Best Treatment for Septic Olecranon Bursitis

In this article, surgeons from The Philadelphia Hand Center explore the best treatment for septic olecranon bursitis. Since studies of this problem are limited, evidence-based treatment has not been established. By reviewing the studies that have been done, the authors provide some thoughts on the problem and its treatment.

Olecranon (elbow) bursitis is the inflammation of the bursa at the tip or point of the elbow. A bursa is a sac made of thin, slippery tissue. Bursae (plural) occur in the body wherever skin, muscles, or tendons need to slide over bone. Bursae are lubricated with a small amount of fluid inside that helps reduce friction from the sliding parts. The olecranon bursa allows the elbow to bend and straighten freely underneath the skin.

This bursa can become irritated and inflamed in a number of ways. Direct impact (a blow or fall) on the elbow can cause bleeding in the bursa. This can cause the bursa to become swollen and tender. Repeated strains on the elbow, such as resting your elbows on a hard surface, can also cause the bursa to become inflamed.

The olecranon bursa can also become infected or septic (the focus of this discussion). This may occur without any warning, or it may be caused by a small injury and infection of the skin over the bursa that spreads down into the bursa. In this the sack fills with pus, and the area around the bursa becomes hot, red, and very tender.

Treatment may depend on what is causing the septic bursitis. The most common approach is the use of antibiotics. A broad spectrum antibiotic is used at first (one that will kill as many different kinds of bacteria as possible). If the fluid in the elbow is aspirated (drawn out), then it can be tested to find out the specific bacteria present. An antibiotic that will target the identified bacteria can be prescribed. With septic olecranon bursitis, it's usually a staph or strep infection.

Antibiotics and aspiration used together is another common treatment choice. In some cases, the surgeon will put a tube into the bursa and remove fluid while cleansing the area twice a day over a period of three to five days. This type of treatment is called serial aspiration. When the fluid is tested clear and free of infection, then the tube can be taken out and antibiotics discontinued.

Surgery is the final treatment option for septic olecranon bursitis. Although it is not usually the first-line treatment, there are no studies to say this wouldn't be the best way to go. Most of the time, surgery is reserved for those patients who don't respond to antibiotics and aspiration. As it stands now, surgeons don't have hard and fast evidence-based guidelines for determining when surgery is advised.

This group of surgeons suggest surgery is needed when the patient is not getting better after 24 to 48 hours of conservative care and/or when there is a skin infection known as cellulitis. Anyone with a fever, chills, low blood pressure, altered mental status, or other symptoms to suggest a systemic disorder should be treated surgically right away.

The authors conclude that there is plenty of room for research regarding the best treatment for septic olecranon bursitis. Studies are needed comparing each of the treatment choices along with a cost analysis to show which one is the most cost effective. Other areas of research needed include collecting information on complications of treatment (aspiration or surgery), type of dressings used to cover the wound, and ways to support healing.

References: Joshua M. Abzug, MD, et al. Septic Olecranon Bursitis. In The Journal of Hand Surgery. June 2012. Vol. 37A. No. 6. Pp. 1252-1253.