General Guideline Principles for Olecranon Bursitis
for workers compensation patients

The New York State workers compensation board has developed these guidelines to help physicians, podiatrists, and other healthcare professionals provide appropriate treatment for Olecranon Bursitis.

These Workers Compensation Board guidelines are intended to assist healthcare professionals in making decisions regarding the appropriate level of care for their patients with ankle and foot disorders.

The guidelines are not a substitute for clinical judgement or professional experience. The ultimate decision regarding care must be made by the patient in consultation with his or her healthcare provider.

Diagnostic Criteria of Olecranon Bursitis

A normally painless effusion of the olecranon bursa is a symptom of the disorder known as olecranon bursitis. Acute olecranon bursitis may be mildly heated, but it usually has little to no tenderness.

Septic (infected) olecranon bursitis can develop as a side effect of aseptic bursitis or as a direct result of trauma. Bursitis often involves the introduction of organisms through the skin, such as abraded skin or an injection, although systemic seeding may also occur, in order to be a complication of aseptic olecranon.

Swelling, discomfort, soreness, and pain with motion are symptoms. Bursitis caused by crystal arthropathies also frequently exhibits symptoms that are comparable to septic bursitis.

Special Studies and Diagnostic and Treatment Considerations of Olecranon Bursitis

For the majority of olecranon bursitis instances, there is no specific research. Aspiration of the fluid and studies such as Gram stain, culture, and sensitivity are advised if the bursa is suspected of being infected.

1. Fluid Aspiration of Swollen Bursa and Analyses for Olecranon Bursitis

   Fluid Aspiration of Swollen Bursa and Analyses for Olecranon Bursitis are recommended Gram stain, culture and sensitivity, and full cell count for a clinically infected or dubiously infected bursa to identify infection for olecranon bursitis. On the fluid that was aspirated, crystal examination (light polarizing microscopy) should also be done at least once.

   Rationale for Recommendation – When paired with Gram stain, culture and sensitivity, and a thorough cell count of the aspirated fluid, aspiration has been employed for diagnosis.

   On the fluid that was aspirated, crystal examination (light polarizing microscopy) should also be done at least once.

    

2. X-Rays for Olecranon Bursitis

   X-Rays for Olecranon Bursitis are recommended to rule out joint effusion or osteomyelitis in instances of severe septic bursitis of the olecranon.

Initial Care of Olecranon Bursitis

Most olecranon bursitis patients receive treatment with gentle elbow padding, support, or an Ace wrap, are advised to avoid elbow pressure, and just need monitoring to ensure resolution.

1. Soft Padding, Soft Elbow Supports, and Ace Wraps for Olecranon Bursitis

   Soft Padding, Soft Elbow Supports, and Ace Wraps for Olecranon Bursitis are recommended for olecranon bursitis.

    

2. Modifying Activities to Avoid Direct Pressure Over the Olecranon

   Modifying Activities to Avoid Direct Pressure Over the Olecranon are recommended It is advised to give the fluid time to reabsorb.

Medications of Olecranon Bursitis

Ibuprofen, naproxen, or other NSAIDs from an earlier generation are suggested as first-line treatments for the majority of patients.

For patients who are not candidates for NSAIDs, acetaminophen (or the analogue paracetamol) may be a viable alternative, even if the majority of research indicates it is just marginally less effective than NSAIDs. There is proof that NSAIDs are less dangerous and just as effective in treating pain as opioids, such as tramadol.

1. Non-Steroidal Anti-inflammatory Drugs (NSAIDs

   NSAIDs for Treatment of Acute, Subacute, Chronic, or Postoperative Olecranon Bursitis

   NSAIDs for Treatment of Acute, Subacute, Chronic, or Postoperative Olecranon Bursitis are recommended to treat Olecranon Bursitis that is acute, subacute, chronic, or postoperative.

   Indications – NSAIDs are advised as a treatment for acute, subacute, chronic, or postoperative olecranon bursitis. First, try over-the-counter (OTC) medications to see whether they work.

   Frequency/Duration – Many patients could find it reasonable to use as needed.

   Indications for Discontinuation – The easing of elbow pain, a lack of effectiveness, or the appearance of side effects that require stopping the treatment.

    

2. NSAIDs for Patients at High Risk of Gastrointestinal Bleeding

   NSAIDs for Patients at High Risk of Gastrointestinal Bleeding are recommended concurrent use of cytoprotective medication classes: Histamine Type 2 receptor blockers, misoprostol, sucralfate, and proton people with a high risk of gastrointestinal bleeding should take pump inhibitors.

   Indications – For patients who additionally have a high-risk factor profile, the use of NSAIDs and cytoprotective drugs should be taken into account, especially if longer-term treatment is being discussed. At-risk Patients having a background of previous gastrointestinal bleeding older people, people with diabetes, and smokers.

   Frequency/Dose/Duration – H2 blockers, misoprostol, sucralfate, and proton pump inhibitors are advised. dosage recommendations from the manufacturer. It is generally accepted that there are no significant differences in effectiveness for preventing gastrointestinal bleeding.

   Indications for Discontinuation – Intolerance, the emergence of negative effects, or the stopping of NSAIDs.

    

3. NSAIDs for Patients at Risk for Cardiovascular Adverse Effects

   NSAIDs for Patients at Risk for Cardiovascular Adverse Effects are recommended Acetaminophen or aspirin tend to be the safest medications for cardiovascular side effects when used as first-line therapy.If necessary, non-selective NSAIDs are recommended to COX-2-specific medications.

   To reduce the chance that an NSAID will negate the protective effects of low-dose aspirin in individuals receiving 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.

    

   • NSAIDs for Patients at Risk for Cardiovascular Adverse Effect

     NSAIDs for Patients at Risk for Cardiovascular Adverse Effects are recommended Acetaminophen or aspirin tend to be the safest medications for cardiovascular side effects when used as first-line therapy.

     If necessary, non-selective NSAIDs are recommended to COX-2-specific medications. To reduce the chance that an NSAID will negate the protective effects of low-dose aspirin in individuals receiving 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.

      

4. Acetaminophen for Treatment of Elbow Pain

   Acetaminophen for Treatment of Elbow Pain is recommended – for the treatment of elbow discomfort, especially in patients who have NSAID contraindications.

   Indications – All patients, including those with acute, subacute, chronic, and post-operative elbow pain.

   Frequency/Dose/Duration – As per the manufacturer’s recommendations; can be used as required. Over four gm/day, there is evidence of liver toxicity.

   Indications for Discontinuation – pain, side effects, or intolerance are gone.

    

5. Injection Therapies of Olecranon Bursitis

   Glucocorticosteroid Injections for Olecranon Bursitis

   Glucocorticosteroid Injections for Olecranon Bursitis are not Recommended for the treatment of bursitis of the olecranon.

Surgical Considerations of Olecranon Bursitis

The most common method of treating olecranon bursitis that has not improved after activity adjustments and additional precautions, such as but not limited to; RICE stands for REST, ICE, COMPRESSION, EXERCISE, HEAT, PT, or a home exercise routine.

1. Surgical Drainage for Olecranon Bursitis

   Surgical Drainage for Olecranon Bursitis is recommended in order to treat olecranon bursitis.

   Indications − When using the above-mentioned soft padding and activity changes, olecranon bursitis is either infected, clinically suspected to be infected, or not infected but present for at least six to eight weeks without showing signs of improvement.

    

2. Surgical Resection for Chronic Olecranon Bursitis

   Surgical Resections for Chronic Olecranon Bursitis are recommended for recurrent drainage in chronic olecranon bursitis.

   Indications – recurring leakage from the olecranon bursitis.

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