Fibrin glue for olecranon bursitis: a case report.

Abstract

Olecranon bursitis is a common cause of elbow pain and swelling. Causes of aseptic inflammation of the olecranon bursa include trauma, gout, calcium pyrophosphate dihydrate crystal deposition disease, rheumatoid arthritis, and systemic lupus erythematosus. Most cases occur in men between the ages of 30 years and 60 years. The inflammatory response within a bursa can lead to permanent epithelial damage and recurrent symptoms. There is little literature to guide therapy for recurrent olecranon bursitis. Commonly used conservative modalities include ice, compression, and activity modification with use of elbow padding. Aspiration, corticosteroid injection, and surgery are often reserved for persistent cases. Weinstein and colleagues studied patients with both acute and chronic olecranon bursitis, finding aspiration alone was sufficient for resolution of effusion in 55% of patients at 2 weeks, 77% at 8 weeks, and 91% at 24 weeks. In contrast, patients who received intrabursal steroid injections improved more quickly, but with more subsequent complications. In the group treated with aspiration and triamcinolone hexacetonide injection, 3 out of 25 patients (12%) developed a septic bursitis compared with none with aspiration only [Weinstein et al. 1984]. A recent review by Baumbach and colleagues suggests that chronic, nonseptic olecranon or prepatellar bursitis that does not resolve after initial aspiration and corticosteroid injection should be treated with bursectomy [Baumbach et al. 2014]. For patients who do not desire to proceed with surgery, the literature offers little further guidance. This case report presents a novel treatment for recurrent olecranon bursitis using a fibrin glue sealant. After failure of conventional therapies, a patient with chronic, refractory nonseptic olecranon bursitis was treated with ultrasound-guided injection of fibrin glue, resulting in complete resolution of his refractory bursitis. This therapy provided a safe and minimally invasive alternative to bursectomy. Fibrin sealants have been used for many years during various types of surgeries and procedures. Its unique properties and minimal risk make it an attractive treatment option for persistent nonseptic olecranon bursitis.