Olecranon Bursitis Medication

  • Author: Patrick M Foye, MD; Chief Editor: Sherwin SW Ho, MD   more...
 
Updated: Aug 31, 2010
 

Medication Summary

Oral NSAIDs can be helpful to reduce the pain and inflammation of olecranon bursitis, but these products 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. Various oral NSAIDs can be used, but none holds a clear distinction as the drug of choice (DOC).

Empiric antibiotic selection is based upon the suspected source of the microorganisms (skin flora with local invasion via puncture or abrasion vs hematogenous spread from a primary infection at another body site). Antibiotic selection is further modified by the results of the culture and sensitivity. Initial antibiotic selection would also be directed by the result of the Gram stain of the aspirate. Antibiotic treatment may start with a broad-spectrum antibiotic; then, when the culture results are available, the antibiotic regimen may be modified as appropriate.

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Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

Class Summary

NSAIDs can help decrease pain and inflammation. Various oral NSAIDs can be used, but none holds a clear distinction as the DOC. Choice of NSAID is largely a matter of convenience (eg, how frequently doses must be taken to achieve adequate analgesic and anti-inflammatory effects) and cost.

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Ibuprofen (Motrin, Advil, Nuprin, NeoProfen)

 

Commonly used NSAID. Many doses are available, either with or without a prescription.

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Ketoprofen (Actron, Orudis, Oruvail)

 

For the relief of mild to moderate pain and inflammation. Small dosages are initially indicated in small and elderly patients and in those with renal or liver disease. Doses over 75 mg do not increase therapeutic effects. Administer high doses with caution, and closely observe the patient for response.

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Corticosteroid Preparation for Focal Injection

Class Summary

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.[1, 3, 11, 12, 15]

When corticosteroid injections are used, a variety of corticosteroid preparations are available to choose from. Commonly, the corticosteroid is mixed with a local anesthetic agent before administering the injection. Again, there are various local anesthetic agents to choose from.

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Methylprednisolone (Depo-Medrol, Medrol, Solu-Medrol, Kenalog)

 

Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing increased capillary permeability. Commonly used for injections into bursae or joints.

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Contributor Information and Disclosures
Author

Patrick M Foye, MD  Associate Professor of Physical Medicine and Rehabilitation, Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, Director of Coccyx Pain Service (Tailbone Pain Service: www.TailboneDoctor.com), University of Medicine and Dentistry of New Jersey, New Jersey Medical School

Patrick M Foye, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists, and International Spine Intervention Society

Disclosure: Nothing to disclose.

Coauthor(s)

Todd P Stitik, MD  Professor, Department of Physical Medicine and Rehabilitation; Director, Outpatient Occupational/Musculoskeletal Medicine, UMDNJ-New Jersey School of Medicine

Todd P Stitik, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Association of Academic Physiatrists, Phi Beta Kappa, and Physiatric Association of Spine, Sports and Occupational Rehabilitation

Disclosure: Nothing to disclose.

Scott F Nadler, DO  Assistant Director of Occupational/Musculoskeletal Medicine, Assistant Professor of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey, Director of Sports Medicine, University Hospital

Scott F Nadler, DO is a member of the following medical societies: American College of Occupational and Environmental Medicine, American College of Sports Medicine, American Medical Association, Association of Academic Physiatrists, North American Spine Society, and Physiatric Association of Spine, Sports and Occupational Rehabilitation

Disclosure: Nothing to disclose.

Specialty Editor Board

Andrew L Sherman, MD, MS  Associate Professor of Clinical Rehabilitation Medicine, Vice Chairman, Chief of Spine and Musculoskeletal Services, Program Director, SCI Fellowship and PMR Residency Programs, Department of Rehabilitation Medicine, Leonard A Miller School of Medicine, University of Miami

Andrew L Sherman, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, and Association of Academic Physiatrists

Disclosure: pfizer Honoraria Speaking and teaching

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Henry T Goitz, MD  Academic Chair and Associate Director, Detroit Medical Center Sports Medicine Institute; Director, Education, Research, and Injury Prevention Center; Co-Director, Orthopaedic Sports Medicine Fellowship

Henry T Goitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons and American Orthopaedic Society for Sports Medicine

Disclosure: Nothing to disclose.

Jon B Whitehurst, MD  Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital

Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America

Disclosure: Nothing to disclose.

Chief Editor

Sherwin SW Ho, MD  Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago

Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America

Disclosure: Breg, Inc. Consulting fee Consulting; Biomet, Inc. Consulting fee Consulting; GMV, Inc. Arthroscopy Simulator Evaluation and teaching; Smith and Nephew Grant/research funds Fellowship funding; DJ Ortho Grant/research funds Course funding

References

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  3. Snider RK. Olecranon bursitis. Essentials of Musculoskeletal Care. 2nd ed. Rosemont, Ill: American Academy Orthopedic Surgeons; 1997:156-9.

