Thursday, June 8, 2023

Olecranon Bursitis

Practice Essentials

Olecranon bursitis, a relatively common condition, is inflammation of the subcutaneous synovial-lined sac of the bursa overlying the olecranon process at the proximal aspect of the ulna (see the images below).
The bursa supports the olecranon and reduces friction between it and the skin, especially during movement. The superficial location of the bursa, between the ulna and the skin at the posterior tip of the elbow, makes it susceptible to inflammation from acute or repetitive (cumulative) trauma. Many cases are idiopathic in nature, but, less commonly, inflammation results secondary to an infectious etiology (septic bursitis). (See Etiology, Workup, Treatment, and Medication.)

Olecranon bursitis, shown here with the elbow flex

Olecranon bursitis, shown here with the elbow flexed. Image courtesy of UMDNJ-New Jersey Medical School,, and

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Olecranon bursitis seen with the elbow extended. F

Olecranon bursitis seen with the elbow extended. Focal swelling at the olecranon is more visible with the elbow extended than in the flexed position. Image courtesy of UMDNJ-New Jersey Medical School,, and

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Olecranon bursitis seen with the elbow extended. I

Olecranon bursitis seen with the elbow extended. Image courtesy of UMDNJ-New Jersey Medical School,, and

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Signs and symptoms of olecranon bursitis

Classically, olecranon bursitis presents as a clearly demarcated, often fluctuant posterior elbow swelling, appearing as a “goose egg” over the olecranon process.

Patient history may include the following findings:

The patient may report pain at the affected site, although sometimes the swelling is painless, especially in noninflammatory, aseptic bursitis

Pain often is exacerbated by pressure; however, chronic, recurrent swelling is often nontender

Swelling may have a gradual (mostly due to a chronic cause) or acute/sudden (due to trauma or infection/inflammation) onset

Workup in olecranon bursitis

If the clinician suspects an underlying condition is present, laboratory studies are necessary. If an infectious etiology is suspected (due to the presence of fever, erythema, previous puncture wounds, or cellulitis), the olecranon bursa should be aspirated and the fluid sent for culture, for a cell count (white blood cells [WBCs], red blood cells [RBCs]), and for Gram staining for bacteria. Additionally, lab work should be obtained, including a blood count with differential, glucose, C-reactive protein, and the erythrocyte sedimentation rate. If there is concern for rheumatoid arthritis or gout, a rheumatoid factor and uric acid level, respectively, should be obtained.

Plain film radiographs of the elbow should be performed to assess for a possible olecranon fracture if significant trauma occurred or if an avulsed osteophyte is present at the triceps insertion into the olecranon, which is fairly common.

The use of ultrasonography has been shown to be extremely effective in the diagnosis of olecranon bursitis and other soft-tissue lesions in the olecranon area by rapidly demonstrating the presence of effusions, synovial proliferation, loose bodies, increased blood flow consistent with inflammation, tendonitis with calcifications, and other indications of bursitis.

In atypical cases, a magnetic resonance imaging (MRI) study may be indicated to help exclude concomitant pathology, such as a stress fracture, triceps tendinopathy versus tear, or the rare case of osteomyelitis/abscess or tumor.

Management of olecranon bursitis

Generally, physical and occupational therapy are not needed for the treatment of olecranon bursitis. In some cases of aseptic bursitis, however, the physician may recommend a course of physical or occupational therapy to speed recovery time.

Oral nonsteroidal anti-inflammatory drugs (NSAIDs) can help to reduce the pain and inflammation of olecranon bursitis, but these products probably should be avoided if joint aspiration reveals a hemorrhagic bursitis. Injectable corticosteroid can be beneficial in cases in which the history, physical examination, and joint aspiration do not raise a significant suspicion of infection.
 Most cases of olecranon bursitis respond very well to a series of 1-2 joint aspirations (with or without corticosteroid injection) combined with additional treatment.

Usually, no surgical intervention is required in cases of olecranon bursitis.
 In severe cases resistant to conservative treatment, a bursectomy may be indicated. 

If surgical intervention is required, endoscopic olecranon bursectomy is an effective alternative to open bursectomy in either aseptic or septic cases. Endoscopic outcomes are excellent and can minimize wound-healing problems.

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