The ideal management of olecranon bursitis is not well defined. The goals of this review were to systematically evaluate clinical outcomes for aseptic versus septic bursitis, compare surgical versus nonsurgical management, and examine the roles of corticosteroid injection and aspiration in aseptic bursitis. The English-language literature was searched using PubMed, Cumulative Index to Nursing and Allied Health Literature, Physiotherapy Evidence Database, Allied and Complementary Medicine, and Cochrane Central Register of Controlled Trials. Analyses were performed for clinical resolution and complications after treatment of aseptic and/or septic olecranon bursitis. Twenty-nine studies containing 1278 patients were included. In comparison with septic bursitis, aseptic bursitis was associated with a significantly higher overall complication rate (p=0.0108). Surgical management was less likely to clinically resolve septic or aseptic bursitis (p=0.0476), and exhibited higher rates of overall complications (p=0.0117), persistent drainage (p=0.0194), and bursal infection (p=0.0060) than nonsurgical management. Corticosteroid injection for aseptic bursitis was related to increased overall complications (p=0.0458) and skin atrophy (p=0.0261). Aspiration did not raise the risk of bursal infection for aseptic bursitis.
Based primarily on level IV evidence, nonsurgical management of olecranon bursitis is significantly more effective and safer than surgical management. The clinical course of aseptic bursitis seems to be more complicated than that of septic bursitis. Corticosteroid injection is related to significant risks without improving the outcome of aseptic bursitis.