What is the treatment for olecranon (elbow) bursitis?

Treatment of Olecranon Bursitis

Conservative management with rest, ice, and NSAIDs is the recommended first-line treatment for aseptic olecranon bursitis, while avoiding corticosteroid injections due to their significant complication rates despite faster symptom resolution. 1, 2

Initial Management of Aseptic Olecranon Bursitis

First-Line Conservative Treatment

• Rest and activity modification to eliminate repetitive trauma should be initiated immediately 1
• Ice application for 10-minute periods through a wet towel provides acute pain relief 3, 1
• NSAIDs (such as naproxen) should be used at the lowest effective dose for the shortest duration to control pain and inflammation 1, 4
  • Naproxen is FDA-approved specifically for bursitis treatment 4
  • For acute bursitis, start with naproxen 500 mg followed by 500 mg every 12 hours or 250 mg every 6-8 hours, not exceeding 1250 mg on day one and 1000 mg daily thereafter 4

Evidence Supporting Conservative Management

• Nonsurgical management is significantly more effective and safer than surgical management, with lower complication rates and better clinical resolution 2
• Conservative treatment typically results in resolution within 3-4 weeks, though this may be delayed compared to injection therapy 5
• Aspiration alone does not increase the risk of bursal infection in aseptic bursitis 2

When to Avoid Corticosteroid Injections

Corticosteroid injections should be avoided in routine aseptic olecranon bursitis despite their faster symptom resolution (median 2.3 weeks vs 3.2 weeks for conservative treatment) due to significant complications: 6, 7, 5

• Bursal infection (documented in multiple studies) 2, 6
• Skin atrophy (reported in up to 20% of patients) 2, 6, 7
• Chronic local pain (reported in up to 28% of patients) 6
• Higher overall complication rates compared to conservative management 2, 7

Management of Refractory Cases

If conservative treatment fails after 3-4 weeks: 1

• Continue conservative measures with rest, ice, and NSAIDs 1
• Consider immobilization with a cast or fixed-ankle walker-type device for persistent cases 1
• Reserve surgical excision only for patients who fail 3-6 months of conservative therapy 3

Management of Septic Olecranon Bursitis

When to Suspect Infection

Evaluate for septic bursitis if systemic symptoms, severe inflammation, or immunocompromised status are present 1

Treatment Approach

• Oral antibiotics targeting Staphylococcus aureus should be initiated empirically 1
• Consider MRSA coverage in areas with high community-acquired MRSA prevalence 1
• Reserve aspiration for patients with severe systemic features, immunocompromised status, or failure to respond to empirical antibiotics after 48-72 hours 1

Key Clinical Pitfalls

• Longer duration of symptoms before treatment is the primary factor associated with treatment failure, so early conservative intervention is critical 5
• Aseptic bursitis has a more complicated clinical course than septic bursitis, contrary to common assumptions 2
• Avoid combining aspiration with corticosteroid injection as routine practice—the complications outweigh the modest benefit of 1 week faster resolution 6, 7, 5