Treatment of Elbow Bursitis
Conservative management with relative rest, activity modification, ice application, and NSAIDs should be the first-line treatment for elbow bursitis, reserving aspiration for suspected septic cases and surgery only for patients who fail 6-12 months of appropriate conservative therapy. 1, 2
Initial Conservative Management (0-4 weeks)
Relative rest and activity modification are essential first steps to prevent ongoing bursal damage and promote healing. 1, 2 Complete immobilization should be avoided as it leads to muscle atrophy and deconditioning. 3 Patients should reduce activities that aggravate symptoms while continuing those that don't worsen pain. 3
Cryotherapy provides effective short-term pain relief by reducing tissue metabolism and blunting the inflammatory response. 4, 1 Apply melting ice water through a wet towel for 10-minute periods repeatedly. 4
NSAIDs are recommended for short-term pain relief:
- For acute bursitis: Naproxen 500 mg initially, followed by 500 mg every 12 hours or 250 mg every 6-8 hours (maximum 1250 mg first day, then 1000 mg/day thereafter). 5
- Topical NSAIDs may be preferred in elderly patients to reduce gastrointestinal, renal, and cardiovascular risks. 1
- NSAIDs provide pain relief but do not alter long-term outcomes. 4
Padding and protection of the elbow during activities helps prevent further trauma. 1
When to Aspirate
Aspiration should NOT be routinely performed for chronic microtraumatic bursitis due to the risk of introducing infection. 2 However, aspiration is indicated when:
- Septic bursitis is suspected (evaluate for fever, warmth, erythema, systemic symptoms). 6, 7
- Acute traumatic swelling requires decompression. 6
For suspected septic bursitis, aspirate the bursa, send fluid for cell count, Gram stain, and culture, and initiate empiric antibiotics pending culture results. 6, 7
Corticosteroid Injections (Use with Caution)
Corticosteroid injections may provide short-term pain relief but should be used cautiously as they do not alter long-term outcomes and carry risks including skin atrophy, infection, and potential tendon weakening. 1, 3 Local injection may be more effective than oral NSAIDs for acute-phase pain relief. 4 However, systemic oral corticosteroids are NOT indicated for localized olecranon bursitis. 1
Persistent Symptoms (4-12 weeks)
Continue conservative measures including rest, ice, NSAIDs, and padding. 1 Early intervention is important, as longer symptom duration before treatment initiation is associated with treatment failure. 1
Surgical Management (>6-12 months)
Surgery should be reserved only for refractory cases that fail 6-12 months of appropriate conservative treatment. 4, 1, 2 Surgical excision of the bursa is the definitive treatment for recalcitrant cases. 2, 6, 7 Arthroscopic techniques are increasingly considered as they avoid wound complications often seen with open excision. 8
Common Pitfalls
- Avoid routine aspiration of chronic non-septic bursitis, as this introduces infection risk without clear benefit. 2
- Do not use complete immobilization, which causes muscle atrophy. 3
- Be cautious with corticosteroid injections due to potential complications and lack of long-term benefit. 1, 3
- In elderly patients, use the lowest effective NSAID dose and consider topical formulations to minimize systemic side effects. 1, 5