Most cases of aseptic olecranon bursitis respond to conservative treatment, yet some will develop a chronic bursitis with sufficient symptoms to warrant surgery. Over a 10-year period 21 cases of aseptic olecranon bursitis were treated surgically at our institution. Surveillance was a minimum of 2 years and averaged 5.2 years. The procedure provided complete and long-term relief in only 40% (two of five) of patients with rheumatoid arthritis, whereas 94% (15 of 16) of the patients without rheumatoid arthritis did well (p = 0.028, Fisher's Exact test). No patients had deep infection or draining wounds. Properly performed surgical treatment of aseptic olecranon bursitis appears to offer long-lasting symptomatic relief to patients without rheumatoid arthritis.