Olecranon Bursitis Medication
- Author: J Michael Wieting, DO, MEd, FAOCPMR, FAAPMR; Chief Editor: Stephen Kishner, MD, MHA more...
Medications are used in cases of olecranon bursitis primarily to decrease pain and inflammation. Thus, the most commonly used medications are oral NSAIDs and focal corticosteroid injection, in conjunction with the rest of the rehabilitation plan.
As previously stated, however, oral NSAIDs probably should be avoided if joint aspiration reveals a hemorrhagic bursitis. Injectable corticosteroid can be beneficial in cases in which the history, physical examination, and joint aspiration do not raise a significant suspicion for infection.
Empiric antibiotic selection is based on the suspected source of the microorganisms (local invasion by skin flora via puncture or abrasion, or hematogenous spread from a primary infection at another body site). Initial antibiotic selection is also directed by the results of the Gram stain of the aspirate.
Antibiotic treatment may start with a broad-spectrum antibiotic; then, when the culture and sensitivity test results are available, the antibiotic regimen may be modified as appropriate.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
NSAIDs can help to decrease pain and inflammation. Various oral NSAIDs can be used. The choice of an agent is largely based on its adverse-effect profile, as well as on convenience (how frequently doses must be taken to achieve adequate analgesic and anti-inflammatory effects), patient preferences, and cost.
Although increased treatment cost can be a negative factor, the incidence of costly and potentially fatal gastrointestinal (GI) bleeds is clearly less with cyclo-oxygenase-2 (COX-2) inhibitors than with traditional NSAIDs. Ongoing analysis of cost avoidance in cases of GI bleeds will further define the populations that will find COX-2 inhibitors to be the most beneficial.
Ibuprofen is the drug of choice for mild to moderate pain. It inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis. Many doses are available, either with or without a prescription.
Celecoxib inhibits primarily COX-2. COX-2 is considered an inducible isoenzyme, induced during pain and inflammatory stimuli. Inhibition of COX-1 may contribute to NSAID GI toxicity. At therapeutic concentrations, the COX-1 isoenzyme is not inhibited; thus, GI toxicity may be decreased. Seek the lowest dose of celecoxib for each patient.
Naproxen is used for the relief of mild to moderate pain. It inhibits inflammatory reactions and pain by decreasing the activity of cyclo-oxygenase (COX), which is responsible for prostaglandin synthesis.
Ketoprofen is used for the relief of mild to moderate pain and inflammation. Small doses are indicated initially in patients with small body size, elderly patients, and persons with renal or liver disease. Doses of over 75 mg do not increase therapeutic effects. Administer high doses with caution, and closely observe the patient for response.
In contrast to the widespread, systemic distribution of an oral anti-inflammatory drug, a local corticosteroid injection can achieve focal placement of a potent anti-inflammatory agent at the site of maximal tenderness or inflammation. A variety of corticosteroid preparations are available for injection. Commonly, the corticosteroid is mixed with a local anesthetic agent prior to injection. Various local anesthetic agents also are available.
Corticosteroids, such as methylprednisolone, are commonly used for local injections of bursae or joints to provide a local anti-inflammatory effect while minimizing some of the GI and other risks of systemic medications.
Methylprednisolone decreases inflammation by suppressing the migration of polymorphonuclear leukocytes and reversing increased capillary permeability.
Dexamethasone may reduce steroid hormone production. It decreases immune reactions. Dexamethasone provides a local anti-inflammatory effect while minimizing some of the gastrointestinal and other risks associated with systemic medications.
Snider RK. Olecranon bursitis. Snider RK, ed. Essentials of Musculoskeletal Care. 2nd ed. Rosemont, Ill: American Academy of Orthopaedic Surgeons; 1997. 156-9.
McGee DJ. Elbow joints. Orthopedic Physical Assessment. 2nd ed. Philadelphia, Pa: WB Saunders Co; 1992. 143-167.
Strakowski JA, Wiand JW, Johnson EW. Upper limb musculoskeletal pain syndromes. Braddom RL, ed. Physical Medicine and Rehabilitation. Philadelphia, Pa: WB Saunders Co; 1996. 756-82.
Morgan WJ. Elbow and forearm. Steinberg GG, Akins C, Baran D, eds. Orthopaedics in Primary Care. 3rd ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 1998. 70-98.
Brinker MR, Miller MD. The adult elbow. Fundamentals of Orthopaedics. Philadelphia, Pa: WB Saunders Co; 1999. 153-64.
