What is the treatment for elbow bursitis?

Treatment of Elbow Bursitis

The treatment of elbow bursitis should begin with conservative measures including relative rest, activity modification, ice application, NSAIDs, and possibly counterforce bracing, with aspiration and antibiotics indicated for septic bursitis. 1, 2

Types and Diagnosis

• Elbow bursitis (olecranon bursitis) presents as swelling and pain over the posterior aspect of the elbow, often due to repetitive pressure, trauma, infection, or inflammatory conditions 2
• Diagnosis is primarily clinical, based on the characteristic swelling over the olecranon process, with aspiration indicated when infection is suspected 3
• Plain radiographs may be useful to rule out other causes of elbow pain such as fractures or arthritis 1

Treatment Algorithm

First-Line Treatment (Non-Septic Bursitis)

• Relative rest and activity modification to prevent ongoing irritation while avoiding complete immobilization 4
• Cryotherapy (ice application) for 10-minute periods through a wet towel to provide effective short-term pain relief 4
• NSAIDs (oral or topical) for pain relief, though they may not affect long-term outcomes 4, 2
• Protective padding to avoid direct pressure on the bursa during activities 2
• Compression wrapping may help reduce swelling in some cases 2

Septic Bursitis Management

• Aspiration of bursal fluid for diagnostic purposes (cell count, Gram stain, culture) is essential when infection is suspected 5
• Septic bursitis typically requires antibiotic therapy, with Staphylococcus aureus being the most common pathogen 5, 6
• Mild cases may be treated with oral antibiotics, but more severe cases require parenteral antibiotics and possibly surgical drainage 5
• Close follow-up within 48-72 hours is crucial as patients may worsen despite initial treatment 5

Second-Line Interventions

• Corticosteroid injection into the bursa may be considered for non-septic, refractory cases that don't respond to conservative measures 3, 2
• Sonographic guidance can improve accuracy and safety of aspiration and injection procedures 7
• Aspiration alone may provide relief in some cases by reducing pressure within the bursa 3

Surgical Management

• Surgical intervention (bursectomy) may be necessary for cases that are:
  • Recalcitrant to conservative treatment for 3-6 months 2
  • Recurrent despite multiple aspirations and injections 2
  • Severely infected and not responding to antibiotics 5

Common Pitfalls and Caveats

• Failure to distinguish between septic and non-septic bursitis can lead to inappropriate treatment and worsening of infection 5
• Corticosteroid injections should be avoided if infection is suspected, as they may worsen the condition 3, 2
• Repeated corticosteroid injections may lead to skin atrophy and increased risk of infection 2
• Complete immobilization should be avoided as it can lead to stiffness and muscle atrophy 4
• Patients with underlying conditions like rheumatoid arthritis or immunosuppression require closer monitoring due to higher risk of infection and poorer healing 6