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Olecranon bursitis



  • Inflammation of the bursal cavity which lies superficially to the olecranon with an abnormal increase in the volume of fluid1
  • Can be with or without infection, Staphylococcus aureus predominates as the causative bacteria with β-haemolytic strundep also being common
    • Proposed reason for infection via a transcutaneous route
  • Of the 150 human bursa, the olecranon is the most commonly affected by an inflammatory process2



  • Typically affects men between 30-60 years of age3
  • 2/3 of cases are nonseptic and occur when repeated trauma or sports injuries lead to bleeding into the bursa or release of inflammatory mediators
  • No predisposition to sex or race
  • Occurs in both adults and children



  • Most common is repeated minor trauma from external pressure4
    • Examples such as
      • Leaning the elbow on the table
      • Falling heavily on bent elbow
      • Sports trauma
    • As a result of infection
    • Can be associated with inflammatory conditions such as:
      • Rheumatoid arthritis
      • Psoriatic arthritis
      • Gout
    • Can be associated with chronic medical conditions such as:
      • Diabetes
      • Alcoholism
      • HIV


Risk factors

  • Underlying bone spur is indicative of risk for repetitive recurrence
    • If present, surgical excision should be considered
  • Patient’s occupation
    • Examples such as technicians crawling on hands and knees
  • Hobbies
  • Medical history
  • Medication
  • Family history
  • Recent trauma
  • Recurrent or nonresolving olecranon bursitis is of particular importance
    • Raises suspicion of retained foreign/loose body, antimicrobial resistance or wrong diagnosis
  • Systemic symptoms should be explored which may indicate infective, or rarely, malignant origin.
    • Fever
    • Anorexia
    • Fatigue
    • Weight-loss
    • Night-sweats



  • Pain at the posterior elbow
  • Swelling, redness and tenderness with normal movement of the elbow are common indications
    • Although as swelling progresses it can restrict elbow movement



  • If sufficiently advanced, there can be a characteristic round or ‘golf ball’ shape at the posterior aspect of the elbow at the location of the olecranon5
  • Swelling and redness of the posterior elbow



  • Swelling, redness and tenderness with normal movement of the elbow
    • Although as swelling progresses it can restrict elbow movement
  • Passive flexion – may be slightly painful and feeling of tightness but not necessarily present
  • Palpation shows tenderness of the tip of the olecranon



  • Can be treated with rest and ice for symptom relief
  • Corticosteroid injections can result in early reduction in symptoms, but carries a 10% risk of iatrogenic infection so it should be used with caution6
  • If aspiration is used there have been studies showing that 25% of patients will have persistent or recurrent swelling at eight weeks, and up to 10% will continue to have persistent symptoms at 6 months



  • The superficial position and limited vascularity puts the olecranon bursa particularly at risk for injury and inflammation
  • Underlying fracture must be excluded
  • It is problematic to indicate whether an infective cause is present by history and examination alone, aspiration is considered the gold standard