What is the recommended treatment for elbow bursitis?

Treatment of Elbow Bursitis

The recommended first-line treatment for elbow bursitis includes relative rest, activity modification, ice application, NSAIDs, and possibly bracing, with progressive rehabilitation exercises introduced as symptoms improve. 1

Initial Conservative Management (0-4 weeks)

• Relative rest prevents ongoing damage while promoting tendon healing, though complete immobilization should be avoided to prevent muscular atrophy 1
• Activities that aggravate symptoms should be modified or temporarily stopped, while those that don't worsen pain may be continued 1
• Cryotherapy (ice application) for 10-minute periods through a wet towel provides effective short-term pain relief 1
• NSAIDs (oral or topical) effectively relieve pain and are specifically indicated for bursitis according to FDA labeling 2
• The recommended starting dose of naproxen for bursitis is 500 mg, followed by 500 mg every 12 hours or 250 mg every 6 to 8 hours as required, with initial total daily dose not exceeding 1250 mg 2
• Counterforce bracing or padding can help protect the affected area during activity 1, 3
• Compression and elevation may help reduce swelling in acute traumatic/hemorrhagic bursitis 3

Rehabilitation Phase (2-8 weeks)

• Progressive eccentric strengthening exercises should be introduced as symptoms improve to promote healing and increase strength 1
• Stretching exercises are beneficial for recovery and preventing recurrence 1
• Continue bracing as needed during activities 1
• Address underlying causes of chronic microtraumatic bursitis to prevent recurrence 3

Second-Line Treatments for Persistent Symptoms

• Bursal aspiration may be considered for acute traumatic/hemorrhagic bursitis to shorten the duration of symptoms 3
• However, aspiration of microtraumatic bursitis is generally not recommended due to the risk of iatrogenic septic bursitis 3
• Corticosteroid injections may provide relief but should be used with caution as they may inhibit healing and reduce tendon strength 1, 3
• Therapeutic ultrasound and deep transverse friction massage may be beneficial for pain reduction 1

Management of Septic Bursitis

• If infection is suspected (fever, significant erythema, rapidly worsening symptoms), prompt bursal aspiration should be performed 3, 4
• Fluid should be examined using Gram stain, crystal analysis, glucose measurement, blood cell count, and culture 3
• Initial antibiotic therapy should target Staphylococcus aureus, the most common causative organism 3, 4
• Outpatient antibiotics may be considered for patients who are not acutely ill, while hospitalization and intravenous antibiotics are recommended for acutely ill patients 3

Surgical Management

• Surgical intervention is reserved for cases that fail to respond to 6-12 months of well-managed conservative treatment 1, 5
• Options include open excision of the bursa or arthroscopic approaches 5
• Arthroscopy is increasingly considered as a suitable minimally invasive alternative to open procedures 5
• For septic bursitis unresponsive to antibiotics or recurrent cases, surgical drainage may be necessary 3, 4

Common Pitfalls and Caveats

• Failure to distinguish between septic and non-septic bursitis can lead to inappropriate treatment 3, 4
• Overreliance on corticosteroid injections may lead to tissue weakening and potential complications 1
• Complete immobilization should be avoided as it leads to muscle atrophy and deconditioning 1
• Bursal aspiration carries a risk of introducing infection and should be performed with strict aseptic technique 3