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Musculoskeletal

Olecranon bursitis

Last revised in June 2026

The olecranon bursa is a sac overlying the olecranon process of the elbow beneath the skin.

Olecranon bursitis: Summary

  • The olecranon bursa is a sac overlying the olecranon process of the elbow beneath the skin. It reduces friction on movement between the skin, tendons, ligaments, and bone, and allows them to glide smoothly over one another.
  • Bursitis occurs when the bursa is irritated and inflamed and is generally classified as:
    • Non-septic (most common) — sterile inflammation resulting from various causes including trauma or overuse.
    • Septic — infection resulting from seeding of the bursal sac with microorganisms, usually bacteria.
  • Olecranon bursitis is more common in:
    • Young or middle-aged men.
    • People in jobs which involve risk of regular elbow trauma or pressure on the bursa. For example gardeners and mechanics.
    • Athletes who play sports which involve repetitive overhead throwing or elbow flexion and extension.
  • Most cases of olecranon bursitis resolve without complications; however, recurrent episodes may occur, especially after recurrent minor trauma. Early initiation of treatment is important — a longer duration of symptoms before treatment is initiated is significantly associated with treatment failure.
  • Olecranon bursitis should be suspected if:
    • There is swelling over the elbow that appears over several hours to several days, may be tender or warm (but may be painless), and is fluctuant.
    • Movement at the elbow joint is painless except at full flexion when the swollen bursa is compressed.
    • There is a history of preceding trauma or bursal disease.
    • There is evidence of local skin abrasion.
  • Management of olecranon bursitis includes:
    • Advising on conservative measures (such as rest, compression bandaging, avoidance of trauma to the elbows, and analgesia) until symptoms improve, and seeking treatment promptly.
    • For non-septic bursitis, management includes:
      • Offering reassurance that most people will respond to conservative treatment.
      • Considering the need for aspiration, particularly if the effusion is large.
      • Considering the need for a corticosteroid injection into the bursa only in refractory cases where conservative management has failed, corticosteroid injection is associated with a higher risk of complications, including bursal infection and skin atrophy, than conservative management.
      • Referral if there is no response to available treatments in primary care after 2 months.
    • For septic bursitis management includes:
      • Aspirating the bursa before starting antibiotic treatment, where possible, to maximise the yield of cultures, and treating empirically with antibiotics until culture results are known.
      • Reviewing within 3–5 days to monitor the effectiveness of therapy.
      • Seeking urgent referral or specialist advice if there is no response, or an inadequate response, to an antibiotic in septic bursitis, or if complications are suspected.
      • Considering the need for repeated aspiration if swelling, tenderness, and erythema recur.
      • Managing any associated conditions, such as gout, rheumatoid arthritis, or cellulitis.
  • Admission to hospital should be arranged urgently if the person has:
    • A suspected septic joint (which presents with a limited range of movement of the elbow joint, unlike septic bursitis).
    • Septic bursitis and severe infection or systemic toxicity.
  • Admission to hospital should be arranged on the same day if the person has septic bursitis and:
    • A pointing abscess requiring incision and drainage, if the expertise to perform this procedure is not available.
    • Extensive cellulitis.
    • Has not responded adequately to outpatient antibiotic treatment after 3–5 days.
  • Urgent referral should be made if the person experiences recurrent septic bursitis.
  • Referral should be considered if a person with non-septic bursitis (in whom septic bursitis has been excluded) does not respond after 2 months of conservative measures (referral should be arranged sooner if the symptoms are pronounced).

Have I got the right topic?

From age 16 years onwards.

This CKS topic covers the diagnosis and management of non-septic and septic olecranon bursitis.

This CKS topic does not cover the management of bursitis at other sites.

There are separate CKS topics on Gout, Greater trochanteric pain syndrome, Rheumatoid arthritis, and Tennis elbow.

The target audience for this CKS topic is healthcare professionals working within the NHS in the UK, and providing first contact or primary healthcare.

How up-to-date is this topic?

Changes

June 2026 — reviewed.  A literature search was conducted in June 2026 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomised controlled trials published since the last revision of the topic. No major changes to the recommendations have been made.

Previous changes

May 2024 — minor update. Information added stating that concomitant treatment with clarithromycin and ivabradine is now contraindicated and caution is now advised when co-administering clarithromycin with edoxaban, as per the manufacturer's updated SPC.

December 2023 — minor update. Update to drug interactions section for erythromycin to include information on interactions with Lomitapide and Corticosteroids, as per the manufacturer's Summary of Product Characteristics (SPC).

November 2023 — minor update. Interactions section for flucloxacillin updated in line with updated manufacturer's summary of product characteristics.

July 2023 — minor update. The summary of manufacturer’s product characteristics for clarithromycin was updated to include a warning regarding concomitant treatment with domperidone (due to the risk of QT prolongation and cardiac arrhythmias).

May 2021 — reviewed. A literature search was conducted in May 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. No significant changes have been made to the recommendations.

January 2021 — minor update. Contraindications and drug interactions for erythromycin have been updated in line with an MHRA drug safety update. 

August to September 2016 — reviewed. A literature search was conducted in August 2016 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. No major changes to clinical recommendations have been made, although minor restructuring of the topic has been undertaken.

July 2015 — minor update. The prescribing information section for clarithromycin and erythromycin has been re-written for clarity.

July 2013 — minor update. Update to the text to reflect recent advice from the MHRA regarding diclofenac.

February 2013 — minor update. The 2013 QIPP options for local implementation have been added to this topic.

October 2012 — minor update. The 2012 QIPP options for local implementation have been added to this topic.

May 2011 — minor update. The 2010/2011 QIPP options for local implementation have been added to this topic.

December 2010 — minor update. Advice on use of pressure dressings after aspiration has been clarified. Dose information for corticosteroid injections has now been added.

June to October 2010 — this is a new CKS topic. The evidence-base has been reviewed in detail, and recommendations are clearly justified and transparently linked to the supporting evidence.

Update

New evidence

Evidence-based guidelines

No new evidence-based guidelines since 1 June 2026.

HTAs (Health Technology Assessments)

No new HTAs since 1 June 2026.

Economic appraisals

No new economic appraisals relevant to England since 1 June 2026.

Systematic reviews and meta-analyses

No new systematic reviews or meta-analysis which reach the CKS threshold for inclusion since 1 June 2026.

Primary evidence

No new primary evidence which reaches the CKS threshold for inclusion published since 1 June 2026.

New policies

No new national policies or guidelines since 1 June 2026.

New safety alerts

No new safety alerts since 1 June 2026.

Changes in product availability

No changes in product availability since 1 June 2026.

Goals and outcome measures

Goals

To support primary healthcare professionals to:

  • Diagnose olecranon bursitis accurately and to differentiate septic from non-septic bursitis.
  • Initiate appropriate management in primary care.
  • Refer appropriately if primary care management is ineffective or measures beyond the expertise of primary care are required.

Outcome measures

No outcome measures were found during the review of this topic.

Audit criteria

No audit criteria were found during the review of this topic.

QOF indicators

No QOF indicators were found during the review of this topic.

QIPP - Options for local implementation

No QIPP indicators were found during the review of this topic.

NICE quality standards

No quality standards were found during the review of this topic.

Background information

What is it?

