Medication Summary
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. [10]
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. Unless the patient is immunocompromised, targeted oral antibiotics should be the preferable initial treatment approach. If the infection does not respond to oral antibiotics or is discovered later in its evolution, intravenous antibiotics with or without surgical irrigation and débridement is indicated.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
Class Summary
NSAIDs can help to decrease pain and inflammation. Various oral NSAIDs can be used. The choice of an agent is largely based on its side-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 (Motrin, Advil, Addaprin, Caldolor)
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 (Celebrex)
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 (Anaprox, Naprelan, Naprosyn)
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
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.
Corticosteroids
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. 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.
Methylprednisolone (Depo-Medrol, Solu-Medrol, Medrol, A-Methapred)
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 (Baycadron)
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.
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Olecranon bursitis, shown here with the elbow flexed. Image courtesy of UMDNJ-New Jersey Medical School, www.DoctorFoye.com, and www.TailboneDoctor.com.
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Olecranon bursitis seen with the elbow extended. Focal swelling at the olecranon is more visible with the elbow extended than in the flexed position. Image courtesy of UMDNJ-New Jersey Medical School, www.DoctorFoye.com, and www.TailboneDoctor.com.
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Olecranon bursitis seen with the elbow extended. Image courtesy of UMDNJ-New Jersey Medical School, www.DoctorFoye.com, and www.TailboneDoctor.com.
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Olecranon bursogram. This image shows a needle injecting contrast material into the olecranon bursa, under fluoroscopic guidance. Although olecranon bursa aspiration/injection usually does not require fluoroscopy or contrast, employing fluoroscopy here has demonstrated the outline of the involved bursa. Image ©2005, by Patrick M. Foye, MD, UMDNJ: New Jersey Medical School.
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Needle aspiration in olecranon bursitis. Image courtesy of UMDNJ-New Jersey Medical School, www.DoctorFoye.com, and www.TailboneDoctor.com.
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Aspiration of a hemorrhagic effusion in a patient with olecranon bursitis. Image courtesy of UMDNJ-New Jersey Medical School, www.DoctorFoye.com, and www.TailboneDoctor.com.
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After fluid is removed from the olecranon bursa, an elastic, tubular compressive sleeve can be used to minimize reaccumulation of the fluid. Image courtesy of UMDNJ-New Jersey Medical School, www.DoctorFoye.com, and www.TailboneDoctor.com.
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Gout. Radiograph of erosions with overhanging edges.
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Gout. Polarizing microscopy revealing needles of urate.
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Rheumatoid arthritis. Rheumatoid nodules at the elbow. Photograph by David Effron MD, FACEP
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Olecranon fracture.
