Treatment

Treatment is not usually required for non-painful, small olecranon bursae.

If there is significant pain or swelling however, aspiration is often necessary and the fluid should be sent for gram stain, culture and crystal microscopy.

In case of non septic bursitis which can be identified clinically, the following conservative methods will be helpful:

• rest - immobilize the elbow until the swelling subsides
• application of ice
• use of an elbow pad - to minimise direct pressure on the swollen elbow
• compressive bandage
• elevation of the elbow
• analgesia (1,2)

In cases refractory to above conservative methods, consider aspiration of fluid and injecting corticosteroids in to the bursa (2).

In traumatic and inflammatory cases steroid injection may be helpful. In septic cases, adequate drainage should be acheived and appropriate antibiotics commenced (3)

• flucloxacillin is the antibiotic of choice
• in penicillin allergic patients erythromycin can be used (4)
• in patients who are ill, appear toxic and immunocompromised, admission and parenteral antibiotic therapy should be considered (3)
• alter the antibiotic regimen according to the culture report and sensitivity
• repeated aspiration may be necessary if fluid reaccumulates (4).

If the cause is gout or rheumatoid arthritis treat the conditions accordingly (4).

Reference:

• (1) National Hand Specialists. Union Memorial Hospital. Shoulder and elbow disorders
• (2) American Academy of Orthopedic Surgeons (AAOP) 2007. Elbow (Olecranon) Bursitis
• (3) Roberts JR. Olecranon Bursitis: Etiology and Clinical Characteristics: Part I in a Series. Emergency Medicine News 2002;24:11-22
• (4) Stell IM. Septic and non-septic olecranon bursitis in the accident and emergency department--an approach to management. J Accid Emerg Med. 1996;13(5):351-3