  • Olecranon bursitis is swelling/or inflammation of the olecranon bursa, a synovial-lined sac located between the skin and the olecranon process at the posterior aspect of the elbow. The bursa normally functions to reduce friction between the skin and the underlying bone during movement.
  • Bursitis occurs when the bursa is irritated, causing an increase in the number of bursal cells and collagen, and a thickening of the bursal wall. When the bursa is inflamed, fluid production and capillary permeability increase, and fluid and proteinaceous exudates collect in the bursa, causing characteristic swelling.
  • Bursitis is generally classified as:
    • Aseptic (non-septic) – the most common form, characterised by sterile inflammation or fluid accumulation within the bursa. It may occur following acute trauma, repetitive minor trauma or prolonged pressure on the elbow, and may be associated with inflammatory conditions such as rheumatoid arthritis.
    • Septic – infection of the bursa, usually caused by bacteria. Infection may occur following direct contact with minor skin trauma, abrasions or adjacent soft-tissue infection.
  • It may be chronic or acute in duration.
  • Olecranon bursitis is also known as miner’s elbow, student’s elbow, and draftsman’s elbow. 

 [Blackwell, 2014; Khodaee, 2017; Brown, 2022 duplicate; Shemesh, 2024]

What causes it?

  • Aseptic (Non-septic) bursitis usually results from either:
    • Trauma or overuse — a single, direct blow to the elbow or repeated mild trauma, such as leaning on the elbow, may cause olecranon bursitis. Sports activities and occupational demands with prolonged pressure on the posterior elbow can result in non-septic olecranon bursitis. Inflammation occurs due to bleeding into the bursa or the release of inflammatory mediators after trauma.
    • Systemic conditions — most commonly gout or rheumatoid arthritis (intra-bursal rheumatoid nodules); rarely conditions such as ankylosing spondylitis, systemic lupus erythematosus, or scleroderma.
    • A large-scale population-based study also identified hyperlipidemia and smoking as independent risk factors for the development of olecranon bursitis.
  • Septic bursitis usually occurs when bacteria (or, rarely, other micro-organisms) enter the bursa — this may follow a penetrating injury from a foreign body. The olecranon bursa is more likely than other bursae to become infected because it is superficial and the overlying skin is prone to minor injuries, which can provide an entry point for micro-organisms.
    • Most cases of septic olecranon bursitis are caused by Staphylococcus aureus (80–90%) and streptococci.
    • Other organisms which have rarely been reported as causing olecranon bursitis include Pseudomonas, Enterobacter agglomerans, Enterococcus faecalis, Haemophilus influenzae, and Escherichia coli. Infections with Candida, Mycobacteria, and other fungi usually only occur in people who are immunocompromised (for example, due to systemic illness).
    • Factors predisposing to septic bursitis include trauma to the elbow (including minor or repeated trauma), pre-existing bursal disease, prior aspiration and infiltration of the bursa, and impaired immunity (for example, due to systemic corticosteroid treatment, diabetes, HIV, or alcohol abuse). 
  • Risk factors for bursitis include:
    • Frequent leaning on the elbows.
    • Occupations involving repetitive elbow trauma or pressure.
    • Participation in contact sports or activities with recurrent elbow impact.
    • Gout.
    • Rheumatoid arthritis and other inflammatory arthritides.
    • Skin disease or breaks in the skin overlying the elbow.
    • Diabetes mellitus, alcohol misuse, chronic kidney disease, or other causes of immunocompromise (particularly for septic bursitis).

[Blackwell, 2014; Nchinda, 2021; Curti, 2021; Weihe, 2023]

How common is it?

  • The overall incidence of olecranon bursitis in primary care is uncertain. 
    • However, some studies have reported a prevalence of around 10 per 100,000 people.
    • Two-thirds of olecranon bursitis cases are non-septic.
  • Olecranon bursitis is more common in:
    • Young and middle-aged men.
    • People with occupations which involve risks of regular elbow trauma or pressure on the bursa, such as gardeners, carpet layers, mechanics, plumbers, roofers, truck drivers, students or people writing on a regular basis.
    • Athletes who play sports which involve repetitive overhead throwing or elbow flexion and extension, or direct impact onto the elbow (such as gymnastics, weightlifting, rugby, football, or hockey).
  • Olecranon bursitis may occur more rarely in:
    • People with chronic lung problems (who often rest their elbows against a hard surface at the level of the lower rib cage to increase inspiratory effort).
    • People on haemodialysis, as the arm position during dialysis may put prolonged pressure on the elbow.

[Del Buono, 2012; Cassidy and Shubert, 2014; Kim, 2016; Reilly and Kamineni, 2016; Nchinda, 2021; Darrieutort-Laffite, 2023; Shemesh, 2024]

What is the prognosis?

  • Most cases of olecranon bursitis resolve without complications. However, recurrent episodes may occur after septic or non-septic bursitis, and this is particularly likely after recurrent minor trauma.
    • Non-infective cases may be more likely to recur or become chronic. People who have an occupation requiring repetitive activity that is likely to precipitate bursitis will benefit from advice on modifying their activity and using protection to prevent recurrence.
  • Non-septic olecranon bursitis of any cause typically has a benign course, and most people respond well to conservative treatment without the need for surgery.
    • A systematic review found that conservative treatment achieves resolution in approximately 3 weeks on average, and that early initiation of treatment is important — a longer duration of symptoms before treatment is initiated is significantly associated with treatment failure.
    • If non-septic olecranon bursitis is treated by aspiration alone, half of cases will settle in 2 weeks, a quarter will still have an effusion after 8 weeks, and 1 in 10 will have a persistent effusion at 6 months. However, overall resolution rates with aspiration are high, with approximately 95% of cases resolving over longer follow-up. It is not known whether the benefits of aspiration outweigh the possible risks with non-septic bursitis, including infection as a result of local dissemination of bacteria and the potential formation of sinus tracts, which may cause chronic symptoms.
  • Septic olecranon bursitis will usually resolve completely without the need for surgical drainage if treated with aspiration and adequate antibiotic therapy. Although some experts assert that needle aspiration may not be necessary for the successful treatment of mild septic olecranon bursitis. 
    • Symptoms usually resolve after 5 weeks on average, although in some cases it has been reported to take up to 20 weeks for clinical resolution.
  • Pain usually settles more quickly with traumatic olecranon bursitis than with crystal-induced olecranon bursitis (for example, when associated with gout) or septic olecranon bursitis.
  • Recurrence may occur following either septic or non-septic bursitis. Factors associated with recurrent or persistent symptoms include:
    • Continued occupational or recreational elbow trauma.
    • Repeated pressure on the elbow.
    • Inflammatory arthritis.
    • Previous episodes of olecranon bursitis.

[Blackwell, 2014; Cassidy and Shubert, 2014; Reilly and Kamineni, 2016; Brown, 2022 duplicate; Kaur, 2023; Weihe, 2023; Victor, 2024]

What are the complications?

  • Septic olecranon bursitis poses the greatest risk of complications. These may include:
    • Fistulae — may result when septic olecranon bursitis has spontaneously ruptured, or after incision and drainage.
    • Sinus tract development after aspiration. 
    • Infective complications (rare), including:
      • Secondary septic arthritis — rare because the olecranon bursa does not communicate with the elbow joint except in some cases of chronic inflammatory arthropathy. However, secondary septic arthritis has been documented in people with rheumatoid arthritis.
      • Bacteraemia and toxic shock syndrome.
      • Sepsis in immunocompromised people.
      • Osteomyelitis of the olecranon process due to persistent infection. 
      • Necrotizing fasciitis.
      • Secondary infection after aspiration.

