What is the recommended treatment for an olecranon (elbow) spur?

Treatment of Olecranon Spur

Conservative management is the first-line treatment for olecranon spurs, including rest, activity modification, ice application, NSAIDs, and physical therapy with eccentric strengthening exercises; surgical excision is reserved for patients who fail conservative treatment after 3-6 months. 1, 2, 3

Initial Conservative Management (First-Line Treatment)

Conservative treatment should be attempted for at least 3-6 months before considering surgical intervention, as approximately 80% of patients with elbow tendinopathies recover completely with non-operative management 1:

• Relative rest and activity modification to reduce repetitive strain on the triceps tendon insertion 1
• Ice application (cryotherapy) for 10-minute periods to provide acute pain relief 1
• NSAIDs for short-term pain control, though they do not alter long-term outcomes 4, 1
• Eccentric strengthening exercises to promote tendon healing and increase strength 4, 1
• Stretching exercises for the triceps and surrounding musculature 1
• Deep transverse friction massage to reduce pain 4, 1
• Progressive strengthening program focused on the triceps and elbow extensors 1

Diagnostic Imaging

Plain radiographs of the elbow are the most appropriate initial imaging study to confirm the presence of an olecranon spur and rule out other pathology 4, 1:

• Standard anteroposterior and lateral elbow radiographs will typically demonstrate the bony spur at the olecranon tip 4
• MRI without IV contrast or ultrasound may be considered if radiographs are normal but clinical suspicion remains high for associated triceps tendon degeneration or tear 4, 1

Surgical Management (For Failed Conservative Treatment)

When conservative management fails after 3-6 months, surgical excision is indicated 2, 3, 5:

Surgical Technique Options

Endoscopic extrabursal excision is preferred over open excision when technically feasible, as it provides satisfactory visualization with less morbidity and avoids wound complications over the sensitive olecranon skin 2:

• The spur is located within the superficial fibers of the distal triceps tendon 5
• Complete excision of the pathological spur under direct visualization is the goal 2, 5
• Open excision remains an option but carries higher risk of wound complications and seroma formation 3, 5

Surgical Outcomes

Short- to mid-term outcomes after olecranon spur excision are generally favorable 5:

• Mean QuickDASH scores of 3 (range 0-23) and Mayo Elbow Performance Scores of 96 (range 80-100) at average 34-month follow-up 5
• Mean pain scores of 0.8/10 and satisfaction scores of 9.6/10 5
• Normal elbow range of motion and strength typically restored 5

Potential Complications

• Wound seroma and olecranon bursitis may occur early postoperatively but typically resolve without additional surgery 5
• Recurrent spur formation occurs uncommonly; one study reported 2 of 11 patients developed recurrence, with one requiring repeat excision at 48 months 5
• Open procedures carry higher risk of wound problems and infection compared to endoscopic techniques 2, 3

Special Considerations

Associated olecranon bursitis should be managed concurrently if present, as olecranon spurs are commonly associated with inflammatory conditions including triceps tendonitis, olecranon bursitis, and gout 2, 3:

• Bursal aspiration may be performed if significant fluid collection is present 3
• Treatment of underlying systemic conditions (e.g., gout, rheumatoid arthritis) is essential 3, 6