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Olecranon bursitis is a relatively common condition characterized by pain, swelling, and inflammation of the olecranon bursa (located in the elbow). Although the overall incidence is not known, it typically affects men between the ages of 30 and 60 years.1 Two-thirds of cases are nonseptic (ie, without infection) and usually occur when trauma or repeated small injuries lead to bleeding into the bursa or release of inflammatory mediators.1
Little information is available regarding the effective treatment of nonseptic olecranon bursitis.2 In the following paper I will describe a 3-step technique I developed to treat nonseptic olecranon bursitis in clinical practice.
PubMed, PubMed Central, and EMBASE were searched from 1966 to 2009 using the terms lidocaine or Xylocaine, methylprednisolone, glucocorticoids, corticosteroids, olecranon, and bursitis. None of the articles generated made reference to this technique.
Step 1 involves aspiration of the bursa with an 18-gauge needle. In step 2, a mixture of 80-mg methylprednisolone and 2% lidocaine (specifically 1 mL of methylprednisolone and 1.5 mL of lidocaine without adrenaline) is injected into the elbow joint from a lateral approach. Step 3 involves the application of a dry gauze dressing, followed by the application of a tensor bandage or elbow brace for a period of 3 to 6 months. A list of materials required to perform this procedure is presented in Box 1.
The technique was discovered over 3 to 4 years, with 4 or 5 cases being treated per month. Follow-up with each patient occurred at 2 weeks, 3 months, and 6 months. At each follow-up visit, side effects, pain assessment, and limitation of function (including warmth, degree of swelling, and tenderness) were assessed and recorded. The typical pain, skin atrophy, and corticosteroid-induced side effects mentioned by some authors1–5 were not observed in any of these cases. In addition, none of my patients who used this technique developed septic bursitis or tendon rupture. My experience with this technique has been rewarding— efficiency rates range from approximately 95% to 100%.
Indications for this technique include the following6:
Contraindications include the frequent use of steroids, septic arthritis, and iatrogenic infection.
I thank Sandhini Lockman for typing the drafts of this manuscript.