Physical Medicine and Rehabilitation for Olecranon Bursitis Treatment & Management

Physical Therapy

In general, physical and occupational therapy are not needed for this condition. In some cases of nonseptic bursitis, however, the physician may recommend a course of physical or occupational therapy to speed recovery time. Individuals who exhibit olecranon bursitis often are advised to apply the RICE (rest, ice, compression, elevation) method of treatment. Physical therapy modalities (eg, phonophoresis, electrical stimulation) also may be helpful in further reducing pain and inflammation, although these modalities are not necessary for most patients with this condition. The therapist can also complete patient education and present compensatory strategies for resting the involved upper extremity while healing takes place. If the patient's condition becomes severe and does not respond to conservative treatment, surgery may be indicated. For the patient who undergoes bursal excision (bursectomy), physical therapy may be recommended postoperatively for regaining or maintaining the elbow's ROM andstrength.

• Complications of the disease process include persistent pain and associated decreased functional use of the affected upper extremity.
• Potential complications of aspiration/injection are as follows:

  • Swelling - This may recur, particularly if the patient does not maintain adequate pressure or icing at the site or if an infection was present at the time of the initial aspiration.
  • Infection
  • Persistent drainage through the injection tract
  • Ulnar nerve injury - This theoretically may occur if a medial approach is used for the aspiration/injection.

Usually, no surgical intervention is required; however, very severe cases of recalcitrant bursitis may require bursectomy.^[14]

• Consultation with a physiatrist (physical medicine and rehabilitation physician) or with another qualified musculoskeletal specialist may be considered by physicians without the training, comfort, or procedural office supplies necessary for aspiration.
• Consultation with a rheumatologist may be helpful if findings are consistent with inflammatory arthropathy.
• Consultation with an orthopedist is generally required only if a fracture is present or in very severe cases of recalcitrant bursitis requiring excision (bursectomy). Some cases may require incision and drainage.

• Oral nonsteroidal anti-inflammatory drugs (NSAIDs) may be helpful. See Medication.
• Focal corticosteroid injection may be an option, but only if the clinician is confident that no local infection is present.

  • A retrospective study by Weinstein and colleagues showed that in 47 patients with traumatic olecranon bursitis, almost all cases resolved via aspiration, with or without intrabursal glucocorticoid injection.^[15] The 25 patients who did receive glucocorticoid injection (20 mg of triamcinolone) in addition to the bursal aspiration resolved much more rapidly, usually within 1 week. However, glucocorticoid injection seemed to be more highly associated with complications, such as infection and skin atrophy.
  • The injection should be on the lateral side of the elbow, so as to avoid the ulnar nerve. The target injection site is the soft-tissue center of the triangle formed by the lateral olecranon, the head of the radius, and the lateral epicondyle. As with most injections, the physician should first aspirate to ensure that the needle is not in a blood vessel and then inject using a slow, but consistent, pressure.^[16]
• A compressive elbow sleeve (eg, a neoprene or elastic sleeve) may help to prevent the bursal fluid from re-accumulating after aspiration.