Intrabursal Doxycycline Sclerotherapy for Recurrent Olecranon Bursitis of the Elbow: A Case Control Study

Daniel McDermott; Dorothy Wakefield; Marc Kowalsky; Paul Sethi; Mark A Vitale; Bernard F Morrey

doi:10.1016/j.jhsg.2024.03.006

Intrabursal Doxycycline Sclerotherapy for Recurrent Olecranon Bursitis of the Elbow: A Case Control Study

J Hand Surg Glob Online. 2024 Apr 8;6(4):504-509. doi: 10.1016/j.jhsg.2024.03.006. eCollection 2024 Jul.

Authors

Daniel McDermott¹, Dorothy Wakefield¹, Marc Kowalsky^{1

2}, Paul Sethi^{1

2}, Mark A Vitale^{1

2}, Bernard F Morrey^{3

4}

Affiliations

¹ ONS Foundation for Clinical Research and Education, ONS, Greenwich, CT.
² Department of Orthopaedic Surgery, Greenwich Hospital, Yale-New Haven Health, Greenwich, CT.
³ Mayo Clinic, Department of Orthopaedic Surgery, Rochester, MN.
⁴ University of Texas Health Center, San Antonio, TX.

Abstract

Purpose: This study aimed to determine the efficacy and safety of intrabursal injection of doxycycline sclerotherapy to treat olecranon bursitis (OB) refractory to conservative management.

Methods: We retrospectively reviewed 27 patients with recurrent OB who were treated over 11 years with intrabursal injections of doxycycline. They were compared with a control group of 18 patients with recurrent OB who underwent surgical bursectomy. Patients were re-evaluated by the treating physician for recurrence of bursitis and treatment complications and completed a questionnaire to assess satisfaction, pain, and other patient-reported outcomes.

Results: Eight patients (29.6%) undergoing doxycycline sclerotherapy had recurrence, requiring one more doxycycline lavage within the first 4 weeks of initial doxycycline treatment. Three patients (16.7%) undergoing surgery had recurrence after surgery, requiring repeat aspiration. There were no patients in either doxycycline or surgical groups with recurrence of bursitis at the final follow-up (median = 195 and 1,055 days, respectively). No patients in the doxycycline group ultimately required surgical bursectomy, and no patients undergoing surgery required repeat surgeries. A regression model controlling for covariates did not find a significant difference between groups in the likelihood of physician-identified complication or repeat aspiration after doxycycline lavage or surgical bursectomy. Of patients undergoing doxycycline sclerotherapy, 85.7% of patients reported high satisfaction (Likert score: 8-10), and 95.2% reported that they would pursue this treatment again.

Conclusions: Use of intrabursal doxycycline as a sclerosing agent for recurrent OB was safe and effective, with high patient satisfaction and no ultimate recurrence of bursitis at the final follow-up. This may be an effective alternative to surgical bursectomy for patients with recurrent OB refractory to conservative management.

Type of study/level of evidence: Therapeutic IV.

Keywords: Doxycycline; Olecranon bursitis; Sclerotherapy.