What is the treatment for olecranon bursitis?

Management of Olecranon Bursitis

Conservative management is the first-line treatment for olecranon bursitis, including rest, ice, NSAIDs, and aspiration in select cases, as surgical intervention should be reserved for refractory cases due to higher complication rates. 1

Diagnosis and Assessment

• Clinical Presentation:

  • Swelling over the posterior elbow (olecranon process)
  • May present with erythema, warmth, tenderness
  • Possible history of trauma, repetitive pressure, or infection
  • Pain may be exacerbated with elbow movement or direct pressure

• Differentiation between Septic vs. Non-septic Bursitis:

  • Aspiration of bursal fluid is essential for diagnosis when infection is suspected 2
  • Send fluid for cell count, Gram stain, culture
  • Septic bursitis typically presents with more acute onset, systemic symptoms, and marked erythema

Treatment Algorithm

1. Non-septic Olecranon Bursitis (Primary Approach)

• First-line Treatment:

  • Rest and protection of the affected elbow
  • Ice application for 15-20 minutes several times daily
  • NSAIDs for pain and inflammation
    • Naproxen 500mg twice daily is recommended for acute bursitis 3
    • Continue until symptoms resolve, typically 7-14 days
  • Avoid direct pressure on the olecranon

• Second-line Treatment (if no improvement after 2 weeks):

  • Aspiration of bursal fluid
    • Aseptic technique is crucial
    • Aspiration alone does not increase risk of infection in aseptic bursitis 1
  • Compression wrap after aspiration
  • Continue NSAIDs and activity modification

• Refractory Cases:

  • Consider surgical referral if no improvement after 4-6 weeks of conservative management
  • Arthroscopic or open bursectomy may be necessary for chronic cases 4

2. Septic Olecranon Bursitis

• Immediate Management:

  • Aspiration of bursal fluid for diagnosis
  • Empiric antibiotic therapy pending culture results
  • Possible hospital admission for severe cases or immunocompromised patients 5

• Ongoing Treatment:

  • Repeat aspirations as needed
  • Complete antibiotic course (typically 10-14 days)
  • Surgical drainage may be required for refractory cases

Important Considerations

Corticosteroid Injections

• Caution with corticosteroid injections: Despite rapid symptom relief, intrabursal corticosteroid injections are associated with significantly higher complication rates including:

  • Skin atrophy (5 cases in one study) 6
  • Increased risk of infection 1
  • Chronic local pain 6
  • Overall higher complication rate compared to other treatments 7

• While triamcinolone acetonide is FDA-approved for bursitis 8, evidence shows that corticosteroid injections should be reserved for refractory cases due to complications.

Surgical vs. Non-surgical Management

• Research demonstrates that non-surgical management is significantly more effective and safer than surgical management for olecranon bursitis 1
• Surgery is associated with:
  • Lower rates of clinical resolution
  • Higher rates of overall complications
  • Increased risk of persistent drainage
  • Greater likelihood of bursal infection

Follow-up and Monitoring

• Regular assessment of treatment response every 2-3 weeks
• Monitor for signs of infection or recurrence
• For chronic cases, measurement of arm circumference at fixed distances above and below the olecranon can help quantify swelling 5

Prevention Strategies

• Avoid direct pressure on the elbow
• Use elbow pads during activities that put pressure on the olecranon
• Proper ergonomic setup for work environments
• Early intervention at first signs of swelling or discomfort

Conclusion

The evidence strongly supports conservative management as the first-line approach for olecranon bursitis. Surgical intervention should be reserved for cases that fail to respond to conservative measures after 4-6 weeks. Corticosteroid injections, while effective for symptom relief, carry significant risks and should be used cautiously in select cases.