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  5. Brinker MR, Miller MD. The adult elbow. Fundamentals of Orthopaedics. Philadelphia, Pa: WB Saunders Co; 1999:153-64.

  6. Gregory T, Mir O, Medioni J, Augereau B, Oudard S. Olecranon bursitis in patients treated with sunitinib for renal cell carcinoma. Med Oncol. Jun 2010;27(2):446-8. [Medline].

  7. Schumacher HR. Arthrocentesis, synovial fluid analysis, and synovial biopsy. In: Schumacher HR, Klippel JH, Koopman WJ, eds. Primer on the Rheumatic Diseases. 10th ed. Richmond, Va: Arthritis Foundation; 1993:67-72.

  8. Weinstein PS, Canoso JJ, Wohlgethan JR. Long-term follow-up of corticosteroid injection for traumatic olecranon bursitis. Ann Rheum Dis. Feb 1984;43(1):44-6. [Medline]. [Full Text].

  9. Blankstein A, Ganel A, Givon U, Mirovski Y, Chechick A. Ultrasonographic findings in patients with olecranon bursitis. Ultraschall Med. Dec 2006;27(6):568-571.

  10. Floemer F, Morrison WB, Bongartz G, Ledermann HP. MRI characteristics of olecranon bursitis. AJR Am J Roentgenol. Jul 2004;183(1):29-34. [Medline]. [Full Text].

  11. Cardone DA, Tallia AF. Diagnostic and therapeutic injection of the elbow region. Am Fam Physician. Dec 1 2002;66(11):2097-100. [Medline]. [Full Text].

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  13. Ogilvie-Harris DJ, Gilbart M. Endoscopic bursal resection: the olecranon bursa and prepatellar bursa. Arthroscopy. Apr 2000;16(3):249-53. [Medline].

  14. Green SM, ed. Nonsteroidal anti-inflammatories. Tarascon Pocket Pharmacopoeia. Loma Linda, Calif: Tarascon Publishing; 2000:11-12.

  15. Olsen NK, Press JM, Young JL. Bursal injections. Physiatric Procedures in Clinical Practice. Philadelphia, Pa: Hanley & Belfus; 1995:36-43.

  16. Friedman ND, Sexton DJ. Bursitis due to Mycobacterium goodii, a recently described, rapidly growing mycobacterium. J Clin Microbiol. Jan 2001;39(1):404-5. [Medline].

  17. Barham GS, Hargreaves DG. Mycobacterium kansasii olecranon bursitis. J Med Microbiol. Dec 2006;55(pt 12):1745-6. [Medline].

  18. Blankstein A, Ganel A, Givon U, Mirovski Y, Chechick A. Ultrasonographic findings in patients with olecranon bursitis. Ultraschall Med. Dec 2006;27(6):568-71. [Medline].

  19. Damert HG, Altmann S, Schneider W. [Soft-tissue defects following olecranon bursitis: treatment options for closure] [German]. Chirurg. Aug 7 2008;epub ahead of print. [Medline].

  20. Degreef I, De Smet L. Complications following resection of the olecranon bursa. Acta Orthop Belg. Aug 2006;72(4):400-3. [Medline].

  21. Jin W, Lee JH, Yang DM, et al. Olecranon bursitis communicating with an olecranon cyst in rheumatoid arthritis. J Ultrasound Med. Jun 2007;26(6):857-61. [Medline].

 
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Olecranon bursitis is shown in a patient with the elbow flexed. Image © 2007 by Patrick Foye, MD, UMDNJ New Jersey Medical School.
Olecranon bursitis is shown in a patient with the elbow extended. Image © 2007 by Patrick Foye, MD, UMDNJ New Jersey Medical School.
Olecranon bursitis is shown close up in a patient, with the elbow extended. Image © 2007 by Patrick Foye, MD, UMDNJ New Jersey Medical School.
Needle aspiration of olecranon bursitis. Image ©2007, by Patrick M. Foye, MD, UMDNJ New Jersey Medical School.
Olecranon bursitis aspiration of a hemorrhagic effusion. Image ©2007, by Patrick M. Foye, MD, UMDNJ New Jersey Medical School.
After fluid is removed from the olecranon bursa, an elastic, tubular, compressive sleeve can be used to minimize reaccumulation of the fluid. Image ©2007, by Patrick Foye, MD, UMDNJ New Jersey Medical School.
Gout. Radiograph of erosions with overhanging edges.
Arthritis, Rheumatoid. Rheumatoid nodules at the elbow. Photograph by David Effron MD, FACEP
Olecranon fracture.
Gout. Polarizing microscopy needles of urate.
 
 
 
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