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Non-surgical treatments better than surgical management of elbow pain

With no standardized approach, a range of different treatments are used

The olecranon bursa is a sac filled with a small amount of fluid in the elbow that helps to cushion bones and tissues in that area and allows for their smooth gliding against one another. It is usually flat, but if it becomes inflamed or irritated-from too much pressure, trauma or an infection-more fluid will accumulate, and when this occurs it's called olecranon bursitis. Cases of olecranon bursitis can be painful or without any symptoms, and may be caused by an infection (septic) or not (aseptic). Unfortunately, no standard approach has yet been established for treating olecranon bursitis, so doctors manage it many different ways. This includes surgical and non-surgical treatments, and it's not known which is better. For this reason, a high-quality study called a systematic review was conducted to determine which treatments are best for olecranon bursitis.

Five databases searched for relevant studies

Five major medical databases were searched for studies on various treatments for olecranon bursitis. This resulted in 29 studies, which contained information on 1,278 patients to be reviewed. These studies ranged significantly in their level of quality and in the treatments used, and 10 studies evaluated olecranon bursitis only while the other 19 included other conditions, as well. The treatments used for septic bursitis included antibiotics, non-steroidal anti-inflammatory drugs, and various types of surgery. Aseptic bursitis was treated with these same treatments, as well as injections of either steroids or anesthetics (pain-relieving medications). The results of each of these studies were compared to determine common trends of the effectiveness of various treatments.

Numerous benefits found for non-surgical over surgical management

Results showed that non-surgical strategies led to better outcomes for patients with olecranon bursitis than surgical treatments. In addition, surgical management was found to produce more overall complications, drainage (or leaking) from the bursa and infections than non-surgical management. These findings strongly suggest that a non-surgical approach is a more effective and safer way of dealing with olecranon bursitis. More high-quality research is needed to further confirm these results, but it appears that non-surgical management should be favored as the first-line treatment for olecranon bursitis in most patients based on better results, fewer complications and cheaper costs.

-As reported in the November'14 issue of Archives of Orthopaedic and Trauma Surgery

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