Elbow Bursitis

Anatomy

The olecranon bursa resides at the elbow joint between the skin and the olecranon process of the ulna. Its function is to reduce friction between the skin and the olecranon process when the elbow is placed through a range of motion, mainly during flexion.

History

The most common complaint of a patient with olecranon bursitis is swelling or fullness of the bursae. Sometimes patients will complain of pain and warmth, but mainly they will have some tightness with flexion of the elbow. If there is significant pain and it is accompanied by redness and warmth, the bursa could also be infected. Often the bursa gets inflamed from a trauma, perhaps from landing on the elbow during sports or from external impact such as being tackled in a contact sport. It may also occur from leaning on the elbows on a hard surface for an extended period of time. Patients rarely have accompanying fevers.

Physical Exam

The examiner will find fullness/swelling overlying the olecranon. The area may be red and hot as [Page 414]well. One must take care to look for breaks in the skin or other signs of possible infectious sources. Red streaking on the skin may signify an overlying cellulitis.

Treatment

Treatment commonly involves minimizing the stress and forces to the area and the application of compression and ice. If there is concern about infection, the area should be sterilely prepared and the fluid aspirated, which should then be sent to the laboratory for cultures and sensitivities. Antibiotics should be started. If there are no signs of infection, the bursae can often be left alone.

Aspiration and injection of a corticosteroid to the bursae is another option, but it may be a little aggressive for this relatively benign process. If the patient is having severe pain, then an aspiration and injection may be warranted. Corticosteroids should never be injected into a bursa that is potentially infected. The risk of infection is higher for this superficial bursa than for other bursae. In the case of a severely infected bursa that does not improve quickly, the patient may need surgical intervention for a washout of the infection.

Conclusion

Patients with olecranon bursitis may always have a little residual swelling overlying the olecranon process thereafter. Often they may feel little nodules within the bursae as well. The risk of reinjury is increased, so care must be taken to avoid resting the elbows on hard surfaces or a repetition of the traumatic injury.