[Abzug, 2012; Del Buono, 2012; Blackwell, 2014; Cassidy and Shubert, 2014; Nchinda, 2021]

Diagnosis of olecranon bursitis

When should I suspect olecranon bursitis?

  • Suspect olecranon bursitis if:
    • There is swelling over the olecranon process (elbow) that:
      • Appears over several hours to several days.
      • May be tender or warm (but may be painless).
      • Is fluctuant (movable and compressible).
    • Movement at the elbow joint is painless except at full flexion when the swollen bursa is compressed.
    • There is a history of preceding trauma or bursal disease.
    • There is evidence of local skin abrasion.
    • There is a history of associated medical conditions such as rheumatoid arthritis or gout.
  • It may be difficult to clinically differentiate between septic and non-septic bursitis.
    • Features that may indicate septic bursitis include:
      • Increased tenderness or painful, red, hot swelling of the bursa which is progressively worsening.
      • Local cellulitis.
      • Abrasion or laceration over the bursa.
      • Fever.
      • Immunocompromised state.
      • Seeking medical help soon after the onset of swelling.
    • Other signs of septic olecranon bursitis may include:
      • Tachycardia.
      • Low blood pressure.
      • A change in mental status.
    • If septic bursitis is suspected or there is any doubt whether bursitis is septic or non-septic, consider aspiration of the bursal fluid.
  • Suspect an alternative diagnosis if:
    • There is generalized joint swelling.
    • The range of elbow movement is restricted, or the arm is held in flexion.
  • Consider an X-ray if bony pathology is suspected (for example, a fracture, underlying joint disease, significant history of trauma, or very rapid swelling).

Basis for recommendation

These recommendations are based on a case report of septic bursitis [Wasserman, 2009]; expert opinion in narrative reviews Septic and non-septic olecranon bursitis in the accident and emergency department - an approach to management [Stell, 1996], Olecranon and prepatellar bursitis: treating acute, chronic, and inflamed [McFarland, 2000], Four common types of bursitis: diagnosis and management [Aaron, 2011], Septic olecranon bursitis [Abzug, 2012], Diagnosis and management of olecranon bursitis [Del Buono, 2012], Olecranon bursitis: a systematic overview [Blackwell, 2014], Olecranon bursitis [Reilly and Kamineni, 2016], 2023 French recommendations for diagnosing and managing prepatellar and olecranon septic bursitis [Darrieutort-Laffite, 2023], Characteristics and management of olecranon or prepatellar septic bursitis [Nguyen, 2023]; and expert opinion from previous expert reviewers of this CKS topic.

What else might it be?

  • The localized swelling of olecranon bursitis is usually distinctive, but conditions that may appear clinically similar include:
    • Rheumatoid arthritis — the whole joint is inflamed, rather than a localized, fluctuant swelling over the olecranon process. Nodules may cause swelling over the olecranon region, but they are firm with no fluctuance. Other joints may also be affected. For more information, see the CKS topic on Rheumatoid arthritis.
    • Septic arthritis — the joint is swollen (with absence of localized bursal swelling), and there is a limited, painful range of movement on joint examination. Secondary septic arthritis can also be a rare complication of olecranon bursitis.
    • Gout or, rarely, pseudogout — joints (for example the first metatarsophalangeal joint in gout, or knee or wrist in pseudogout) may have been affected in the past, and laboratory examination of aspiration fluid will show crystals. Acute gout may occur in the bursa with or without local tophi. For more information, see the CKS topic on Gout.
    • Cellulitis — this may coexist with septic olecranon bursitis. For more information, see the CKS topic on Cellulitis - acute.
    • Tennis elbow (lateral epicondylitis) — tenderness to palpation over the origin of the extensor carpi radialis brevis tendon. For more information, please see the CKS topic on Tennis elbow.
    • Trauma (such as a fracture, tendon or ligament injury) — the history is usually indicative of more significant trauma.
    • Local bone or soft tissue tumours — these can be clinically similar to any local bursitis, with pain, swelling, and erythema. Findings suggestive of neoplasia, such as rapid expansion, overt invasive skin changes, and weight loss, should be observed with suspicion as recurrent sarcomas have been initially misdiagnosed as olecranon bursitis. For more information, see the CKS topic on Bone and soft tissue sarcoma - recognition and referral.

Basis for recommendation

This information is based on a case report of septic bursitis [Wasserman, 2009]; expert opinion in narrative reviews Four common types of bursitis: diagnosis and management [Aaron, 2011], Olecranon bursitis: a systematic overview [Blackwell, 2014], Olecranon bursitis [Reilly and Kamineni, 2016], 2023 French recommendations for diagnosing and managing prepatellar and olecranon septic bursitis [Darrieutort-Laffite, 2023], and Characteristics and management of olecranon or prepatellar septic bursitis [Nguyen, 2023]; and expert opinion from previous expert reviewers of this CKS topic.

When should I aspirate olecranon bursitis?

  • Bursal aspiration should only be performed by healthcare professionals who have been trained to do so. 
  • Bursal aspiration is recommended if septic bursitis is suspected or if there is any doubt about whether bursitis is septic or non-septic.
    • Clinical features alone cannot reliably differentiate septic from non-septic bursitis. Bursal aspiration with analysis of bursal fluid is required to confirm or exclude infection.
    • Where possible, aspiration should be performed before antibiotic treatment is started, to maximise the yield of cultures.
  • Aspiration can also be used therapeutically for both septic and non-septic bursitis to relieve symptoms.
  • When aspirating olecranon bursitis:
    • Approach the bursa from the lateral or medial side of the olecranon (not directly over the tip of the olecranon) to reduce the risk of sinus tract formation.
    • Use strict aseptic technique.
    • Remove as much fluid as possible.
    • Send fluid for:
      • Gram stain and culture — to identify the infecting organism and guide antibiotic therapy.
      • Differential cell count — a high white blood cell count is associated with septic bursitis.
      • Microscopy for crystals — to diagnose crystal arthropathy.
  • For non-septic bursitis, whether to aspirate is controversial. Some studies suggest aspiration can be therapeutic and reduce symptoms, while others suggest that aspiration alone is insufficient and may increase the risk of sinus tract formation.
  • Do not inject a corticosteroid at the same time as aspirating for suspected septic bursitis.

Basis for recommendation

These recommendations are based on expert opinion in narrative reviews Septic and non-septic olecranon bursitis in the accident and emergency department - an approach to management [Stell, 1996], Olecranon and prepatellar bursitis: treating acute, chronic, and inflamed [McFarland, 2000], Four common types of bursitis: diagnosis and management [Aaron, 2011], Septic olecranon bursitis [Abzug, 2012], Diagnosis and management of olecranon bursitis [Del Buono, 2012], Olecranon bursitis: a systematic overview [Blackwell, 2014], and Olecranon bursitis [Reilly and Kamineni, 2016]; a chapter on Olecranon bursitis in the medical textbook Essentials of physical medicine and rehabilitation [Cassidy and Shubert, 2014]; a systematic review Treatment of olecranon bursitis: a systematic review [Sayegh, 2014], 2023 French recommendations for diagnosing and managing prepatellar and olecranon septic bursitis [Darrieutort-Laffite, 2023], and Characteristics and management of olecranon or prepatellar septic bursitis [Nguyen, 2023]; and the American College of Occupational and Environmental Medicine (ACOEM) consensus guideline ACOEM practice guidelines: elbow disorders [Hegmann, 2013].

