What is the treatment for bursitis of the elbow?

Treatment of Elbow Bursitis

Begin with conservative management including relative rest, ice application, and padding for 4-12 weeks; if symptoms persist, consider local corticosteroid injection, reserving surgery only for cases that fail 6-12 months of appropriate conservative treatment. 1

First-Line Conservative Treatment

Conservative therapy is the cornerstone of initial management and should be implemented for all patients with elbow bursitis:

• Relative rest is essential to prevent further damage and promote healing, though complete immobilization should be avoided to prevent muscle atrophy 1
• Activities that do not worsen pain may be continued, but those that aggravate symptoms should be modified or temporarily stopped 1
• Ice application (cryotherapy) should be applied for 10-minute periods through a damp towel to provide effective short-term pain relief 1
• Padding and protection of the affected elbow area helps prevent additional irritation and trauma 1
• NSAIDs (oral or topical) are indicated for relief of signs and symptoms of bursitis 2
  • For acute bursitis, naproxen 500 mg initially, followed by 500 mg every 12 hours or 250 mg every 6-8 hours as required (initial daily dose should not exceed 1250 mg, thereafter not exceeding 1000 mg daily) 2

Duration of conservative treatment: Continue for 4-12 weeks before considering escalation 1

Second-Line Treatment for Persistent Symptoms

If symptoms persist despite adequate conservative management:

• Local corticosteroid injections may be more effective than NSAIDs for relief in the acute phase 1
• However, use corticosteroids with caution due to potential complications including skin atrophy, infection, and tendon weakening 1
• Aspiration may be considered for acute traumatic or hemorrhagic bursitis and may shorten symptom duration 3

Important caveat: Bursal aspiration for chronic microtraumatic bursitis is generally not recommended due to the risk of iatrogenic septic bursitis 3

Septic Bursitis Considerations

If infection is suspected based on clinical presentation:

• Perform bursal aspiration with fluid analysis including Gram stain, crystal analysis, glucose measurement, blood cell count, and culture 3
• Initiate antibiotics effective against Staphylococcus aureus as the initial treatment 3
• Outpatient oral antibiotics may be appropriate for patients who are not acutely ill; acutely ill patients require hospitalization with intravenous antibiotics 3
• Surgery is reserved for septic bursitis not responsive to antibiotics or for recurrent cases 3

Surgical Treatment

Surgical intervention should only be considered after failure of 6-12 months of appropriate conservative treatment 1

• Surgical excision of the bursa is recommended only for recalcitrant cases that do not respond to comprehensive conservative management 4, 5
• Incision and drainage is rarely needed but may be indicated for injuries that do not respond to other treatments 4

Common Pitfalls to Avoid

• Do not aspirate chronic microtraumatic bursitis routinely as this increases the risk of introducing infection 3
• Avoid overreliance on corticosteroid injections which may lead to skin atrophy and tendon complications 1
• Do not immobilize completely as this leads to muscle atrophy and deconditioning 1
• Always rule out septic bursitis before proceeding with corticosteroid injection, as steroids in an infected bursa can lead to serious complications 3