Olecranon Bursitis

Olecranon bursitis is a condition in which the bursa of the elbow joint becomes inflamed. The bursa is a sac of fluid that facilitates the movement of the elbow. It does so  by acting as a cushion between the bones and soft tissues of the joint.

Symptoms of olecranon bursitis are swelling in the elbow – sometimes significant enough to restrict motion – and pain that can spread to the rest of the arm. Patients also experience warmth and redness of the skin around the elbow.

Doctors sometimes also refer to olecranon bursitis as elbow bursitis.

If an infection is present, doctors may treat olecranon bursitis by removing the fluid from the bursa using a needle. They then prescribe antibiotics to counter it. In cases that are not due to an infection, doctors will take other measures that we describe in detail below.

Cause

The elbow bursa sits at the bony tip of the joint (called the olecranon). This bursa, known as the olecranon bursa, is normally flat in shape. Olecranon bursitis occurs when the olecranon bursa becomes irritated and inflamed. This causes an increase in the amount of the fluid in it, and consequently swelling of the bursa.

There are many possible reasons why this can happen. We list the most common causes below:

• A hard blow (trauma) to the tip of the elbow;
• Prolonged pressure on the tip of the elbow. For example, leaning for an extended period on a hard surface and supporting your weight on the point of your elbow can result in swelling of the bursa. Many cases of knee bursitis have similar causes (kneeling on a hard surface for extended periods).
• Infection at the tip of the elbow. This in turn can be due to an insect bite, scrape or a wound that punctures the skin. Any of these can leave an entry point into the bursa for bacteria
• Other medical conditions involving joint inflammation, such as rheumatoid  arthritis or gout, can cause olecranon bursitis as a secondary condition.

Risk Factors

Some of the factors that can lead to a higher risk of developing olecranon bursitis  are:

• Working in an occupation in which you have to spend long periods leaning on your elbows. Occupations in which you frequently have to crawl through tight spaces on your knees and elbows (e.g. plumbers and heating or air conditioning technicians) are especially subject to this risk;
• Individuals who spend long periods working on computer keyboards have a higher risk of developing elbow bursitis. These individuals tend to spend significant time leaning on their elbows. In this situation, the condition is frequently referred to as “student’s elbow”;
• Athletes in sports in which falling is common, such as football, basketball and hockey. Falling onto the point of the elbow can easily produce the trauma we have described above and lead to olecranon bursitis;
• Individuals with inflammatory arthritis in the elbow joint (such as gout or rheumatoid) face a higher risk of developing elbow bursitis.

Symptoms

The first and most noticeable symptom of olecranon bursitis is swelling at the tip of the elbow. The patient may sometimes not notice this swelling right away, because the skin at the tip of the elbow is somewhat loose. As the swelling proceeds, the following signs and symptoms may also appear:

• Pain due to the stretching of the bursa;
• The pain will also become more severe when the patient bends the elbow or places any pressure on the elbow point;
• Warmth & redness at the elbow tip. This is a more common symptom in cases of bursitis due to an infection;
• Occasionally, the skin at the tip of the elbow may open and drain pus ( a thick fluid containing dead tissue and cells as well as bacteria).

If some or all of the symptoms are present, the patient should urgently consult a doctor for an examination and diagnosis. In cases of olecranon bursitis due to an infection that is left untreated, the infection can spread to other parts of the body and even into the bloodstream. At this point, it can become a serious (and possibly life threatening) condition.

Diagnosis & Treatment Of Olecranon Bursitis

Examination & Diagnosis

The doctor will normally question the patient about his or her symptoms and medical history. He or she will want to know about the location of the pain and what actions of the patient make it more or less severe.

In addition, (s)he will perform a physical examination of the affected elbow.

If the doctor suspects that a foreign body is behind the infection of the bursa, he or she may request an X-Ray scan of the elbow. In many cases of chronic olecranon bursitis, bone spurs are found to be a contributing factor. An X ray scan can reveal the presence of either a foreign object or a bone spur.

If the doctor suspects that the bursa is infected, he or she may also remove some of the fluid from the bursa with a needle. The doctor will then send this fluid to a lab for testing.

Treatment

The treatment plan adopted for olecranon bursitis will depend on its cause. The doctor may  conclude that an infection is present and has caused the bursitis. If so, he or she may choose to remove the extra fluid from the bursa using a needle – a process known as aspiration. Analysis of this fluid can help the doctor determine the type of infection and the antibiotic required to eliminate it.

However, while waiting for a determination of the exact nature of the infection, the doctor may prescribe a general antibiotic (i.e. one capable of fighting a wide range of infections).

Alternatively, the doctor may conclude that the olecranon bursitis is due to trauma or prolonged elbow pressure, and not to an infection. If so, he or she may suggest:

• Wearing elbow pads to cushion the elbows;
• Avoiding activities that put extended pressure on the tip of the elbow; and
• Using anti inflammatory medications such as ibuprofen to reduce the swelling and ease the pain.

Should these treatments not work, the doctor may suggest removal of the fluid from the bursa. Once this is done, a powerful anti inflammatory corticosteroid medication would be directly injected into the bursa.

Surgical Treatment Of Olecranon Bursitis

Should all of the treatments above fail to produce the desired results, the doctor may suggest surgery to remove the entire bursa.  Another healthy bursa will normally grow in its place a few months later.

The patient will be given a splint to wear over the tip of the elbow to protect the skin while healing proceeds. Many doctors will also suggest that the patient commence exercises to increase elbow range of motion within a few days of surgery.

The patient should expect to be fully healed within12 to 16 days of the surgery. He or she will usually have normal use of the joint after 3-4 weeks.