Management

Scenario: Management

From age 16 years onwards.

How should I manage olecranon bursitis?

  • Advise the person to use conservative measures until symptoms improve. These include: 
    • Rest, ice, and reduced activity. Avoiding trauma or direct pressure to the elbows and/or the use of protective elbow pads is recommended.
      • Ice may be used to reduce swelling. It can be applied topically to the area for 10 minutes at a time, every few hours (but not directly onto the skin; a thin towel can be placed between ice and skin). 
    • Compressive bandaging (for example, an elasticated tubular bandage) if tolerated.
    • Considering the use of an analgesic for pain relief — paracetamol or a nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen. For more information, see the CKS topic on NSAIDs - prescribing issues.
    • Seeking treatment promptly — a systematic review of non-surgical treatment found that a longer duration of symptoms before treatment is initiated is significantly associated with treatment failure.
  • If clinically confident that the bursitis is non-septic:
    • Reassure the person that most people will respond to conservative treatment.
    • Advise the person to re-attend if there are worsening symptoms, such as increasing pain and spreading inflammation, which could be caused by infection.
    • Consider aspiration (if the expertise and equipment are available) to improve function and comfort, particularly if the effusion is large.
    • If there is no response to conservative measures and/or aspiration, consider a corticosteroid injection into the bursa only if you are confident that bursitis is non-septic and there is expertise and experience at performing this procedure. A systematic review found that corticosteroid injection achieves faster symptom resolution than conservative management, but is associated with a significantly higher risk of complications, including bursal infection and skin atrophy, and should therefore be reserved for refractory cases where conservative management has failed.
      • If the requisite skills are not available and/or there is a risk of introducing or aggravating infection (signs of inflammation, a surgical scar, or abnormal skin at the injection site), refer to a specialist.
    • Refer if there is no response to available treatments in primary care after 2 months. 
  • If septic bursitis is suspected:
    • Where possible, aspirate bursal fluid before starting antibiotic treatment to maximise the yield of cultures. Use an aseptic technique and treat empirically with an oral antibiotic that covers staphylococcal and streptococcal species (for an initial period of 7 days) until culture results are known. If aspiration is not possible, treat empirically with an oral antibiotic and refer for aspiration.
      • Flucloxacillin (500 mg four times daily) is the preferred antibiotic. For people over 70 kg, prescribe 1000 mg four times daily.
      • Clarithromycin (500 mg twice daily) may be used if the person is allergic to penicillin. Erythromycin (500 mg four times daily) is the preferred macrolide in pregnancy and breastfeeding.
      • If the person is immunocompromised, seek specialist advice.
    • Provide advice about conservative management and analgesic pain relief. 
    • Review every 3–5 days to monitor the effectiveness of therapy
      • Antibiotic treatment may be necessary for 1–4 weeks, depending on individual response.
    • Adjust antibiotic treatment according to sensitivities.
    • If swelling, tenderness, and erythema recur, consider repeated aspiration. The period between aspirations should be guided by clinical response.
    • Admit or refer (depending on severity of symptoms) if the response is inadequate after 3–5 days of antibiotic treatment, or if complications are suspected.
  • If the person has gout, rheumatoid arthritis, or associated cellulitis, ensure that these conditions are managed appropriately. For more information, see the CKS topics on Gout, Rheumatoid arthritis, and Cellulitis - acute.

Basis for recommendation

These recommendations are based on the American College of Occupational and Environmental Medicine (ACOEM) consensus guideline ACOEM practice guidelines: elbow disorders [Hegmann, 2013]; a chapter on Olecranon bursitis in the medical textbook Essentials of physical medicine and rehabilitation bursitis [Cassidy and Shubert, 2014]; expert opinion in narrative reviews Olecranon and prepatellar bursitis: treating acute, chronic, and inflamed [McFarland, 2000], Complications following resection of the olecranon bursa [Degreef, 2006], Prepatellar and olecranon bursitis: literature review and development of a treatment algorithm [Baumbach, 2014], Four common types of bursitis: diagnosis and management [Aaron, 2011], Diagnosis and management of olecranon bursitis [Del Buono, 2012], Olecranon bursitis: a systematic overview [Blackwell, 2014], Olecranon bursitis  [Reilly and Kamineni, 2016], and Clinical management of olecranon bursitis: a review [Nchinda, 2021], 2023 French recommendations for diagnosing and managing prepatellar and olecranon septic bursitis [Darrieutort-Laffite, 2023], Non-surgical treatment of aseptic olecranon bursitis: A systematic review [Kaur, 2023]; and Guideline for Skin and Soft Tissue Infection Including Diabetic Foot Ulcer [Doncaster & Bassetlaw Teaching Hospitals, 2022].

 

When should I admit or refer a person with olecranon bursitis?

  • Admit the person urgently if they have:
    • A suspected septic joint (which presents with a limited range of movement of the elbow joint, unlike septic bursitis).
    • Septic bursitis and severe infection or systemic toxicity, including high fever.
  • Admit the person on the same day if they have septic bursitis and: 
    • Extensive cellulitis.
    • A pointing abscess requiring incision and drainage, if the expertise to perform this procedure is not available in primary care.
  • Admission to hospital may also be required if the person is immunocompromised or has other comorbid medical conditions, such as diabetes or rheumatoid arthritis.
  • Refer urgently or seek specialist advice if there is no response, or an inadequate response, to an antibiotic in septic bursitis — a change in antibiotic, intravenous antibiotic, or incision and drainage may be required.
  • Also refer if:
    • Aspiration is needed but there is no expertise available in primary care.
    • The person experiences recurrent septic bursitis — surgical excision of the bursa may be required, but only after infection has cleared.
  • Consider referral if a person with non-septic bursitis, in whom septic bursitis has been excluded, does not respond after 2 months of conservative measures (refer sooner if their symptoms are pronounced, for example significant discomfort) — corticosteroid injection into the bursa or surgical management may be beneficial.

Basis for recommendation

These recommendations are based on the American College of Occupational and Environmental Medicines (ACOEM) consensus guideline ACOEM practice guidelines: elbow disorders [Hegmann, 2013]; expert opinion in a chapter on Olecranon bursitis in the medical textbook Essentials of physical medicine and rehabilitation bursitis [Cassidy and Shubert, 2014]; expert opinion in narrative reviews Four common types of bursitis: diagnosis and management [Aaron, 2011], Olecranon bursitis: a systematic overview [Blackwell, 2014], and Olecranon bursitis [Reilly and Kamineni, 2016].

Referral of people with septic bursitis
Referral of people with non-septic bursitis
  • Expert opinion suggests that surgical management may be needed if conservative measures fail [Blackwell, 2014; Reilly and Kamineni, 2016], therefore CKS recommends referral in this situation.
  • Expert opinion in a review article suggests that people with a history of bursitis lasting 2 months or longer do not improve with conservative treatment [Shell et al, 1995]. CKS therefore recommends referral of this group for consideration of further treatment, such as corticosteroid injection.
  • Previous expert reviewers of this CKS topic emphasized the importance of excluding septic bursitis. They advised that if there are symptoms suggestive of septic bursitis, referral should be made sooner than the 2 month timescale.
Secondary care investigation and treatment
  • Investigations that may be requested in secondary care include magnetic resonance imaging to exclude osteomyelitis if response to antibiotics has been poor [Aaron, 2011].
  • Treatments potentially available in secondary care include:

Prescribing information

Important aspects of prescribing information relevant to primary healthcare are covered in this section specifically for the drugs recommended in this CKS topic. For further information on contraindications, cautions, drug interactions, and adverse effects, see the electronic Medicines Compendium (eMC), or the British National Formulary (BNF).

