What is the recommended treatment for olecranon spurring?

Treatment of Olecranon Spurring

For olecranon spurring, conservative management is the recommended first-line treatment, including rest, activity modification, ice application, and anti-inflammatory medications, with surgical intervention reserved for cases that fail conservative management. 1, 2

Initial Conservative Management

• Rest and activity modification, including avoiding pressure on the affected elbow, is the cornerstone of first-line treatment 1
• Open-backed elbow protection helps reduce pressure on the affected area 1, 3
• Ice application through a wet towel for 10-minute periods reduces swelling and pain 1, 3
• Topical NSAIDs may provide effective pain relief with fewer systemic side effects than oral medications 1, 3
• For patients with cardiovascular disease or risk factors, use acetaminophen or non-acetylated salicylates before considering NSAIDs 3
• Radiographs should be obtained as the initial imaging modality to exclude fractures, dislocations, or other bony abnormalities 1, 4

Second-Line Management for Persistent Symptoms

• Immobilization with a splint or brace may be beneficial for acute or refractory cases 1
• Bursal fluid aspiration can be considered for symptomatic relief in cases with significant swelling 2
• If conservative management fails, surgical intervention should be considered 1, 2

Surgical Options for Refractory Cases

• Traditionally, symptomatic olecranon spurs that fail conservative management are excised along with the overlying bursa using an open technique 5, 6
• Endoscopic extrabursal excision is an emerging minimally invasive alternative that may result in less morbidity and avoids a wound over the sensitive olecranon skin 5
• In a case series of 11 patients (12 elbows) who underwent excision of painful olecranon traction spurs after failing conservative care, patients had good outcomes with mean QuickDASH score of 3 and mean Mayo Elbow Performance Score of 96 6

Clinical Pearls and Pitfalls

• The olecranon spur is typically found in the superficial fibers of the distal triceps tendon 6
• Recurrence of the spur is possible after surgical excision (2 out of 11 patients in one study) 6
• Early postoperative complications may include wound seroma and olecranon bursitis 6
• In patients with inflammatory arthritis, evaluation for systemic disease involvement is necessary 1
• Recent evidence increasingly supports conservative management over surgical intervention for olecranon bursitis associated with spurring 7

Follow-up Recommendations

• Monitor for symptom improvement with conservative measures for 4-6 weeks 1, 2
• If symptoms persist despite adequate conservative management, consider surgical referral 1, 6
• Post-surgical patients should be monitored for potential complications including seroma, bursitis, and recurrent spur formation 6