Treatment Options for Olecranon Bursitis
The first-line treatment for olecranon bursitis consists of conservative measures including rest, activity modification, ice application, and topical NSAIDs, with more invasive interventions reserved for persistent or recurrent cases. 1, 2
Diagnosis
- Radiographs are recommended as the initial imaging modality to exclude fractures, dislocations, or bony abnormalities 1, 3
- Ultrasound can be useful for demonstrating bursal thickening and heterogenicity in chronic cases 1
- Joint effusion on radiographs, indicated by posterior and anterior fat pad elevation, may suggest an occult elbow fracture in traumatic cases 3
Treatment Algorithm
First-Line (Conservative Management)
- Rest and activity modification, including avoiding pressure on the affected elbow 1, 2
- Use of open-backed elbow protection to reduce pressure on the affected area 1, 2
- Ice application through a wet towel for 10-minute periods to reduce swelling and pain 1, 2
- Topical NSAIDs for pain relief with fewer systemic side effects 1, 2
- For patients with cardiovascular disease or risk factors, start with acetaminophen or non-acetylated salicylates before considering NSAIDs 2
Second-Line (For Persistent or Recurrent Cases)
- Immobilization with a splint or brace for acute or refractory cases 1
- Aspiration of bursal fluid for diagnostic purposes and symptomatic relief 4, 5
- For non-septic bursitis, aspiration alone may be sufficient, possibly combined with NSAIDs 5
- For septic bursitis, aspiration (potentially repeated) combined with a long course of antibiotics is recommended 5
Advanced Interventions (For Chronic or Refractory Cases)
- Surgical evaluation for cases that fail conservative management 1
- Complete olecranon bursectomy with debridement for chronic therapy-resistant bursitis 6
- Arthroscopic procedures are increasingly considered as a less invasive alternative to open bursectomy 4
- Hydrothermal ablation (irrigation with heated saline at 50-52°C) shows promise as a safe treatment option for recurrent or chronic olecranon bursitis with fewer complications than open bursectomy 7
Special Considerations
- In patients with inflammatory arthritis, evaluation for systemic disease involvement is necessary 1
- For complicated courses with soft-tissue defects, various treatment options exist including vacuum-assisted closure therapy and different types of flaps 8, 6
- Septic bursitis recovery can take months and may occasionally require hospitalization 5
- When using NSAIDs in patients with cardiovascular risk factors, use the lowest effective dose for the shortest duration 2
Common Pitfalls and Caveats
- Distinguishing between septic and non-septic bursitis can be challenging as both may present with local erythema 5
- Always aspirate when infection is suspected, with microscopy, Gram staining, and culture of the aspirate to confirm diagnosis 5
- While intrabursal corticosteroids can produce rapid resolution, concerns remain about their long-term local effects 5
- Surgical interventions, while effective, carry risks of complications including wound problems and dehiscence 6, 4