Treatment of Right Elbow Bursitis
Start with conservative management including relative rest, ice application, and NSAIDs, reserving corticosteroid injections for cases that fail 4-12 weeks of initial treatment, and consider surgery only after 6-12 months of failed conservative therapy. 1
Initial Conservative Treatment (First-Line)
Relative rest is the cornerstone of treatment to prevent further damage and promote healing, though complete immobilization should be avoided to prevent muscle atrophy. 1 Patients should continue activities that don't worsen pain but modify or temporarily stop those that aggravate symptoms. 1
Ice application (cryotherapy) should be applied for 10-minute periods through a damp towel to provide effective short-term pain relief. 1
Protection with padding helps prevent additional irritation to the affected bursa. 1
NSAIDs (oral or topical) effectively relieve pain and can be initiated early in treatment. 2 For acute bursitis, naproxen 500 mg initially, followed by 500 mg every 12 hours or 250 mg every 6-8 hours is appropriate, with initial total daily dose not exceeding 1250 mg. 2
Distinguishing Septic from Non-Septic Bursitis
Critical clinical assessment is required because approximately one-third of olecranon bursitis cases are septic. 3 Clinical features help separate the two, though local erythema can occur in both. 3
Aspiration should be performed in all cases where infection is suspected, with fluid examined using Gram stain, crystal analysis, glucose measurement, blood cell count, and culture. 4 Ultrasonography can help distinguish bursitis from cellulitis. 4
For septic bursitis, antibiotics effective against Staphylococcus aureus are the initial treatment, with repeated aspiration often necessary. 4, 3 Outpatient oral antibiotics may be considered for patients who are not acutely ill; acutely ill patients require hospitalization with intravenous antibiotics. 4 Recovery from septic bursitis can take months. 3
Second-Line Treatment for Non-Septic Bursitis
If symptoms persist despite 4-12 weeks of conservative treatment, local corticosteroid injections may be more effective than NSAIDs for relief in the acute phase. 1
However, corticosteroid injections should be used with caution due to potential complications including skin atrophy, infection, and tendon weakening. 1 There is concern over their long-term local effects despite producing rapid resolution. 3
Aspiration of non-septic microtraumatic bursitis is generally not recommended because of the risk of iatrogenic septic bursitis. 4 However, acute traumatic/hemorrhagic bursitis may benefit from aspiration to shorten symptom duration. 4
Surgical Treatment
Surgery should only be considered after failure of 6-12 months of appropriate conservative treatment. 1 Surgical intervention may be required for recalcitrant cases not responsive to conservative management. 5 Some septic cases require surgery when not responsive to antibiotics or for recurrent episodes. 4
Special Considerations
Patients with cardiovascular disease or risk factors for ischemic heart disease should follow a gradual approach to pharmacological treatment. 1
For chronic inflammatory bursitis (such as from gout or rheumatoid arthritis), treatment focuses on addressing the underlying condition, and intrabursal corticosteroid injections are often used in these specific cases. 4