The most appropriate treatment for this patient is NSAID therapy. The patient is experiencing olecranon bursitis, most likely from the low-level repetitive trauma of rubbing his elbow against the car armrest. The olecranon bursa is a subcutaneous synovial-lined sac overlying the olecranon process at the proximal aspect of the ulna. It cushions the olecranon and reduces friction between the olecranon and the skin during movement. Because of its superficial location, it is particularly susceptible to inflammation with acute or chronic trauma. Although most cases of olecranon bursitis are noninfectious, they may be caused by bacterial infection, particularly if there is an overlying abrasion or cellulitis. Less commonly, olecranon bursitis may be due to a crystalline process, such as gout. Aspiration is indicated in patients with suspected infectious or crystalline bursitis, or if the swelling is extensive and impairs activity, even if likely benign. Protection of the bursa from further trauma or irritation is the cornerstone of therapy, and treatment with an agent that inhibits inflammation and provides pain relief is usually helpful in decreasing fluid accumulation and providing symptom relief. NSAIDs have both analgesic and anti-inflammatory effects, which is ideal for this purpose. Given the patient's otherwise good health, a short course of NSAID therapy at an anti-inflammatory dose will provide maximal benefit with relatively little risk.

Intrabursal glucocorticoid injections may reduce swelling in bursitis. However, there is not strong evidence of effectiveness when used in superficial areas such as the olecranon bursa, and there is significant risk of side effects, including skin atrophy, development of a draining sinus tract, and infection. Additionally, glucocorticoids provide no analgesia. They are therefore used only in severe or refractory cases of olecranon bursitis.

Topical lidocaine and tramadol are analgesic agents and do not have anti-inflammatory effects. They will provide some pain relief but will not reduce the swelling of the bursitis. Topical analgesics may have value in minimizing systemic drug exposure; however, this would not be a major issue for this patient.