Analgesia

Flucloxacillin

What are the contraindications and cautions for flucloxacillin?

  • Do not prescribe flucloxacillin in people with:
    • A true penicillin allergy — allergic reactions to penicillins occur in 1–10% of exposed individuals; anaphylactic reactions occur in fewer than 0.05% of treated people.
      • People with a history of atopy (e.g. asthma, eczema, hay fever) are at a higher risk of anaphylactic reactions to penicillins — people with a history of anaphylaxis, urticaria, or rash immediately after penicillin administration are at risk of immediate hypersensitivity and should not receive a penicillin.
      • People with a history of a minor rash (non-confluent, non-pruritic rash restricted to a small area of the body) or a rash that occurs more than 72 hours after penicillin administration are probably not allergic to penicillin and it should not be withheld unnecessarily for serious infections — the possibility of an allergic reaction should, however, be borne in mind.
    • History of flucloxacillin-associated jaundice or hepatic dysfunction.
  • Prescribe flucloxacillin with caution in people with:
    • Hepatic dysfunction (not flucloxacillin-related), aged over 50 years, or with a serious underlying medical condition — these people are at increased risk of hepatic reactions.
    • Severe renal impairment — reduce the dose if the person's estimated glomerular filtration rate (eGFR) is less than 10 mL/minute/1.73 m2.
    • A history of allergy — these people are more likely to develop a sensitivity reaction.

[EMC, 2023; BNF, 2026]

What are the adverse effects of flucloxacillin?

  • Gastrointestinal — diarrhoea, nausea and vomiting (common).
    • Very rarely: antibiotic-associated colitis.
  • Nervous system — headache, dizziness (uncommon).
  • Skin and subcutaneous tissue — skin rash, urticaria and purpura (uncommon).
    • Very rarely: erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis, acute generalised exanthematous pustulosis.
  • Other rare, or very rare adverse effects include:
    • Anaphylaxis.
    • Arthralgia and myalgia (very rare) — may sometimes develop more than 48 hours after the start of the treatment.
    • Hepatitis, cholestatic jaundice — this may occur up to several weeks after treatment with flucloxacillin has been stopped. Risk factors include treatment for more than 2 weeks, and increasing age.
    • Interstitial nephritis.
    • Neutropenia, thrombocytopenia, haemolytic anaemia.

 [EMC, 2023; BNF, 2026]

What are the drug interactions of flucloxacillin?

  • Paracetamol — concomitant use of flucloxacillin and paracetamol has been associated with high anion gap metabolic acidosis (HAGMA), due to accumulation of 5-oxoproline. The risk is higher with prolonged use and in people who are older, female, malnourished, have vitamin B deficiency, diabetes, or severe illness. Be vigilant for signs of metabolic acidosis in these groups, particularly when treatment extends beyond 2–3 weeks. If HAGMA is suspected, discontinue paracetamol promptly.
  • Methotrexate — methotrexate clearance may be reduced, causing an increased risk of toxicity, however, serious interactions are uncommon. 
    • Standard routine monitoring will identify any decreases in elimination in people on high-dose regimens. For people on low-dose regimens, consult local or national guidelines/protocols for monitoring and management.
  • Coumarin and indanedione anticoagulants (warfarin, phenidione) — consider increased monitoring of international normalized ratio (INR) and adjust the dose accordingly.
  • Posaconazole, voriconazole — concentrations of antifungal is greatly decreased. If concurrent use is unavoidable, monitor for decreased efficacy and consider increasing the dose of the azole (although this may not resolve the issue). 
  • Probenecid — concomitant administration may result in increased levels of flucloxacillin.
  • Live cholera vaccine — efficacy of vaccine may be reduced. Avoid flucloxacillin from 14 days before to 10 days after receiving live cholera vaccine.
  • Live typhoid vaccine — immune response to vaccine may be reduced. Avoid flucloxacillin from 3 days before to 3 days after receiving live typhoid vaccine.

For a complete list of possible drug interactions for flucloxacillin, see the electronic Medicines Compendium (eMC) or the British National Formulary (BNF).

[Preston, 2026]

Pregnancy and breastfeeding

Pregnancy

  • Flucloxacillin is not known to be harmful in pregnancy.

Breastfeeding

  • All penicillin antibiotics, including flucloxacillin, can be used during breastfeeding. Flucloxacillin is one of the preferred choices as there is more evidence and experience to support its use. Only negligible quantities pass into breastmilk.
  • As a precaution, monitor the infant for gastrointestinal disturbances, oral candida infection, hypersensitivity reactions (including rashes or breathing problems), nausea, irritability, and drowsiness. These effects are generally mild and self-limiting.
  • If the infant is unwell or premature, or multiple medicines are being taken, seek further specialist advice from the UK Drugs in Lactation Advisory Service
    • Penicillins (and cephalosporins) are the antibiotics of choice in women who are breastfeeding.

 

[SPS, 2024; EMC, 2023]

Erythromycin

  • Clarithromycin is preferred and better tolerated than erythromycin, but nausea, vomiting, or diarrhoea can sometimes occur with both drugs. Erythromycin is preferred in women who are pregnant or breastfeeding.

What are the contraindications and cautions for erythromycin?

  • Do not prescribe erythromycin to people with: 
    • Acute porphyrias.
    • A history of QT interval prolongation (congenital or acquired) or ventricular cardiac arrhythmia, including Torsades de Pointes.
    • Electrolyte disturbances (such as hypokalaemia or hypomagnesaemia) — due to the risk of arrhythmia associated with QT interval prolongation.
  • Prescribe erythromycin with caution to people with:
    • Cardiac disease or heart failure, conduction disturbances or clinically relevant bradycardia, or if taking concomitant medicines associated with QT interval prolongation.
    • Hepatic impairment.
    • Severe renal impairment — maximum dose 1500 mg daily due to the risk of ototoxicity.
    • Myasthenia gravis.

  [MHRA, 2020; BNF, 2026; EMC, 2025a]

What are the adverse effects of erythromycin?

  • Gastrointestinal (GI) — diarrhoea, GI discomfort/disorders, nausea, vomiting, pancreatitis (common or very common); constipation (uncommon).
    • Rare or very rare: antibiotic-associated colitis.
  • Cardiovascular — QTc interval prolongation, Torsades de Pointes, palpitations and cardiac rhythm disorders, including ventricular tachyarrhythmias (uncommon).
  • Ear and labyrinth disorders — hearing impairment, tinnitus.
  • Hepatobiliary — cholestatic hepatitis, jaundice, hepatic dysfunction, hepatomegaly, hepatic failure, hepatocellular hepatitis.
  • Skin and subcutaneous tissues — skin reactions (common or very common); Stevens-Johnson syndrome, toxic epidermal necrolysis, erythema multiforme (uncommon); acute generalized exanthematous pustulosis (AGEP) (frequency unknown).
  • Other common adverse effects include:
    • Dizziness.
    • Headache.
    • Vasodilation.
    • Vision disorders.

