Olecranon Bursitis Treatment & Management
- Author: Patrick M Foye, MD; Chief Editor: Sherwin SW Ho, MD more...
Acute Phase
Rehabilitation Program
Physical Therapy
In general, physical and occupational therapy are not needed for olecranon bursitis. In some cases of nonseptic bursitis, however, the physician may recommend a course of physical or occupational therapy to speed the patient's recovery time. Individuals who exhibit olecranon bursitis are often advised to apply the RICE (ie, rest, ice, compression, elevation) method of treatment.
Physical therapy modalities (eg, phonophoresis, electrical stimulation) may also be helpful to further reduce pain and inflammation, although these modalities are not necessary for most patients with this condition.[12] The therapist can also educate the patient and present compensatory strategies for resting the involved upper extremity while healing is occurring. If the patient's condition becomes severe and does not respond to conservative treatment, surgery may be indicated. For patients who undergo bursectomy (bursal excision), postoperative physical therapy may be recommended for regaining or maintaining ROM and strength of the elbow.
Medical Issues/Complications
Complications of the disease process in olecranon bursitis include persistent pain and an associated decreased functional use of the affected upper extremity.
Potential complications of aspiration/injection include the following:
- Swelling: This may recur, particularly if the patient does not maintain adequate pressure or icing at the site or if infection was present at the time of the initial aspiration
- Infection: The clinician should use appropriate techniques, including aseptic techniques, to minimize the chance of causing iatrogenic infection.
- Persistent drainage
Surgical Intervention
Usually, no surgical intervention is required in cases of olecranon bursitis; however, very severe cases may require bursectomy. A study by Ogilvie-Harris and Gilbart demonstrated endoscopic bursal resection relieves pain symptoms and typically gives satisfactory results in patients with chronic olecranon bursitis.[13] Fortunately, most cases of olecranon bursitis respond to nonsurgical treatment.
Consultations
Consultation with a physiatrist (physical medicine and rehabilitation physician) or with an orthopedic surgeon may be considered by physicians without the training, comfort, or procedural office supplies that are necessary for joint aspiration.
Consultation with a rheumatologist may be helpful if the clinical findings are consistent with inflammatory arthropathy.
Consultation with an orthopedic surgeon is required if a fracture is present, if the patient has a very severe case of recalcitrant bursitis that requires excision (bursectomy), or if septic bursitis is present for which incision and drainage is required.
Other Treatment
Oral nonsteroidal anti-inflammatory drugs (NSAIDs) are used in the treatment of olecranon bursal inflammation.[14]
Glucocorticoid injection can be used to treat this condition (see Procedures). A retrospective study by Weinstein et al showed that in 47 patients with traumatic olecranon bursitis, almost all cases resolved via aspiration with or without an intrabursal glucocorticoid injection.[8] The 25 patients who received a glucocorticoid injection (20 mg of triamcinolone) in addition to the bursal aspiration had much more rapid resolution of their olecranon bursitis condition, usually within 1 week, compared with those who did not receive the injection. However, glucocorticoid injection seemed to be more highly associated with complications, such as infection and skin atrophy.[8]
The posterior elbow should be iced 15-20 minutes at a time, several times per day, during the acute inflammatory period of 2-5 days.
A compressive wrap using an elastic wrap or an elastic sleeve should be applied, but the application of excessive pressure over the elbow should be avoided (see image below).
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. Avoiding further trauma to the olecranon bursa is the key to recovery and preventing recurrence. Consider use of elbow pads to cushion the elbow.
Recovery Phase
Medical Issues/Complications
Medical issues and complications of olecranon bursitis during the recovery phase are the same as those listed for the acute phase (see Acute Phase, Medical Issues/Complications).
Other Treatment (Injection, manipulation, etc.)
For cases of olecranon bursitis in which there is repeated recurrence, consider use of a posterior plaster splint to limit elbow motion for 1-2 weeks following aspiration. For severely recalcitrant cases, consider referral to an orthopedic surgeon for possible bursal excision.
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