Treatment of Olecranon Bursitis

Diagnosis and Clinical Features

Radiographs are recommended as the initial imaging modality to exclude fractures, dislocations, or bony abnormalities, according to the American College of Radiology 1, 2
Ultrasound can be useful for demonstrating bursal thickening and heterogeneous echogenicity in chronic cases, as reported by the Annals of the Rheumatic Diseases 3

Rest and activity modification, including avoiding pressure on the affected elbow, is recommended by the American Academy of Family Physicians 4
Use of open-backed elbow protection can help reduce pressure on the affected area, as suggested by the American Academy of Family Physicians 5
Ice application through a wet towel for 10-minute periods can reduce swelling and pain, and cryotherapy is effective for short-term pain relief by reducing tissue metabolism, according to the American Academy of Family Physicians 4
Topical NSAIDs may also be effective with fewer systemic side effects, as reported by the American Academy of Family Physicians 4

Immobilization with a splint or brace may be beneficial for acute or refractory cases, as recommended by the American Academy of Family Physicians 4, 5
Advanced interventions, such as surgical evaluation, may be considered for chronic or recurrent cases that fail conservative management, as reported by the Annals of the Rheumatic Diseases 3

In patients with inflammatory arthritis, evaluation for systemic disease involvement is necessary, as recommended by the American Academy of Family Physicians 4

The IDSA recommends drainage as the primary treatment for septic olecranon bursitis, rather than antibiotics alone, in cases with purulent collections and surrounding inflammation 6

The American College of Radiology (ACR) recommends plain radiographs as the first‑line imaging study for patients with suspected olecranon bursitis to exclude fractures, dislocations, or other bony abnormalities. 7
According to ACR guidelines, plain radiographs can also detect heterotopic ossification and soft‑tissue calcifications that may be associated with olecranon bursitis. 8, 9, 10
The ACR guidelines for acute and chronic elbow pain consistently emphasize radiographs as the beneficial initial imaging assessment, even though the guidelines primarily address intra‑articular pathology rather than bursal disease. 7, 8, 9, 10

The ACR advises against the routine use of CT, bone scan, or contrast‑enhanced studies for olecranon bursitis because these modalities have no established role in bursal pathology. 7, 8, 9, 10