 [EMC, 2025a; BNF, 2026]

What are the drug interactions of erythromycin?

  • Drug interactions for erythromycin include:

    • Aminophylline, theophylline — aminophylline can cause hypokalaemia (potentially increasing the risk of Torsade de Pointes) when given with erythromycin. Theophylline clearance (from aminophylline) can be reduced if given concurrently with erythromycin. Oral erythromycin exposure may be reduced by theophylline. Monitor theophylline levels after 48 hours and adjust the dose accordingly. Monitor potassium concentrations closely and the effects of oral erythromycin to ensure they are adequate. Consider giving an alternative antibiotic. 
    • Calcium channel blockers (amlodipine, diltiazem) — erythromycin possibly inhibits the metabolism of calcium channel blockers, increasing the risk of adverse effects, such as hypotension. Monitor for adverse effects (for example, bradycardia, hypotension, headache, oedema) and reduce the calcium channel blocker dose as necessary.
    • Corticosteroids — levels of corticosteroids may be increased. Monitor for corticosteroid adverse effects (such as moon face, weight gain, hyperglycaemia), and adjust the corticosteroid dose or stop the macrolide as appropriate. 
    • Rifampicin — may induce the metabolism of erythromycin, resulting in sub-therapeutic levels.
      • If concurrent use is necessary, monitor erythromycin efficacy closely.
    • Carbamazepine — erythromycin can increase carbamazepine levels, causing carbamazepine toxicity (which may present as nausea and vomiting, ataxia, and drowsiness).
      • Avoid concurrent use, unless carbamazepine levels can be monitored closely. 
    • Ciclosporin — levels are greatly increased by erythromycin. Monitor concentrations and effects (for example, renal function) more frequently if erythromycin is started or stopped. Adjust the ciclosporin dose as required. 
    • Cisapride, domperidone — levels may be raised, increasing the risk of potentially life-threatening arrhythmias (Torsade de Pointes). Concurrent use is contraindicated.
    • Colchicine — erythromycin possibly increases the risk of colchicine toxicity.
      • Stop or reduce the dose of colchicine.
      • Avoid concurrent use in renal or hepatic impairment.
    • Drugs that prolong the QT interval (such as amiodarone, amisulpride, fluconazole, sildenafil, mizolastine, hydroxyzine) — macrolides can also prolong the QT interval, increasing the risk of arrhythmias (such as Torsades de Pointes).
      • Concurrent use of drugs that prolong the QT interval is contraindicated.
    • Drugs that cause hypokalaemia (such as diuretics, corticosteroids, short-acting beta-2 agonists) — hypokalaemia is a risk factor for QT prolongation. Monitor potassium levels closely. 
    • Digoxin — erythromycin may increase the concentration of digoxin. 
      • Monitor digoxin concentration.
    • Edoxaban — erythromycin slightly increases edoxaban levels. Decrease dose of edoxaban to 30 mg once daily. Monitor for signs and symptoms of bleeding. 
    • Ergot alkaloids (such as ergotamine and dihydroergotamine) — concurrent use with erythromycin may result in acute ergot toxicity. 
      • Concurrent use is contraindicated.
    • Lomitapide — concurrent use with erythromycin increases transaminase levels and is contraindicated.
    • Protease inhibitors (ritonavir, saquinavir) — erythromycin levels may be increased. Monitor for adverse effects. 
    • Rivaroxaban — erythromycin slightly increases levels, but this is not considered clinically significant. 
    • Statins — there is an increased risk of myopathy (due to cytochrome P450 enzyme CYP3A4 inhibition) [MHRA, 2014].    
      • Lovastatin, simvastatin  — concurrent use is contraindicated. If erythromycin treatment cannot be avoided, withhold the statin during the course of the treatment.
      • Atorvastatin — levels of atorvastatin increased slightly with concurrent use. Temporarily withhold the statin, or if necessary give the lowest dose of statin and advise the person to seek medical advice if they experience symptoms of myopathy (for example muscle pain, tenderness, or weakness).
      • Pravastatin — prescribe erythromycin with caution, and advise the person to report any muscle pain, tenderness, or weakness.
    • Quetiapine — erythromycin increases the plasma concentration of quetiapine and both drugs are associated with QT interval prolongation.
      • Concurrent use is contraindicated, but if necessary, monitor for quetiapine adverse effects (for example somnolence, dry mouth, tachycardia) and reduce the dose if needed.
    • Warfarin — erythromycin may cause a minor increase in warfarin effects. 
      • Consider increased monitoring of the international normalized ratio (INR) when both drugs are used (particularly in elderly people), and adjust the warfarin dose accordingly. 
  • Oral hormonal contraception — additional contraceptive precautions are not required during or after a course of erythromycin. 
  • For a complete list of possible drug interactions for erythromycin, see the electronic Medicines Compendium (eMC) or the British National Formulary (BNF).

[MHRA, 2020; BNF, 2026]

Pregnancy and breastfeeding

Pregnancy

  • Erythromycin should only be used if the potential benefits outweigh the possible risks.  
    • The majority of data do not provide evidence that macrolide use during pregnancy increases the risk of adverse pregnancy outcomes. However, a limited number of studies have described small increased risks of malformation and miscarriage. Macrolide use should be reserved for compelling indications where there are no suitable alternatives with adequate pregnancy safety data, and should only be used if the expected benefits outweigh any small increased risks [MHRA, 2021]. 
  • Erythromycin is the preferred macrolide antibiotic for use in pregnancy where a macrolide is clinically indicated, for example, in true penicillin allergy. The available evidence is insufficient to confirm with certainty the presence or absence of a small increased risk of malformations or miscarriage with macrolide use in early pregnancy, but erythromycin remains the preferred macrolide in this context.

Breastfeeding

  • Erythromycin is excreted in breast milk in small amounts, and it is not known to be harmful [LactMed, 2024]. 
    • Monitor the infant for irritability and possible effects on the gastrointestinal flora, such as diarrhoea, candidiasis (thrush, nappy rash). 
  • However the manufacturer advises exercising caution due to reports of infantile hypertrophic pyloric stenosis in breastfed infants [EMC, 2025a]. 

Clarithromycin

What are the contraindications and cautions for clarithromycin?

  • Do not prescribe clarithromycin in people with:
    • A history of QT prolongation (congenital or acquired) or ventricular cardiac arrhythmia, including Torsades de Pointes.
    • Electrolyte disturbances (such as hypokalaemia or hypomagnesaemia) — due to the risk of arrhythmia associated with QT interval prolongation.
    • Severe hepatic impairment if renal impairment is also present.
  • Prescribe clarithromycin with caution in people with:
    • Coronary artery disease, severe cardiac insufficiency, conduction disturbances or clinically relevant bradycardia, or taking drugs that prolong the QT interval. 
    • Impaired hepatic function, or receiving potentially hepatotoxic drugs.
    • Renal impairment — reduce dose by half if estimated glomerular filtration rate (eGFR) is less than 30 mL/minute/1.73 m2.
      • Avoid clarithromycin m/r preparations if eGFR is less than 30 mL/minute/1.73 m2. 
    • Myasthenia gravis.

[EMC, 2025b; BNF, 2026]

What are the adverse effects of clarithromycin?

