The guidelines for Olecranon Bursitis have been created by the New York State Workers Compensation Board to support doctors, podiatrists, and healthcare professionals in delivering suitable treatment.
These guidelines from the Workers Compensation Board aim to aid healthcare professionals in determining the right level of care for individuals dealing with Olecranon Bursitis.
It’s crucial to note that these guidelines do not replace the need for clinical judgment or the expertise of healthcare professionals. The ultimate decision regarding patient care should be a collaborative effort between the patient and their healthcare provider.
Diagnostic Criteria of Olecranon Bursitis
Olecranon bursitis is characterized by the painless accumulation of fluid in the olecranon bursa. In cases of acute olecranon bursitis, there may be mild warmth, but tenderness is typically minimal.
In instances of septic (infected) olecranon bursitis, the infection can arise as a complication of aseptic bursitis or directly from trauma. The entry of organisms into the bursa often occurs through the skin, such as in cases of skin abrasions or injections. However, systemic seeding is also a possibility and can be a complication of aseptic olecranon.
Common symptoms include swelling, discomfort, tenderness, and pain during movement. Bursitis associated with crystal arthropathies often presents with symptoms similar to septic bursitis.
Special Studies and Diagnostic and Treatment Considerations of Olecranon Bursitis
For most cases of olecranon bursitis, there isn’t specific research available. If there’s suspicion of infection in the bursa, it’s recommended to aspirate the fluid and conduct studies like Gram stain, culture, and sensitivity.
Aspiration of Swollen Bursa Fluid and Analyses for Olecranon Bursitis are suggested for clinically infected or potentially infected bursa to identify infection. This involves Gram stain, culture and sensitivity, and a complete cell count of the aspirated fluid. Additionally, crystal examination using light polarizing microscopy should be performed at least once.
Reasoning for the Recommendation – Aspiration, when combined with Gram stain, culture and sensitivity, and a comprehensive cell count of the aspirated fluid, has been utilized for diagnostic purposes.
Crystal examination using light polarizing microscopy should also be conducted at least once on the aspirated fluid.
X-Rays for Olecranon Bursitis are advised to rule out joint effusion or osteomyelitis, especially in cases of severe septic bursitis of the olecranon.
Initial Care of Olecranon Bursitis
Many individuals with olecranon bursitis typically undergo treatment involving gentle elbow padding, support, or the use of an Ace wrap. Patients are encouraged to steer clear of placing direct pressure on the elbow and may only require monitoring to ensure that the condition resolves.
Utilizing Soft Padding, Soft Elbow Supports, and Ace Wraps for Olecranon Bursitis is suggested as part of the treatment approach.
Adjusting Activities to Prevent Direct Pressure Over the Olecranon is also recommended to allow the fluid sufficient time to reabsorb.
Medications of Olecranon Bursitis
Ibuprofen, naproxen, or other NSAIDs from an earlier generation are recommended as the primary options for the majority of patients.
For individuals not suitable for NSAIDs, acetaminophen (or its analogue paracetamol) may be a potential alternative, even though research suggests it might be slightly less effective than NSAIDs. There is evidence supporting that NSAIDs are both less risky and equally effective in managing pain compared to opioids, such as tramadol.
Non-Steroidal Anti-inflammatory Drugs (NSAIDs) for Treating Acute, Subacute, Chronic, or Postoperative Olecranon Bursitis are suggested for managing various olecranon bursitis conditions.
Indications – NSAIDs are recommended for treating acute, subacute, chronic, or postoperative olecranon bursitis. It is advisable to first try over-the-counter (OTC) medications to assess their effectiveness.
Frequency/Duration – Many patients may find it reasonable to use NSAIDs as needed.
Indications for Discontinuation – Discontinuation may be prompted by a reduction in elbow pain, a lack of effectiveness, or the emergence of side effects requiring cessation of the treatment.
NSAIDs for Patients at High Risk of Gastrointestinal Bleeding are recommended, especially in conjunction with cytoprotective medication classes like Histamine Type 2 receptor blockers, misoprostol, sucralfate, and proton pump inhibitors, for individuals at high risk of gastrointestinal bleeding.
Indications – For patients with a high-risk profile considering NSAIDs, concurrent use of cytoprotective drugs is advised, particularly for longer-term treatment. At-risk patients include those with a history of previous gastrointestinal bleeding, the elderly, individuals with diabetes, and smokers.
Frequency/Dose/Duration – H2 blockers, misoprostol, sucralfate, and proton pump inhibitors are recommended with dosage following the manufacturer’s recommendations. There is generally no significant difference in effectiveness for preventing gastrointestinal bleeding.
Indications for Discontinuation – Intolerance, the emergence of negative effects, or cessation of NSAIDs may necessitate discontinuation.
NSAIDs for Patients at Risk for Cardiovascular Adverse Effects are recommended, and acetaminophen or aspirin is considered the safest choice for cardiovascular side effects as first-line therapy. If required, non-selective NSAIDs are suggested over COX-2-specific medications.
To minimize the risk of NSAIDs nullifying the protective effects of low-dose aspirin in individuals using it for primary or secondary cardiovascular disease prevention, the NSAID should be taken at least 30 minutes after or eight hours before the daily aspirin.
Acetaminophen for the Treatment of Elbow Pain is recommended for managing elbow discomfort, particularly in patients with NSAID contraindications.
Indications – All patients, including those with acute, subacute, chronic, and post-operative elbow pain.
Frequency/Dose/Duration – According to the manufacturer’s recommendations, it can be used as needed, but caution is advised to stay under four gm/day to avoid evidence of liver toxicity.
Indications for Discontinuation – Discontinuation can be considered when pain, side effects, or intolerance subsides.
Injection Therapies for Olecranon Bursitis, particularly Glucocorticosteroid Injections, are not recommended for the treatment of olecranon bursitis.
Surgical Considerations of Olecranon Bursitis
The primary approach to treating olecranon bursitis, when adjustments in activity and additional precautions like RICE (Rest, Ice, Compression, Exercise, Heat, PT, or a home exercise routine) prove ineffective, is through surgical drainage.
Surgical Drainage for Olecranon Bursitis is recommended when olecranon bursitis remains unimproved despite soft padding and activity modifications. This can be due to infection, clinical suspicion of infection, or non-infected cases persisting for at least six to eight weeks without signs of improvement.
For cases of Chronic Olecranon Bursitis with recurrent drainage, Surgical Resection is recommended.
Indications – Surgical Resections are advised when there is repeated drainage from the olecranon bursitis.
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