Definition

Olecranon bursitis, commonly called elbow bursitis, consists of the inflammation and collection of fluid in the bursa, a fluid-containing membrane located under the skin at the posterior end of the elbow above the olecranon.

Pathology

Olecranon bursitis is a frequent condition caused by the inflammation of the bursa, which is a soft cushion located at the proximal end of the ulna, named olecranon. Generally a bursa facilitates the gliding of the bones during joint movement. As a result of prolonged inflammation of the membrane, the bursa becomes swollen and reddish triggering significant pain with movement of the elbow.

Classification

Aseptic bursitis is usually caused by trauma or prolonged pressure on the elbow with specific activities. Injuries to this area can damage vessels and lead to accumulation of blood in the bursa.

Septic bursitis involves the infection of the bursa. This occurs when the skin of the elbow breaks allowing bacteria to infiltrate the sac. Ongoing infection results in the accumulation of fluid, redness, swelling and pain. When advanced, it can lead to pus formation in the bursa.

Causes

Olecranon bursitis can arise from an injury to the elbow, prolonged leaning on the elbows during physical work and an infection caused by a laceration to the elbow. It also occurs in patients with medical conditions that affect the joints such as gout and rheumatoid arthritis. Various mechanisms can lead to olecranon bursitis:

Acute direct injury (aseptic)

Repetitive microtraumas

Prolonged pressure on the elbow (aseptic)

Infection (septic)

Risk factors

The most frequent risk factors for the development of olecranon bursitis are:

Overuse of the elbow

Leaning on the elbow during carpentry

Medical conditions (rheumatoid arthritis, gout, psoriasis, diabetes, thyroid disease, steroid use)

Life style (alcohol/drug abuse)

Injury to the skin around the elbow causing infection of the bursa

Presence of a bone spur at the olecranon

Symptoms

Olecranon bursitis causes a number of symptoms including pain especially when applying manual pressure on the olecranon. Typical symptoms of this pathology are:

Swelling of the tip of the elbow

Redness

Local heat

Mild impaired range of movement of the elbow joint

Fever, general unwell, break of the skin in case of infection

Treatment

Nonoperative treatment

Conservative treatment is the most common approach to manage an olecranon bursitis. It consists of:

Rest

Application of ice pads, compression, arm elevation

Aspirations (1 or 2) of the fluid accumulated in the bursa

Administration of NSAID's

Pain killers

Local steroids injection to reduce inflammation in aseptic bursitis

Administration of antibiotics in case of septic bursitis

Elbow protection with pads

Surgical treatment

If symptoms do not improve with conservative treatment, surgical removal of the inflamed bursa or bursectomy may be necessary. For this procedure an incision is made over the tip of the elbow, the thickened bursa is excised and the skin closed with stitches. Septic surgery of the infected bursa is performed if antibiotics fail to improve the condition. Surgery is required in more complicated and displaced olecranon fractures or in case of open fractures whereby the laceration/bone fragments are cleaned up to reduce the risk of infection. An incision in the back of the elbow allows the surgeon to access the fracture. Open reduction and internal fixation is achieved with various devices relative to the shape of the fracture (pin, wires, plates, sutures of the bone) in order to reconnect the bone parts. If fragments of the fractured bone are excised during surgery mostly in elderly, osteoporotic patients, the triceps tendon is reattached to the olecranon. Importantly, removal of over 50% of the olecranon causes elbow instability. Occasionally bone replacement material may be required to substitute lost bone. This procedure includes the use of autologous bone taken from the pelvic crest or artificial bone and cadaver bone transplant.

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