  • Gastrointestinal — diarrhoea, vomiting, dyspepsia, nausea, abdominal pain (common).
  • Nervous system — headache, dysgeusia (common), dizziness, somnolence, tremor (uncommon).
    • Rarely: convulsions, paraesthesia.
  • Psychiatric — insomnia (common), anxiety, nervousness (uncommon).
    • Rarely or very rarely: psychotic disorders, depression, mania, hallucination.
  • Skin — rash, hyperhidrosis (common), pruritus, urticaria (uncommon).
    • Rarely, or very rarely: drug reaction with eosinophilia and systemic symptoms (DRESS), Stevens-Johnson syndrome, toxic epidermal necrolysis, acute generalized exanthematous pustulosis (AGEP).
  • Other adverse effects reported rarely, or very rarely, include: 
    • Anaphylaxis.
    • Arrhythmias.
    • Deafness.
    • Hepatic failure, jaundice.
    • Pancreatitis. 
    • QT interval prolongation.

 [EMC, 2025b; Joint Formulary Committee, 2021]

What are the drug interactions of clarithromycin?

  • Calcium channel blockers (CCBs) (verapamil, amlodipine, diltiazem) — clarithromycin increases exposure to CCBs. Monitor for adverse effects (for example bradycardia, hypotension, headache, oedema) and reduce the calcium-channel blocker dose as necessary.
  • Ciclosporin — clarithromycin can affect clearance of ciclosporin. If concurrent use is necessary, monitor ciclosporin levels and adjust the dose accordingly.
  • Colchicine — clarithromycin moderately increases the levels of colchicine. The manufacturer advises that concurrent use is contraindicated. 
  • CYP3A enzyme inducers (rifampicin, carbamazepine, phenobarbital) — these may induce the metabolism of clarithromycin, resulting in sub-therapeutic levels.
    • It may be necessary to monitor the levels of these drugs, as CYP3A is inhibited by clarithromycin leading to higher plasma levels of the inducer.
  • Digoxin — clarithromycin significantly increases digoxin levels. Monitor for signs of adverse effects, measure digoxin levels, and reduce the digoxin dose if required.
  • Eplerenone — clarithromycin may increase exposure to eplerenone, concurrent use is contraindicated.
  • Ergot alkaloids — concurrent administration is contraindicated, due to the risk of acute ergot toxicity.
  • Edoxaban — manufacturer advises caution with concurrent treatment with edoxaban, particularly in those with a high risk of bleeding.
  • Ivabradine — concomitant treatment is contraindicated, owing to CYP3A4 inhibition by clarithromycin which can cause elevated levels of ivabradine.
  • Oral hormonal contraception — additional contraceptive precautions are not required during or after courses of clarithromycin.
  • Oral hypoglycaemic drugs (sulfonylureas) and insulin — the concurrent use of clarithromycin and oral hypoglycaemic drugs and/or insulin can result in significant hypoglycaemia. Monitor glucose levels.
  • Statins — these are extensively metabolized by CYP3A4. Concurrent administration with clarithromycin increases the plasma levels and the risk of myopathy.
    • Lovastatin, simvastatin — concurrent use is contraindicated. If treatment with clarithromycin cannot be avoided, stop treatment with statin temporarily.
    • Atorvastatin — levels moderately increased with concurrent use. Temporarily withhold statin, or if necessary, reduce dose and warn patients to report any unexplained muscle pain or weakness. 
  • Ticagrelor — levels markedly increased. Concurrent use is contraindicated.
  • Warfarin — clarithromycin increases the anticoagulant effect of warfarin. Monitor the international normalized ratio (INR), and adjust the warfarin dose accordingly.
  • Drugs that prolong the QT interval — all macrolides can prolong the QT interval, and caution is advised with concurrent use. Concurrent use is contraindicated with domperidone, ivabradine, mizolastine, astemizole, cisapride, pimozide, and terfenadine.
  • For a complete list of possible drug interactions for clarithromycin, see the electronic Medicines Compendium (eMC) or the British National Formulary (BNF). 

 

[EMC, 2025b; BNF, 2026]

Pregnancy and breastfeeding

Pregnancy

  • Avoid clarithromycin in pregnancy if possible — erythromycin is the preferred macrolide where a macrolide antibiotic is required in pregnancy.
  • The available evidence is insufficient to confirm with certainty whether there is a small increased risk of malformations or miscarriage when macrolides are taken in early pregnancy.
  • If a macrolide antibiotic is clinically necessary and no suitable alternative is available, the potential benefits and risks should be discussed with the patient [MHRA, 2021].

Breastfeeding

  • Clarithromycin is acceptable in nursing mothers. Only low levels pass into breastmilk and the small amounts present are unlikely to cause adverse effects in the infant.
  • Monitor the infant for possible effects on gastrointestinal flora, such as diarrhoea and candidiasis [LactMed, 2022].
    • Earlier concerns about a possible increased risk of infantile hypertrophic pyloric stenosis (IHPS) with maternal macrolide use during breastfeeding have not been confirmed — two subsequent meta-analyses have failed to demonstrate this relationship
  • The manufacturer advises that clarithromycin use should be avoided in women who are breastfeeding unless the potential benefits outweigh the possible risks.

[EMC, 2025b; Joint Formulary Committee, 2021]

Supporting evidence

This CKS topic is largely based on the American College of Occupational and Environmental Medicine (ACOEM) consensus guideline ACOEM practice guidelines: elbow disorders [Hegmann, 2013]; a chapter on Olecranon bursitis in the medical textbook Essentials of physical medicine and rehabilitation bursitis [Cassidy and Shubert, 2014]; expert opinion in narrative reviews Olecranon and prepatellar bursitis: treating acute, chronic, and inflamed [McFarland, 2000], Prepatellar and olecranon bursitis: literature review and development of a treatment algorithm [Baumbach, 2014], Four common types of bursitis: diagnosis and management [Aaron, 2011], Diagnosis and management of olecranon bursitis [Del Buono, 2012], Olecranon bursitis: a systematic overview [Blackwell, 2014], Olecranon bursitis [Reilly and Kamineni, 2016], Clinical management of olecranon bursitis: a review [Nchinda, 2021], the systematic review Non-surgical treatment of aseptic olecranon bursitis [Kaur, 2023] and the 2023 French recommendations for diagnosing and managing prepatellar and olecranon septic bursitis [Darrieutort-Laffite, 2023]. The rationale for individual recommendations is outlined in the relevant basis for recommendation sections of the topic.

How this topic was developed

This section briefly describes the processes used in developing and updating this topic. Further details on the full process can be found in the About Us section and on the Clarity Informatics website.

Search strategy

A literature search was conducted for guidelines, systematic reviews and randomized controlled trials on primary care management of olecranon bursitis, with additional searches in the following areas:

  • Management of any infection
  • Work related injury
  • Referral for surgery

Search dates

April 2021- 1 June 2026

Key search terms

Various combinations of searches were carried out. The terms listed below are the core search terms that were used for Medline.

  • exp Bursitis/, exp Elbow Joint/, exp Elbow/, bursitis.tw, olecranon bursitis.tw, elbow bursitis.tw
  • exp olecranon process/
  • *elbow joint/

Sources of guidelines

Sources of systematic reviews and meta-analyses

  • The Cochrane Library:
    • Systematic reviews
    • Protocols
    • Database of Abstracts of Reviews of Effects
  • Medline (with systematic review filter)
  • EMBASE (with systematic review filter)

Sources of health technology assessments and economic appraisals

Sources of randomized controlled trials

  • The Cochrane Library:
    • Central Register of Controlled Trials
  • Medline (with randomized controlled trial filter)
  • EMBASE (with randomized controlled trial filter)

Sources of evidence based reviews and evidence summaries

Sources of national policy

Patient experiences

Sources of medicines information

The following sources are used by CKS pharmacists and are not necessarily searched by CKS information specialists for all topics. Some of these resources are not freely available and require subscriptions to access content.

