Olecranon bursitis

Olecranon bursitis is a swelling of the subcutaneous , synovium-lined fluid filled sac located posteriorly over the olecranon process of the ulna and triceps tendon 
( Donovan Essentials of Physical Medicine and Rehabilitation IVth Edition 2020 )

abnormal increase in the volume of fluid (increased synovial fluid ) within the bursal cavity the bursa is prone to injury & inflammation due to its superficial position and limited vascularity most common bursa to be affected by an inflammatory process in the human body infection can spread via the transcutaneous route rather than haematogenous even no obvious wound is present a relatively common presentation which typically affects men between 30-60

Causes – direct trauma / repeated microtrauma
○ hence several pseudonyms as students elbow , plumbers elbow ,dart throwers elbow , miners elbow repetitive irritation of the olecranon bursa
○ for e.g repeated leaning on the elbow medical conditions ( directly or a consequence )
○ immunosuppression
○ diabetes , rheumatoid arthritis , psoriatic arthritis , alcoholism , HIV infection

Presentation -swelling over the olecranon bursa as the swelling progresses it may restrict elbow movement pain / swelling with any movement of the elbow particularly with extension the patient may be more concerned about the swelling then the pain characteristic round or golf ball shape due to the shape of the bursa point tenderness over the the olecranon passive flexion and resisted extension of the elbow will reproduce the pain systemic symptoms as fever ( in up to 77 % of septic cases ) , chills , erythema may indicate infection severe pain may also suggest infection or gout significant overlap in presentation of non-septic and septic OB physical and laboratory data may overlap

diagnosis is generally made on the basis of history and physical exam obtain vital signs always asses for risk of septic bursitis radiograph ( of the posterior elbow , consider if h/o trauma or if arthritis is suspected ) needle aspiration with fluid analysis laboratory evaluation

acute non infective bursitis is self limited no standardized approach to non-septic olecranon bursitis conservative management with
○ protection / elevation / ice / NSAIDs / splintage
○ corticosteroid inj ( supported by some studies , carries the risk of iatrogenic infection )

options include
○ outpatient Rx with prolonged oral antibiotic with or without aspiration
○ hospitalization with surgical drainage or suction irrigation / immobilization / antibiotics NCBI StatPearls suggest antibiotics against streptococcal & staphylococcal organisms for 7 days Take into account co-morbidities /situation and seek advice from T/O if unsure

surgical management can be considered for
○ refractory to non operative management / recurrent
○ presence of omplications options include bursectomy or olecranon spur excision.

PATIENT INFORMATION

6 Page printable leaflet from Shoulderdoc London covering all aspects of olecranon bursitis https://www.shoulderdoctor.co.uk/pdfs/7_olecranon_bursitis.pdf

American Academy of Orthopaedic Surgeons ( AAOS ) – concise patient information section on Olecranon bursitis https://orthoinfo.aaos.org/en/diseases–conditions/elbow-olecranon-bursitis/

REFERENCES

1. Pangia J, Rizvi TJ. Olecranon Bursitis. [Updated 2021 Jul 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470291/
2. Blackwell, John R et al. “Olecranon bursitis: a systematic overview.” Shoulder & elbow vol. 6,3 (2014): 182-90. doi:10.1177/1758573214532787
3. Olecranon Bursitis, Editor(s): Donna G. Blankenbaker, Kirkland W. Davis, Andrew Sonin, Julia R. Crim, Michael J. Tuite, Carol L. Andrews, In Diagnostic Imaging,
   Diagnostic Imaging: Musculoskeletal Trauma (Second Edition), Elsevier,2016,Pages 332-335,ISBN 9780323392532,https://doi.org/10.1016/B978-0-323-39253-2.50089-6.
   (https://www.sciencedirect.com/science/article/pii/B9780323392532500896) Abstract
4. Steven D. Waldman, 48 – Olecranon Bursitis, Editor(s): Steven D. Waldman, Atlas of Common Pain Syndromes (Fourth Edition), Elsevier, 2019,Pages 187-190,ISBN 9780323547314,
   https://doi.org/10.1016/B978-0-323-54731-4.00048-7. (https://www.sciencedirect.com/science/article/pii/B9780323547314000487) Abstract