Olecranon Bursitis

Olecranon Bursitis treatment and information

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What is Olecranon Bursitis?

Olecranon bursitis is a condition caused by an inflammation of a small sac of fluid, called a bursa, located at the back of the elbow. A bursa is a very small and thin slippery sac with a very small amount of fluid inside that serves to reduce friction anywhere in the body where skin, muscles or tendons have to slide over a bony surface.

The pointy bone at the back of your elbow is called the olecranon and so the bursa located there is called the olecranon bursa. The “itis” at the end of the word refers to inflammation when it is present.

What are the causes of Olecranon Bursitis?

There are many different causes for inflammation on this part of the elbow, but perhaps the most common is caused by repetitive microtrauma such as rubbing, leaning or putting pressure on the tip of the elbow, such as in students and office workers that tend to lean on their elbows at a table.

Other common causes include local trauma which can also restrict the mobility of the elbow and lead to inflammation of the bursa as it sits superficially (close to the surface) to the skin.

In rare instances bursitis can also be caused by an infection. This can happen without warning and following a wound on the skin of the tip of the elbow providing access to bacteria.
In these cases, besides the typical swelling of the bursitis, the elbow is also warm and red.
This is called infectious bursitis and it is treated with antibiotics prescribed by your doctor.

Some systemic conditions such as Rheumatoid Arthritis, Gout, and Diabetes, might make you more likely to develop symptoms of bursitis.

What are the symptoms of Olecranon Bursitis?

The first symptom of olecranon bursitis is most commonly swelling at the back of the elbow.
On the acute stage alongside the swelling there is usually pain that can be quite severe on direct pressure over the back of the elbow, such as when supporting weight over bent elbows on a table. Another symptom that can be a result of swelling in the elbow is pain on movement of the elbow when the elbow is in full flexion. There can also be a clicking or crepitus sensation when moving the elbow caused by thickening of the tissue or excess fluid in the bursa.

On the rare occasions that this condition is caused by an infection, the elbow is usually more swollen, red and hot, than in the case of inflammatory bursitis. The most distinguishable sign is the presence of fever.

How long does Olecranon Bursitis last? 

The bursa can remain swollen for quite some time, which is generally related to your activities. More overuse of the elbow (such as for example racket sports) or excessive pressure applied to the tip of the elbow will contribute to a prolonged recovery, just like keeping pressure on a bruise will not let the bruise go away.

Can Olecranon Bursitis be prevented?

Although not all types of bursitis can be prevented, you can reduce your risk of developing bursitis by having a healthy lifestyle especially if you already suffer from one of the conditions that can make you more likely to develop bursitis (as described above).

Equally if you have a desk job or are a student, it is important to not spend too much time with pressure on the tips of your elbows as over time this is likely to compress the bursa tissue between the skin and the bone of the tip of the elbow.

How is Olecranon Bursitis diagnosed?

Olecranon Bursitis bodytonic clinic SE16 London

Olecranon bursitis is usually diagnosed through a physical examination. Your healthcare professional will take a thorough case history. This will include questions such as:

  • When did the swelling start to occur?
  • Were you doing anything at the time the swelling occurred?
  • Do you have a fever or feel unwell?
  • Has your range of motion in the elbow been affected?
  • Are you diagnosed with any other medical conditions?
  • Has there been any recent trauma to the elbow?

Following on from the initial case history your practitioner will carry out a physical examination. This will include observing and palpating the elbow and olecranon bursa to look and feel for signs of swelling and for any potential signs of infection. Active and passive range of motion testing will also be performed.

In some cases further investigations might be needed to rule out any other medical conditions and further diagnose. These tests can include:

Aspiration: this is when the fluid inside the bursa is removed using a needle and syringe. The fluid is then tested in the lab to check for any signs of infection and inflammatory conditions.

Blood tests: these are used to see if there are any system wide inflammatory conditions or infection.

Xray: this type of imaging is used to show if there is any fracture of the elbow joints and to see if there are any signs of osteoarthritis. Osteoarthritis can be one cause of bursitis.

Ultrasound Scan: this type of scan is used to detect the outline for the area of swelling.

What are the treatment options for Olecranon Bursitis?

The type of treatment required depends on whether the bursa is septic (caused by infection) or aseptic (not caused by infection). In most cases aseptic bursitis can be treated conservatively following self care advice.

Conservative Treatment

R.I.C.E. Protocol. This stands for Rest, Ice, Compression and Elevation. The treatment protocol is often used when swelling is present.

  • Rest: individuals with olecranon bursitis should avoid partaking in activities that will aggravate the bursa. These include leaning on or putting weight onto the elbow.
  • Ice: the use of a cold compress applied over the swollen elbow for 10-20 minute periods a few times a day can help reduce symptoms of olecranon bursitis.
  • Compression: the use of an elastic compression bandage can be used and wrapped around the elbow joint to help control the swelling.
  • Elevation: lifting the affected elbow joint above the height of the heart helps to reduce blood flow to the elbow joint. In turn this helps to reduce inflammation.

Non-steroidal anti-inflammatory medication. Also known as NSAIDs, this type of medication is used to help with reducing inflammation and pain. Examples include over the counter ibuprofen and prescribed naproxen. Your doctor may also prescribe you with a medication that helps protect the lining of your stomach as NSAIDs can cause gastrointestinal problems and irritation to the stomach lining. This is also another reason why it is not recommended to take NSAIDS for an extended period of time. Always speak to your doctor before taking new medication.

Antibiotics: In cases of septic bursitis then a course of antibiotics will be prescribed to help get rid of the infection.

Aspiration. As mentioned above, aspiration of the swollen bursa is used as a medical diagnostic tool. This procedure can also be used in the medical management of olecranon bursitis. This procedure uses a needle and syringe to remove all of the excess fluid within the bursa.

Corticosteroid injection. Corticosteroid is a very powerful antiinflammatory medication and is used to help reduce pain and inflammation. During this procedure the skin around the elbow joint is numbed and a needle is inserted directly into olecranon bursa using ultrasound to guide the needle. Corticosteroid is then injected into the bursa.

Surgical Intervention

Within the NICE guidelines if treatment sought through primary care has not been successful after 2 months then referral to other services is made. In some cases this may be to the surgical team. However this is very rare. There are a few different surgical procedures that may be discussed with you in terms of the best treatment for the condition. These procedures may include:

Incision and drainage: during this surgical procedure a small incision is made into the bursa and the contents of the bursa is drained.

Bursectomy: in this procedure the inflamed bursa is drained and then completely removed. Protection of the elbow after the surgery is required. This is due to several months following this procedure a new bursa will start to grow back in place of the old one (aren’t bodies amazing!).

Do I need to go to the GP or visit my local hospital?

The NHS website recommend seeking medical attention if:

  • The symptoms have not improved or are getting worse after 2 weeks
  • You have signs of a fever including, a high temperature, feel hot and shivery.
  • You are not able to move the elbow joint
  • You have severe, sharp or intense shooting pains in the joint.

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