Treatment of Elbow Bursitis
The recommended treatment for elbow bursitis follows a stepped care approach starting with conservative measures including rest, NSAIDs, and ice, progressing to aspiration and corticosteroid injection if needed, with surgical intervention reserved for refractory cases. 1, 2, 3
Initial Conservative Management
First-Line Treatment
- Rest and activity modification: Avoid activities that put pressure on the affected elbow
- NSAIDs: Use naproxen 500mg twice daily or ibuprofen 1.2-2.4g daily as first-line pharmacological treatment 2, 4
- Ice application: Apply for 15-20 minutes every 2-3 hours to reduce inflammation 2
- Compression: Use an elastic bandage to reduce swelling
- Elevation: Keep the affected elbow elevated when possible
The FDA-approved indication for naproxen specifically includes the treatment of bursitis, with a recommended starting dose of 500mg followed by 500mg every 12 hours or 250mg every 6-8 hours as required 4. The American Heart Association recommends using the lowest effective dose for the shortest duration to minimize cardiovascular risk 1.
Second-Line Treatment
If symptoms persist after 2-3 weeks of conservative management:
Aspiration: For significant swelling or suspected septic bursitis
- Aspiration helps diagnose infection and provides symptomatic relief
- Send fluid for culture if infection is suspected
Corticosteroid injection: Consider for persistent inflammation 2, 5
- Limit to 2-3 injections with 4-6 weeks between injections
- Caution: Avoid repeated injections as they may lead to skin atrophy or tendon weakening
Management of Specific Types of Elbow Bursitis
Septic Bursitis
- Requires oral antibiotics (empiric coverage for Staphylococcus aureus)
- May require repeated aspirations
- Consider hospitalization for IV antibiotics in severe cases or immunocompromised patients
Chronic/Recurrent Bursitis
- Continue NSAIDs and activity modification
- Consider protective padding to prevent recurrence
- Physical therapy may help with range of motion and strengthening
Surgical Management
Surgical intervention should be considered only when:
- Symptoms persist despite 3-6 months of well-managed conservative treatment 2
- Significant functional limitations impact quality of life
- Recurrent episodes despite appropriate conservative management
Surgical options include:
- Bursectomy (open or arthroscopic)
- Recent evidence increasingly supports minimally invasive arthroscopic approaches 3, 6
Follow-up and Return to Activity
- Follow up within 1-2 weeks if symptoms persist
- Return to full activity when:
- Complete resolution of pain during and after activity
- Full range of motion compared to uninjured side
- Gradual return to normal activities
Common Pitfalls to Avoid
- Failing to rule out infection: Always consider septic bursitis, especially with acute onset, significant erythema, or systemic symptoms
- Overuse of corticosteroid injections: Limit to 2-3 injections to prevent complications
- Premature return to aggravating activities: Ensure adequate healing before resuming activities that put pressure on the elbow
- Missing underlying conditions: Consider systemic conditions like gout or rheumatoid arthritis in recurrent or unusual presentations 6
Remember that most cases of elbow bursitis respond well to conservative management, with recent evidence increasingly supporting non-surgical over surgical interventions for most patients 6.