Olecranon bursitis

Definition

• 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

 

Occurrence

• 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

 

Causes

• 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

 

Indications

• 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

 

Observation

• 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

 

Examination

• 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

 

Treatment

• 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

 

Consideration

• 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