Elbow Case 5 ED Management
Infectious bursitis is treated with an anti-staphylococcal antibiotic selected based on local resistance and the patient’s MRSA risk factors.
Sterile olecranon bursitis should be managed with compression and NSAIDS unless they are contraindicated. Joint aspiration is typically performed but there is no conclusive evidence that aspiration of aseptic olecranon bursitis benefits patients more than compression and NSAIDs (Sayegh et al). However, it is important to note that a systematic review by Sayegh et al found no increased risk of infection secondary to aspiration of aseptic olecranon bursitis so it is reasonable to aspirate and drain bursa that are causing discomfort. It is important to note that steroid injection is not recommended based on the increased risk of iatrogenic complications (post-procedural infection, skin atrophy, chronic pain) noted by Weinstein et al in a long term follow-up study.