

   • Look for cardinal signs of infection: erythema, warmth, tenderness, fluctuant swelling, and systemic symptoms 1
   • Differentiate between septic and non-septic bursitis (approximately one-third of cases are septic) 2

2. Diagnostic Procedures:

   • Aspiration of bursa for definitive diagnosis 1
   • Send fluid for cell count, Gram stain, cultures, and crystal analysis 1
   • Radiographs to exclude fractures or bony abnormalities 1
   • Ultrasound to confirm bursal fluid collection and guide aspiration if needed 1

Treatment Algorithm

Non-Septic Olecranon Bursitis

1. Initial Conservative Management (1-2 weeks):

   • Rest and activity modification to reduce pressure on the affected elbow
   • Ice application for 10-minute periods through a wet towel
   • NSAIDs (e.g., naproxen 500mg twice daily) 1, 3
   • Compression and protective padding

2. If no improvement after 1-2 weeks:

   • Aspiration of bursal fluid 1, 2
   • Continue NSAIDs and activity modification

3. For persistent cases:

   • Serial aspirations every 3-5 days if reaccumulation occurs 1
   • Caution: Intrabursal corticosteroid injections should be used only as a short-term bridging option due to increased risk of complications including skin atrophy, infection, and chronic local pain 1, 4

Septic Olecranon Bursitis

1. Immediate Management:

   • Aspiration of bursal fluid 1
   • Empiric antibiotic therapy targeting Staphylococcus aureus and streptococci 1
     • First-line oral options: Cephalexin or Dicloxacillin
     • First-line IV options: Cefazolin or Nafcillin/Oxacillin

2. Ongoing Management:

   • Adjust antibiotics based on culture results 1
   • Continue antibiotics for at least 14 days 1
   • Serial aspirations every 3-5 days if reaccumulation occurs 1
   • Consider hospitalization for patients with systemic symptoms, immunocompromised patients, or surrounding cellulitis 1

3. For refractory cases:

   • Surgical consultation if no improvement after 3-5 days of appropriate treatment 1

Special Considerations

• Surgery: Should be reserved for refractory cases that fail conservative management, as nonsurgical approaches are significantly more effective and safer 1, 5

• Corticosteroid Injections: While they can provide rapid symptom relief, they carry significant risks including infection, skin atrophy, and chronic local pain 4, 5

• Naproxen Dosing: For bursitis, the recommended dose is 500mg initially, followed by 500mg every 12 hours or 250mg every 6-8 hours as required. Initial total daily dose should not exceed 1250mg, with subsequent daily doses not exceeding 1000mg 3

Prevention of Recurrence

• Address underlying mechanical factors and treat underlying medical conditions 1
• Use protective padding over susceptible areas 1
• Correct biomechanical abnormalities 1
• Modify activities that cause repetitive trauma 1
• Ensure complete healing before returning to normal activities 1

Common Pitfalls to Avoid

1. Failing to distinguish between septic and non-septic bursitis
2. Premature use of corticosteroid injections before ruling out infection
3. Inadequate duration of antibiotic therapy for septic bursitis
4. Rushing to surgical intervention before adequate trial of conservative measures
5. Overlooking the need for activity modification and protective padding to prevent recurrence