Olecranon bursitis is inflammation of olecranon bursa which is a subcutaneous bursa overlying the olecranon process of the ulna. Bursa functions to reduce the friction between olecranon and skin.
Olecranon bursitis may result from inflammation caused by various factors like repetitive trauma and infection of the bursa.
Normally, olecranon bursa is Superficial locations of the olecranon bursa makes it susceptible.
Other names for olecranon bursitis are elbow bump, student’s elbow, Popeye’s elbow, or baker’s elbow.
Causes of Olecranon Bursitis
- Acute injuries
- Repetitive minor trauma such as the elbow constantly rubbing against a table during writing
- Bursal infection
- Rheumatoid arthritis
- Crystal-deposition disease (gout, pseudogout).
Patients with diabetes mellitus, uremia, intravenous drug abuse, long-term use of steroids are at increased risk of olecranon bursitis.
Presentation of Olecranon Bursitis
Swelling at the posterior aspect of the elbow, with or without pain is main presenting feature. Initially, only swelling may be noted. Pain may come later. Swelling may be gradual [due to a chronic cause] or sudden onset [trauma or infection]. Leaning on the elbow or rubbing of the elbow may exacerbate the pain.
There may be a history of acute injury or repetitive microtrauma.
On examination, there is a posterior elbow swelling, often lying over the over the olecranon process. It may be tender on palpation. Warmth and redness suggest infection. Fever is generally not present unless the infection is severe. Severe pain may cause restriction of terminal flexion.
Differential Diagnoses
- Crystalline inflammatory arthropathy
- Fracture of the olecranon process
- Synovial cyst of the elbow joint
- Olecranon traction osteophyte/Olecranon spur
- Triceps avulsion/tear
- Rheumatoid Arthritis
Lab Studies
Lab studies are done to rule out an underlying condition. CBC, ESR, CRP, RF and may be done to rule out infection, rheumatoid arthritis, and gout.
Aspiration of the bursa and gram staining of the fluid is done to immediately rule out/confirm infection. Other tests which may be done on the fluid are
- Leucocyte count
- Bacterial culture
- Crystal analysis
Imaging
Xrays are done to rule out bony lesions. Like olecranon fracture or olecranon oste0phyte or spur
Ultrasonography may reveal the presence of effusions, synovial proliferation, loose bodies, tendonitis with calcifications etc.
Generally not done routinely, MRI can exclude a stress fracture, triceps tendinopathy or tear, or infection.
Aspiration of Bursa
The olecranon bursa is aspirated by the posterolateral approach. The aspiration may be followed by corticosteroid injection but if the infection is suspected or aspirate is turbid, it should be sent for immediate Gram stain, leukocyte count, culture, and antibiotic sensitivity testing. No corticosteroids should be given until these tests prove negative. After the fluid is removed from the olecranon bursa, a compression bandage is applied.
Treatment of Olecranon Bursitis
RICE
The standard RICE (rest, ice, compression, elevation) should be started. In the acute period, ice should be applied for 15-20 minutes at a time, several times daily.
Drugs
NSAIDs like ibuprofen or other drugs should be used for relieving the pain by reducing pain and swelling by their anti-inflammatory action.
Repeated Aspirations
If swelling and pain is not relieved by 3-4 weeks, noninfected olecranon bursitis can be treated by repeated bursal aspiration with or without corticosteroid injection.
Surgery, generally, is not required in cases olecranon bursitis. However, in nonresponsive patients, bursectomy may be required.
A compressive elbow sleeve may be prescribed for further prevention of fluid accumulation.
The patient should avoid further trauma to elbow and may consider the use of elbow pads.
After resolution of symptoms, patients may be allowed to resume the activities of the elbow.
In case of infection, the patient should be put on antibiotics, broad spectrum to begin with and then as suggested by sensitivity. Infections that do not respond to medication may require surgery for drainage.
Some people might get a recurrence of olecranon bursitis, where a minor bump may cause a significant swelling.
Activities that may irritate the bursa should be avoided.
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