What is the recommended treatment for olecranon bursitis?

Treatment of Olecranon Bursitis

Conservative management with rest, ice application, activity modification, and NSAIDs is the first-line treatment for olecranon bursitis, with corticosteroid injections reserved only for refractory cases due to significant complication risks including infection, skin atrophy, and chronic pain. 1, 2

Initial Conservative Approach

Start with non-invasive measures for all patients:

• Rest and activity modification by avoiding direct pressure on the affected elbow 1
• Ice application through a wet towel for 10-minute periods to reduce swelling and pain 1
• Elbow protection using open-backed elbow pads to minimize pressure on the bursa 1
• Topical NSAIDs as first-line pharmacologic therapy, offering efficacy with fewer systemic side effects 1

Oral Pharmacologic Management

If topical therapy is insufficient:

• Oral NSAIDs (such as naproxen) are FDA-approved for bursitis treatment 3
• Naproxen dosing: Start with 500 mg followed by 500 mg every 12 hours or 250 mg every 6-8 hours, with initial daily dose not exceeding 1250 mg 3
• For patients with cardiovascular disease or risk factors: Use acetaminophen or non-acetylated salicylates first, before considering NSAIDs at the lowest effective dose for the shortest duration 1

When Conservative Treatment Fails

Aspiration alone (without corticosteroid injection) is preferred for persistent cases:

• Simple bursal aspiration allows delayed but complete recovery without significant complications 4
• Clinical resolution occurs with conservative methods when implemented earlier in the disease course 2

Corticosteroid Injection: Use With Extreme Caution

Intrabursal corticosteroid injections should be reserved only for truly refractory cases due to high complication rates:

• While corticosteroid injections provide faster symptom resolution (typically within one week), they carry significant risks 4, 2
• Documented complications include:
  • Bursal infection (12% in one study) 4
  • Skin atrophy (20% in one study) 4
  • Chronic local pain (28% in one study) 4
• Recent literature demonstrates adverse effects of intrabursal injections compared with noninvasive management for initial treatment 5

Surgical Considerations

Reserve bursectomy for chronic, recurrent cases unresponsive to all conservative measures:

• Open excisional bursectomy completely removes pathological bursal tissue but has high complication rates including wound problems 6
• Arthroscopic approaches are increasingly considered as minimally invasive alternatives, though not complication-free 6
• Hydrothermal ablation (irrigation with heated saline at 50-52°C) shows 75% success rate with fewer complications than open bursectomy in refractory cases 7

Critical Pitfalls to Avoid

• Do not rush to corticosteroid injection: The condition is often self-limited, and spontaneous resolution can be expected with conservative management 4, 5
• Rule out septic bursitis: Ensure no clinical signs of infection before any invasive intervention 7
• Avoid early surgical intervention: Surgery should only be considered after exhausting conservative options due to high complication rates 6, 5