Stakeholder engagement

Our policy

The external review process is an essential part of CKS topic development. Consultation with a wide range of stakeholders provides quality assurance of the topic in terms of:

  • Clinical accuracy.
  • Consistency with other providers of clinical knowledge for primary care.
  • Accuracy of implementation of national guidance (in particular NICE guidelines).
  • Usability.

Principles of the consultation process

  • The process is inclusive and any individual may participate.
  • To participate, an individual must declare whether they have any competing interests or not. If they do not declare whether or not they have competing interests, their comments will not be considered.
  • Comments received after the deadline will be considered, but they may not be acted upon before the clinical topic is issued onto the website.
  • Comments are accepted in any format that is convenient to the reviewer, although an electronic format is encouraged.
  • External reviewers are not paid for commenting on the draft topics.
  • Discussion with an individual or an organization about the CKS response to their comments is only undertaken in exceptional circumstances (at the discretion of the Clinical Editor or Editorial Steering Group).
  • All reviewers are thanked and offered a letter acknowledging their contribution for the purposes of appraisal/revalidation.
  • All reviewers are invited to be acknowledged on the website. All reviewers are given the opportunity to feedback about the external review process, enabling improvements to be made where appropriate.

Stakeholders

  • Key stakeholders identified by the CKS team are invited to comment on draft CKS topics. Individuals and organizations can also register an interest to feedback on a specific topic, or topics in a particular clinical area, through the Getting involved section of the Clarity Informatics website.
  • Stakeholders identified from the following groups are invited to review draft topics:
    • Experts in the topic area.
    • Professional organizations and societies (for example, Royal Colleges).
    • Patient organizations, Clarity has established close links with groups such as Age UK and the Alzheimer’s Society specifically for their input into new topic development, review of current topic content and advice on relevant areas of expert knowledge.
    • Guideline development groups where the topic is an implementation of a guideline.
    • The British National Formulary team.
    • The editorial team that develop MeReC Publications.
  • Reviewers are provided with clear instructions about what to review, what comments are particularly helpful, how to submit comments, and declaring interests.

Patient engagement

Clarity Informatics has enlisted the support and involvement of patients and lay persons at all stages in the process of creating the content which include:

  • Topic selection
  • Scoping of topic
  • Selection of clinical scenarios
  • First draft internal review
  • Second draft internal review
  • External review
  • Final draft and pre-publication

Our lay and patient involvement includes membership on the editorial steering group, contacting expert patient groups, organizations and individuals.

Evidence exclusion criteria

Our policy

Scoping a literature search, and reviewing the evidence for CKS is a methodical and systematic process that is carried out by the lead clinical author for each topic. Relevant evidence is gathered in order that the clinical author can make fully informed decisions and recommendations. It is important to note that some evidence may be excluded for a variety of reasons. These reasons may be applied across all CKS topics or may be specific to a given topic.

Studies identified during literature searches are reviewed to identify the most appropriate information to author a CKS topic, ensuring any recommendations are based on the best evidence. We use the principles of the GRADE and PICOT approaches to assess the quality of published research. We use the principles of AGREE II to assess the quality of published guidelines.

Standard exclusions for scoping literature:

  • Animal studies
  • Original research is not written in English

Possible exclusions for reviewed literature:

  • Sample size too small or study underpowered
  • Bias evident or promotional literature
  • Population not relevant
  • Intervention/treatment not relevant
  • Outcomes not relevant
  • Outcomes have no clear evidence of clinical effectiveness
  • Setting not relevant
  • Not relevant to UK
  • Incorrect study type
  • Review article
  • Duplicate reference

Organizational, behavioural and financial barriers

Our policy

The CKS literature searches take into consideration the following concepts, which are discussed at the initial scoping of the topic.

  • Feasibility
    • Studies are selected depending on whether the intervention under investigation is available in the NHS and can be practically and safely undertaken in primary care.
  • Organizational and Financial Impact Analysis
  • Studies are selected and evaluated on whether the intervention under investigations may have an impact on local clinical service provision or national impact on cost for the NHS. The principles of clinical budget impact analysis are adhered to, evaluated and recorded by the author. The following factors are considered when making this assessment and analysis.
    • Eligible population
    • Current interventions
    • Likely uptake of new intervention or recommendation
    • Cost of the current or new intervention mix
    • Impact on other costs
    • Condition-related costs
    • In-direct costs and service impacts
    • Time dependencies
  • Cost-effectiveness or cost-benefit analysis studies are identified where available. 

We also evaluate and include evidence from NICE accredited sources which provide economic evaluations of recommendations, such as NICE guidelines. When a recommended action may not be possible because of resource constraints, this is explicitly indicated to healthcare professionals by the wording of the CKS recommendation.

Declarations of interest

Our policy

Clarity Informatics requests that all those involved in the writing and reviewing of topics, and those involved in the external review process to declare any competing interests. Signed copies are securely held by Clarity Informatics and are available on request with the permission of the individual. A copy of the declaration of interest form which participants are asked to complete annually is also available on request. A brief outline of the declarations of interest policy is described here and full details of the policy is available on the Clarity Informatics website. Declarations of interests of the authors are not routinely published, however competing interests of all those involved in the topic update or development are listed below. Competing interests include:

  • Personal financial interests
  • Personal family interest
  • Personal non-financial interest
  • Non-personal financial gain or benefit

Although particular attention is given to interests that could result in financial gains or losses for the individual, competing interests may also arise from academic competition or for political, personal, religious, and reputational reasons. An individual is not obliged to seek out knowledge of work done for, or on behalf of, the healthcare industry within the departments for which they are responsible if they would not normally expect to be informed.

Who should declare competing interests?

Any individual (or organization) involved in developing, reviewing, or commenting on clinical content, particularly the recommendations should declare competing interests. This includes the authoring team members, expert advisers, external reviewers of draft topics, individuals providing feedback on published topics, and Editorial Steering Group members. Declarations of interest are completed annually for authoring team and editorial steering group members, and are completed at the start of the topic update and development process for external stakeholders.

Competing interests declared for this topic:

None.

References

  • Aaron, D.L., Patel, A., Kayiaros, S. and Calfee, R. (2011) Four common types of bursitis: diagnosis and management. Journal of the American Academy of Orthopaedic Surgeons 19(6), 359-367. [Abstract]
  • Abzug, J.M., Chen, N.C. and Jacoby, S.M. (2012) Septic olecranon bursitis. Journal of Hand Surgery 37(6), 1252-1253. [Abstract]
  • Baumbach, S.F., Lobo, C.M. and Badyine, I. (2014) Prepatellar and olecranon bursitis: literature review and development of a treatment algorithm. Archives of Orthopaedic and Trauma Surgery 134(3), 359-370. [Abstract]
  • Blackwell, J.R., Hay, B.A., Bolt, A.M. and Hay, S.M. (2014) Olecranon bursitis: a systematic overview. Shoulder and Elbow 6(3), 182-190. [Abstract]
  • BNF (2026) British National Formulary. National Institute for Health and Care Excellence. https://bnf.nice.org.uk [Free Full-text]
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