What is the treatment for olecranon bursitis?

Treatment of Olecranon Bursitis

Initial Management: Conservative Treatment First-Line

Conservative management should be the initial approach for all cases of aseptic olecranon bursitis, as it is significantly more effective and safer than surgical management. 1

Core Conservative Measures

• Rest and activity modification to eliminate repetitive trauma and avoid direct pressure on the affected elbow 2, 3
• Ice application for 10-minute periods through a wet towel to reduce swelling and pain 2, 3
• Open-backed elbow protection to reduce pressure on the affected area 2
• NSAIDs (such as naproxen) at the lowest effective dose for the shortest duration to control pain and inflammation 3, 4
  • Naproxen is FDA-approved specifically for bursitis treatment 4
  • For acute bursitis, naproxen dosing: 500 mg initially, then 500 mg every 12 hours or 250 mg every 6-8 hours (max 1250 mg first day, then 1000 mg/day thereafter) 4
• Topical NSAIDs may be effective with fewer systemic side effects 2

Septic vs. Aseptic Bursitis: Critical Distinction

Septic Olecranon Bursitis

• Drainage is the primary treatment rather than antibiotics alone for purulent collections with surrounding inflammation 2
• Oral antibiotics targeting Staphylococcus aureus should be used for uncomplicated cases, with MRSA coverage in high-prevalence areas 3
• Aspiration should be reserved for patients with severe systemic features, immunocompromised status, or failure to respond to empirical antibiotics after 48-72 hours 3

Aseptic Bursitis

• Aseptic bursitis has a more complicated clinical course than septic bursitis with higher overall complication rates 1
• Conservative management is particularly effective when implemented earlier in the disease course 5

Refractory Cases: Second-Line Options

Immobilization

• Immobilization with a splint or brace may be beneficial for acute or refractory cases that fail initial conservative measures 2, 3

Corticosteroid Injection: Use With Caution

Corticosteroid injection should be reserved for refractory cases only due to significant complication risks. 5

• While CSI provides rapid recovery (usually within one week) and reduces symptom duration 5, 6, it carries substantial risks:
  • Bursal infection (significantly increased risk) 1, 6
  • Skin atrophy (significantly increased risk) 1, 6
  • Chronic local pain 6
• The American Academy of Family Physicians suggests corticosteroid injections may be considered for olecranon bursitis, but the evidence shows higher complication rates without improving overall outcomes 1, 5
• If used, triamcinolone hexacetonide 20 mg intrabursal has been studied 6

Aspiration Alone

• Aspiration without corticosteroid does not increase the risk of bursal infection for aseptic bursitis 1
• Patients treated with bursal aspiration alone have delayed recovery but no complications of therapy 6

Surgical Management: Last Resort Only

Surgical intervention should be reserved only for chronic or recurrent cases that fail all conservative management. 2

• Surgery is significantly less likely to achieve clinical resolution and demonstrates:
  • Higher rates of overall complications 1
  • Higher rates of persistent drainage 1
  • Higher rates of bursal infection 1
• Arthroscopic approaches are increasingly considered over open excision to avoid wound complications 7

Key Clinical Pitfalls to Avoid

• Do not rush to corticosteroid injection - the complication rate (infection, skin atrophy, chronic pain) outweighs benefits except in truly refractory cases 1, 5, 6
• Do not proceed to surgery prematurely - nonsurgical management is significantly more effective and safer 1
• Do not forget to evaluate for systemic disease in patients with inflammatory arthritis 2
• Obtain radiographs initially to exclude fractures, dislocations, or bony abnormalities 2