What is the treatment for olecranon bursitis?

Treatment of Olecranon Bursitis

Conservative management with rest, ice, NSAIDs, and activity modification should be the first-line treatment for olecranon bursitis, with progression to more invasive interventions only if symptoms persist. 1

Initial Conservative Management

Start with non-invasive measures for all patients with olecranon bursitis:

• Rest and activity modification to reduce pressure on the affected bursa 1, 2
• Ice application for 10-minute periods through a wet towel for pain relief 1
• NSAIDs for pain and inflammation control 1, 2
  • Naproxen is FDA-approved for bursitis treatment: 500 mg initially, followed by 500 mg every 12 hours or 250 mg every 6-8 hours as needed (maximum 1250 mg first day, then 1000 mg/day thereafter) 3
  • If NSAIDs are contraindicated or poorly tolerated, consider acetaminophen or opioids for pain control 1

Avoid complete immobilization to prevent muscular atrophy and deconditioning 1

When Conservative Treatment Fails

If symptoms persist after conservative management, aspiration alone is preferred over corticosteroid injection:

• Aspiration without steroid injection is safer and equally effective for resolution by 4 weeks 4, 5
• Aspiration does not increase the risk of bursal infection in aseptic bursitis 4
• Corticosteroid injection should be reserved for refractory cases only due to higher complication rates including bursal infection and skin atrophy 6, 4
  • While steroid injection after aspiration achieves earlier resolution (2.3 weeks vs 3.1-3.2 weeks), it carries significantly higher risks of overall complications and skin atrophy 4, 5

Critical Diagnostic Consideration

Rule out septic bursitis before any treatment:

• Septic bursitis requires different management and may need outpatient parenteral antimicrobial therapy 7
• Interestingly, aseptic bursitis has a higher overall complication rate than septic bursitis when treated 4

Surgical Management

Reserve surgery only for chronic, recurrent, or refractory cases that fail conservative and aspiration treatments:

• Nonsurgical management is significantly more effective and safer than surgical management, with lower rates of overall complications, persistent drainage, and bursal infection 4
• When surgery is necessary, arthroscopic techniques are increasingly preferred over open excisional bursectomy to avoid wound complications 2
• Hydrothermal ablation (irrigation with heated saline at 50-52°C) shows promise for refractory cases, with 75% success rate and fewer complications than open bursectomy 8

Important Caveats

Duration of symptoms before treatment predicts outcome: Longer symptom duration before initiating treatment is the only factor associated with treatment failure by 4 weeks 5. Therefore, early conservative intervention is crucial.

Earlier treatment with conservative methods improves outcomes: Clinical resolution of aseptic olecranon bursitis occurs more readily with conservative methods when implemented earlier in the disease course 6