Conservative treatment may resolve olecranon bursitis without complications
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BOSTON — Results presented at the American Society for Surgery of the Hand Annual Meeting showed conservative treatment may lead to resolution of olecranon bursitis without complications, infections, atrophy, skin depigmentation or surgery.
Richard A. Bernstein, MD, and colleagues retrospectively categorized 135 patients with 137 cases of olecranon bursitis into three groups based on whether they had olecranon bursitis with fluid, olecranon bursitis with minimal or no fluid, or a red, cellulitic olecranon bursa. Bernstein noted patients with olecranon bursitis with fluid were treated with aspiration and a corticosteroid injection. He added patients with olecranon bursitis without fluid were given an elbow pad and a course of anti-inflammatories if medically appropriate, while patients with a red, cellulitic olecranon bursa were treated with oral antibiotics, anti-inflammatories, protection and observation.
“In those cases who had a fluid-filled elbow that was aspirated, we followed these patients over a period of 4 months,” Bernstein said.
Results showed 100% resolution of 82 cases in 81 patients, with 10 patients lost to follow-up. Bernstein noted patients with olecranon bursitis with fluid had no complications, cases of skin depigmentation, atrophy or infections and no patients required surgery.
“In those patients that came with a tender olecranon bursa without fluid, these patients were treated conservatively,” Bernstein said. “Within 3 months, we saw 100% resolution and 14 cases were lost to follow-up.”
Patients with a red, cellulitic olecranon bursa were seen within 48 hours after the start of oral antibiotic treatment, according to Bernstein.
“By 5 weeks, 100% of these patients who came in with a red skin area over a swollen bursa – they were not treated with aspiration, they were just treated with conservative measures – none of these patients required any surgery, though three cases were lost to follow-up,” Bernstein said.
Perspective
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Olecranon bursitis is a common problem that has not been adequately studied to be able to make reliable, safe treatment recommendations. This study includes a large number of patients and is a useful resource. However, it does not reflect my own clinical experience, either because there are insufficient numbers to show complications of the treatment or the nature of my practice that deals with the unfavorable outcomes.
Cortisone injection, in particular, is a concern. While I have no doubt that it is usually helpful, it can cause a serious infection not only of the skin, but also the bone and elbow joint. Also, the subtype with a skin infection does not always resolve with oral antibiotics and IV antibiotics. Immobilization or even surgery may be required.
I commend the authors' efforts, but more cases are needed to draw definitive conclusions and I would ask what percentage of failures is acceptable.
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Bernstein RA, et al. Paper 72. Presented at: American Society for Surgery of the Hand Annual Meeting; Sept. 29-Oct. 1, 2022; Boston.
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