Olecranon Bursitis

What It Is It?

The olecranon bursa is a fluid filled sac which allows movement between the skin and the underlying bones of the elbow.  The olecranon bursa is at the tip of the elbow and may become inflamed and irritated when it fills with fluid, and can cause pain and swelling.  This fluid can become infected in some cases.  The pain and swelling is known as a bursitis.  There are a number of reasons why bursitis can occur.  Localised trauma to this region can cause pain and swelling at this site.  An infection can be caused by a cut or a scrape to the site causing infection within the bursa.  In some conditions, such as rheumatoid arthritis and possibly gout, swellings can form in the same sites giving another cause for olecranon bursitis. 

What Are the Symptoms?

The most common symptoms are pain and swelling over the bursa over the tip of the elbow.  This bursa can swell to a large size and restrict movement and become uncomfortable.  If the bursa becomes infected, patients commonly describe pain, weakness, swelling and limited movement.  The elbow may also be hot to touch and other signs of infection include fevers, chills and feeling unwell.  This should be treated quickly with antibiotics as it can cause an ongoing problem.

Clinical Examination

On examination, a powerful fluid-filled sac over the tip of the elbow is obvious.  This may transilluminate with a light as it is usually filled with fluid. 

What Investigations Are Required?

An ultrasound or MRI scan may be required to visualise the bursa more clearly and an x-ray may also show a bony underlying injury. 

What Are The Treatment Options?

Treatment can be surgical or non-surgical.  Most frequently, non-surgical treatment is trialled first.

1. Non-operative Treatment
Olecranon bursitis can be treated with anti-inflammatories and/or antibiotics.  Recurrent bursitis can be treated with an aspiration where a needle is used to remove some of the fluid from the bursa.  A cortisone injection may also be advised to reduce the inflammation and pain but should not be given in situations where an infection is possible.

2. Operative Treatments
If the bursitis does not improve with non-surgical procedures, surgery may be needed to remove the bursa.  This is done as a day surgery case and is usually done as an open procedure.  An infected bursa will need to be excised if antibiotics have not resolved the infection.  Surgery will involve removing the fluid and clearing the infected area and may require a longer stay in hospital.

Possible Complications

All treatment options carry the risk of recurrence of olecranon bursitis, even surgical incision and removal of the bursa.  This recurrence with operative and non operative treatment make bursitis a difficult and annoying condition to treat. Wound breakdown or non healing of the surgical incision over the bony surface of the elbow is also possible after surgical treatment.

 

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