What is the initial treatment for a patient with an olecranon bone spur?

Initial Treatment for Olecranon Bone Spur

The initial treatment for an olecranon bone spur should include rest, ice application, NSAIDs, and activity modification to reduce pressure on the affected elbow. 1

Conservative Management (First-Line)

Conservative treatment should be implemented for 1-2 weeks before considering more invasive options:

• Rest: Avoid activities that aggravate symptoms
• Ice: Apply for 15-20 minutes several times daily to reduce inflammation
• NSAIDs: For pain control and to decrease inflammation
• Activity modification: Reduce repetitive elbow movements and pressure on the olecranon

If the patient has contraindications to NSAIDs, acetaminophen can be used as an alternative analgesic 1.

Physical Therapy Interventions

If symptoms persist beyond initial management, physical therapy should be incorporated:

• Progressive range-of-motion exercises focusing on supination/pronation
• Strengthening exercises for forearm muscles
• Joint mobilization techniques to improve function 1

Physical therapy modalities may include:

• Ultrasound therapy
• Electrical stimulation 1

Advanced Interventions

For patients who fail to respond to conservative measures after 2-4 weeks:

Corticosteroid Injections

• Intrabursal corticosteroid injections may be considered for persistent olecranon bursitis associated with the bone spur 1
• Caution: These should be used as a short-term bridging option only due to potential complications 1

Surgical Management

Surgery should be reserved for cases that fail conservative management 1. Surgical options include:

1. Endoscopic extrabursal excision: Less morbidity compared to open techniques and avoids a wound over the sensitive skin of the olecranon 2
2. Open excision: Traditional approach for symptomatic olecranon spurs that have failed conservative management 3

Prevention and Long-Term Management

To prevent recurrence:

• Use protective padding over the olecranon during activities
• Correct biomechanical abnormalities
• Modify activities that cause repetitive trauma 1

Special Considerations

• Radiographs should be the initial imaging modality to evaluate the bone spur 4
• If radiographs are inconclusive, CT without contrast provides detailed bone assessment 1
• MRI without contrast may be indicated if there is suspicion of associated soft tissue injury 1
• Ensure proper differential diagnosis to rule out fracture, infection, or inflammatory arthritis 1

Monitoring and Follow-up

• Reassess after 1-2 weeks of conservative management
• If symptoms persist beyond 4-6 weeks despite conservative treatment, consider advanced interventions
• Monitor for complications such as bursitis, which may require additional treatment 3