From the Guidelines
Olecranon bursitis should be treated with conservative measures, including rest, ice, and non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen, as the initial approach to manage symptoms and prevent further irritation. The treatment of olecranon bursitis depends on the severity of the condition, and it is essential to consider the potential causes, such as trauma, pressure, infection, or inflammatory conditions like gout or rheumatoid arthritis 1.
Conservative Management
For mild cases, the following conservative measures can be taken:
- Rest the affected elbow
- Apply ice for 15-20 minutes several times daily
- Take NSAIDs like ibuprofen (400-800mg three times daily with food) or naproxen (500mg twice daily)
- Consider compression with an elastic bandage
- Avoid leaning on the elbow and consider padding it during activities
Further Evaluation and Treatment
If infection is suspected (redness, warmth, fever), it is crucial to seek medical attention immediately, as antibiotics will be necessary 1. For moderate to severe cases, a doctor may perform aspiration to remove fluid and possibly inject corticosteroids. Surgical intervention is rarely needed but may be considered for recurrent or severe cases.
Diagnostic Considerations
Musculoskeletal ultrasound can be helpful in detecting joint effusion, synovial proliferation, cartilage lesions, and bony lesions, among other conditions 1. However, the primary approach to diagnosing olecranon bursitis involves a thorough physical examination and medical history.
Recovery and Prognosis
Recovery from olecranon bursitis typically takes 1-2 weeks for minor cases but may take longer for severe or infected cases. It is essential to prioritize conservative management and seek medical attention if symptoms persist or worsen over time.
From the Research
Diagnosis and Management of Olecranon Bursitis
- Olecranon bursitis is a condition characterized by inflammation of the olecranon bursa, often due to microtrauma 2.
- The first line of treatment is conservative, including ice, rest, anti-inflammatory and analgesic drugs, and occasionally, bursal fluid aspiration 3.
- In unresponsive patients, arthroscopy is increasingly being considered as a suitable new modality of management, although open excisional procedures can completely remove the pathological bursal tissue 3.
Treatment Options
- Nonsurgical management of olecranon bursitis is significantly more effective and safer than surgical management, based on level IV evidence 4.
- Corticosteroid injection for aseptic bursitis is associated with increased overall complications and skin atrophy, without improving the outcome of aseptic bursitis 4.
- Aspiration does not increase the risk of bursal infection for aseptic bursitis 4.
- Empiric antibiotic therapy without bursal aspiration may be a reasonable initial approach to ED management of select patients with suspected septic olecranon bursitis 5.
Clinical Features and Outcomes
- Aseptic bursitis is associated with a significantly higher overall complication rate compared to septic bursitis 4.
- Surgical management is less likely to clinically resolve septic or aseptic bursitis and demonstrates higher rates of overall complications, persistent drainage, and bursal infection compared to nonsurgical management 4.
- The clinical course of aseptic bursitis appears to be more complicated than that of septic bursitis 4.
- Approximately 88% of ED patients with suspected septic olecranon bursitis treated with empiric antibiotics without aspiration had resolution without need for subsequent bursal aspiration, hospitalization, or surgery 5.