Wasserman AR, Melville LD, Birkhahn RH. Septic bursitis: a case report and primer for the emergency clinician. J Emerg Med. 2009 Oct. 37(3):269-72. [Medline].
Wagner C, Iking-Konert C, Hug F, et al. Cellular inflammatory response to persistent localized Staphylococcus aureus infection: phenotypical and functional characterization of polymorphonuclear neutrophils (PMN). Clin Exp Immunol. 2006 Jan. 143(1):70-7. [Medline]. [Full Text].
Wessolossky M, Haran JP, Bagchi K. Paecilomyces lilacinus olecranon bursitis in an immunocompromised host: case report and review. Diagn Microbiol Infect Dis. 2008 Jul. 61(3):354-7. [Medline].
Turan H, Serefhanoglu K, Karadeli E, Timurkaynak F, Arslan H. A case of brucellosis with abscess of the iliacus muscle, olecranon bursitis, and sacroiliitis. Int J Infect Dis. 2009 Nov. 13(6):e485-7. [Medline].
Malkin J, Shrimpton A, Wiselka M, Barer MR, Duddridge M, Perera N. Olecranon bursitis secondary to Mycobacterium kansasii infection in a patient receiving infliximab for Behcet's disease. J Med Microbiol. 2009 Mar. 58:371-3. [Medline].
Gregory T, Mir O, Medioni J, Augereau B, Oudard S. Olecranon bursitis in patients treated with sunitinib for renal cell carcinoma. Med Oncol. 2010 Jun. 27(2):446-8. [Medline].
Larsen BT, Smith ML, Grys TE, Vikram HR, Colby TV. Histopathology of Disseminated Mycobacterium bovis Infection Complicating Intravesical BCG Immunotherapy for Urothelial Carcinoma. Int J Surg Pathol. 2015 May. 23 (3):189-95. [Medline].
Schumacher HR. Arthrocentesis, synovial fluid analysis, and synovial biopsy. Schumacher HR, ed. Primer on Rheumatic Diseases. 10th ed. Atlanta, Ga: Arthritis Foundation; 1993. 67-72.
Blankstein A, Ganel A, Givon U, Mirovski Y, Chechick A. Ultrasonographic findings in patients with olecranon bursitis. Ultraschall Med. 2006 Dec. 27(6):568-71. [Medline].
Olsen NK, Press JM, Young JL. Bursal injections. Lennard TA, ed. Physiatric Procedures in Clinical Practice. Philadelphia, Pa: Hanley & Belfus; 1995. 36-43.
Degreef I, De Smet L. Complications following resection of the olecranon bursa. Acta Orthop Belg. 2006 Aug. 72(4):400-3. [Medline].
Ogilvie-Harris DJ, Gilbart M. Endoscopic bursal resection: the olecranon bursa and prepatellar bursa. Arthroscopy. 2000 Apr. 16(3):249-53. [Medline].
Baumbach SF, Lobo CM, Badyine I, et al. Prepatellar and olecranon bursitis: literature review and development of a treatment algorithm. Arch Orthop Trauma Surg. 2014 Mar. 134(3):359-70. [Medline].
Rhyou I, Park K, Kim K, Lee J, S Kim. Endoscopic Olecranon Bursal Resection for Olecranon Bursitis. J Hand Surg Asian-Pac. 2016 Jun. 21:167-72.
Kim JY, Chung SW, Kim JH, et al. A Randomized Trial Among Compression Plus Nonsteroidal Antiinflammatory Drugs, Aspiration, and Aspiration With Steroid Injection for Nonseptic Olecranon Bursitis. Clin Orthop Relat Res. 2016 Mar. 474 (3):776-83. [Medline].
Green SM. Nonsteroidal anti-inflammatory drugs (NSAIDs). Tarascon Pocket Pharmacopoeia 2000. Loma Linda, Calif: Tarascon; 2000. 11-2.
Perez C, Huttner A, Assal M, Bernard L, Lew D, Hoffmeyer P, et al. Infectious olecranon and patellar bursitis: short-course adjuvant antibiotic therapy is not a risk factor for recurrence in adult hospitalized patients. J Antimicrob Chemother. 2010 May. 65(5):1008-14. [Medline]. [Full Text].
Lennard TA. Fundamentals of procedural care. Physiatric Procedures in Clinical Practice. Philadelphia, Pa: Hanley & Belfus; 1995. 1-13.
Wasserzug O, Balicer RD, Boxman J, Klement E, Ambar R, Zimhony O. A cluster of septic olecranon bursitis in association with infantry training. Mil Med. 2011 Jan. 176(1):122-4. [Medline].