What is the recommended oral steroid regimen for treating elbow bursitis?

Oral Steroids for Elbow Bursitis

Oral corticosteroids are NOT recommended for the treatment of elbow (olecranon) bursitis, whether septic or aseptic. The evidence consistently supports local management strategies over systemic steroid therapy for this condition.

Primary Treatment Approach

For Aseptic (Non-Septic) Olecranon Bursitis

Conservative management without oral steroids is the standard of care:

• Aspiration alone is the preferred initial intervention for symptomatic relief and can be repeated if fluid reaccumulates 1, 2
• NSAIDs (such as naproxen 500 mg BID or meloxicam 7.5-15 mg daily) provide effective pain control and may hasten symptomatic improvement 3, 2
• Ice, activity modification, compression, and padding form the foundation of treatment 1, 4

Local corticosteroid injection (not oral steroids) may be considered but comes with significant caveats:

• Intrabursal corticosteroid injection can produce rapid resolution 5, 2
• However, this approach is associated with significantly increased overall complications (p = 0.0458) and skin atrophy (p = 0.0261) compared to aspiration alone 6
• The long-term local effects remain concerning 2
• A systematic review of 1,278 patients found corticosteroid injection did not improve outcomes despite increasing complication rates 6

For Septic Olecranon Bursitis

Oral antibiotics (not oral steroids) are the cornerstone of treatment:

• Aspiration should be performed in all cases for diagnostic purposes (Gram stain, culture) and therapeutic decompression 1, 2
• Oral or intravenous antibiotics should be started to prevent septicemia 1
• Repeated aspiration may be necessary 2
• Recovery can take months even with appropriate antibiotic therapy 2

Why Oral Steroids Are Not Indicated

The available evidence does not support oral corticosteroid use for olecranon bursitis for several critical reasons:

1. No evidence base: None of the clinical guidelines or research studies on bursitis management recommend oral steroids as a treatment modality 1, 4, 5, 2, 6

2. Risk without benefit: Systemic steroids would expose patients to significant adverse effects (glucose intolerance, mood disturbance, infection risk, osteoporosis) without addressing the localized pathology 7

3. Superior alternatives exist: Aspiration with or without local injection provides targeted therapy with fewer systemic risks 6

4. Infection concerns: In septic bursitis, systemic steroids could worsen infection and delay healing 2

Clinical Algorithm for Management

Step 1: Differentiate septic from aseptic bursitis

• Perform aspiration in all cases 2
• Send fluid for cell count, Gram stain, and culture 2
• Clinical features help but may overlap (both can have erythema) 2

Step 2: For confirmed aseptic bursitis

• Aspiration alone (may repeat if needed) 1, 2, 6
• NSAIDs for symptom control 2
• Ice, compression, padding 1, 4
• Avoid corticosteroid injection given complication profile 6

Step 3: For confirmed septic bursitis

• Oral or IV antibiotics (long course) 1, 2
• Repeated aspiration as needed 2
• Consider admission for severe cases 2
• Surgical drainage only for refractory cases 1

Common Pitfalls to Avoid

• Do not prescribe oral steroids thinking they will reduce inflammation—this is not supported by evidence and exposes patients to unnecessary systemic risks 7
• Do not use intrabursal steroids routinely—a systematic review shows increased complications without improved outcomes 6
• Do not assume all erythematous bursae are infected—aspiration with analysis is essential for accurate diagnosis 2
• Do not pursue surgical excision prematurely—reserve this only for truly recalcitrant cases after exhausting conservative measures 1, 4

The evidence strongly favors nonsurgical management with aspiration and NSAIDs over any form of corticosteroid therapy (local or systemic) for olecranon bursitis 6.