How is olecranon bursitis managed?

Management of Olecranon Bursitis

For olecranon bursitis, treatment should be based on whether the condition is septic or non-septic, with initial conservative management for non-septic cases and appropriate antibiotic therapy for septic cases. 1

Diagnosis and Classification

Clinical Assessment

• Pain, swelling, and erythema over the olecranon process
• Distinguish between septic and non-septic bursitis:
  • Septic: More acute onset, marked erythema, warmth, tenderness, fever
  • Non-septic: Often related to trauma, gout, or rheumatoid arthritis

Diagnostic Testing

• Aspiration may be considered for diagnostic purposes when infection is suspected
• Fluid should be sent for:
  • Cell count (WBC >3000/mm³ suggests infection)
  • Gram stain and culture
  • Crystal analysis to rule out gout

Treatment Algorithm

Non-Septic Olecranon Bursitis

1. First-line treatment:

   • Rest and activity modification
   • Ice application (10 minutes through a wet towel)
   • Compression with elastic bandage
   • NSAIDs for pain and inflammation
   • Avoidance of direct pressure on the elbow

2. Second-line treatment (if no improvement after 2-3 weeks):

   • Aspiration of bursal fluid to relieve pressure
   • Consider corticosteroid injection (controversial due to risk of introducing infection)
   • Protective padding or elbow sleeves

3. Refractory cases:

   • Surgical bursectomy (open or arthroscopic)
   • Arthroscopic approach may reduce wound complications 2

Septic Olecranon Bursitis

1. Initial management:

   • Empirical antibiotic therapy targeting Staphylococcus aureus (most common pathogen)
   • Options include first-generation cephalosporins or anti-staphylococcal penicillins
   • Consider MRSA coverage based on local prevalence

2. Drainage options:

   • Traditional approach: Aspiration and drainage of the infected bursa 3
   • Alternative approach: Empirical management without aspiration may be considered in uncomplicated cases 4
   • For severe cases: Percutaneous placement of suction-irrigation system with local antibiotic irrigation 3

3. Antibiotic duration:

   • Minimum 14 days of antibiotic therapy is recommended
   • Treatment duration <14 days is associated with higher failure rates 5

4. Surgical intervention indications:

   • Failed conservative management
   • Recurrent infections
   • Persistent drainage
   • Extensive cellulitis
   • Systemic symptoms

Special Considerations

Recurrent Olecranon Bursitis

• Identify and address underlying causes (occupation, sports, anatomical factors)
• Consider protective padding during activities
• Surgical bursectomy may be necessary for chronic recurrent cases

Complications to Monitor

• Chronic draining sinuses
• Spread of infection to adjacent structures
• Recurrence after treatment

Follow-up Recommendations

• Regular assessment every 1-2 weeks during active treatment
• Monitor for resolution of symptoms and signs of infection
• Educate patient on prevention strategies (avoiding direct pressure on elbow, protective padding)

Prevention

• Protective padding for high-risk activities
• Avoid prolonged pressure on the elbow
• Prompt treatment of minor trauma to the elbow area

The evidence suggests that while aspiration has traditionally been recommended for septic olecranon bursitis, empirical antibiotic treatment without aspiration may be effective in uncomplicated cases, with potentially fewer complications such as chronic draining sinuses 4.