Olecranon Bursitis | Symptoms & Treatment

Olecranon Bursitis (or Student Elbow) is a swelling of the bursa at the olecranon tip that is cystic, well-localized and translucent.

Olecranon bursitis is common in individuals who spend long periods weightbearing through the elbows, such as students, or where the potential for falling and striking an elbow on hard playing surfaces is high.

See Also: Biceps Tendonitis

Related Anatomy

The redundancy of the skin overlying the olecranon process facilitates the extreme amount of flexion possible at the elbow. When the elbow is fully extended, this redundant skin is loose and wrinkled. The olecranon bursa lies between the tip of the olecranon and the overlying skin, facilitating the large amount of sliding motion that takes place between the skin and the bone.

Because of its superficial location, the olecranon bursa is easily injured through direct trauma or can be irritated through repetitive grazing and weight bearing, resulting in elbow bursitis.

See Also: Elbow Anatomy

Olecranon Bursitis Symptoms

Acute bursitis presents as a swelling over the olecranon process that can vary in size from a slight distension to a large mass several centimeters in diameter.

In chronic cases, the pain and swelling can be gradual, or sudden as in acute injury or an infection.

An inflamed bursa can occasionally become infected, requiring differentiation between elbow septic bursitis and non-septic bursitis.

Redness and heat suggest infected bursa elbow, whereas exquisite tenderness indicates trauma or infection as the underlying cause.

Patients often note a decreased range of motion or an inability to wear a long-sleeved shirt.

Differential diagnoses of olecranon bursitis are:

1. Acute fractures,
2. Rheumatoid arthritis,
3. Gout,
4. Synovial cysts.

Olecranon Bursitis Treatment

The simple posttraumatic Olecranon bursitis treatment includes the principles of PRICEMEM:

1. Protection,
2. Rest,
3. Ice,
4. Compression,
5. Elevation,
6. Manual therapy,
7. Early motion,
8. Medication.

The infected bursa of elbow needs prompt medical attention.

If the patient is experiencing significant pain or discomfort with movement of the elbow, a sling helps to
reduce these symptoms and calm the joint.

In those cases of marked swelling, or to distinguish between a septic and nonseptic bursitis, aspiration is the appropriate management.

Aspiration also helps to reduce the level of discomfort and restriction of movement. The aspirated fluid is cultured and evaluated for crystals to rule out infection or gout. After aspiration, the elbow should be maintained in a splint and sling and reevaluated after 1 week.

Bursitis that recurs despite three or more repeated aspirations, or an infection that does not respond to antibiotics, requires evaluation for surgical excision.

Injection of corticosteroids is used to manage chronic bursitis once the diagnosis of infection has been excluded.

Surgical Resection

Chronic and persistent olecranon bursitis has been treated with surgical removal. This may be performed arthroscopically.

A review of the surgical experience at the Mayo Clinic found good to excellent results in 15 of 16 patients with intractable, nonseptic olecranon bursitis that was not associated with RA.

The specific indications for surgical removal are unclear.

Olecranon Impingement Syndrome

Olecranon Impingement Syndrome is a repetitive impingement of the olecranon in the olecranon fossa may occur with valgus stresses in throwing sports.

Stress to both articular surfaces of the joint may result in the formation of loose bodies, osteophytes, chondromalacia, and synovitis.

The patient may report catching, clicking, and crepitus, which are worsened by elbow extension. Full elbow extension may be limited by a mechanical block.

X-rays confirm loose bodies, olecranon osteophytes, and commonly associated anterior elbow changes.

Mild cases respond to a rehabilitation program focusing on restoration of normal motion, strength, and endurance.

Continued pain, loose bodies, or mechanical blockage are indications for surgery.

References

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2. Onieal ME. Common wrist and elbow injuries in primary care. Lippincotts Prim Care Pract. 1999 Jul-Aug;3(4):441-50. PMID: 10624278.
3. Shell D, Perkins R, Cosgarea A. Septic olecranon bursitis: recognition and treatment. J Am Board Fam Pract. 1995 May-Jun;8(3):217-20. PMID: 7618500.
4. Reid DC, Kushner S: The elbow region. In: Donatelli RA, Wooden MJ, eds. Orthopaedic Physical Therapy, 2nd ed. New York, NY: Churchill Livingstone, 1994:203–232.
5. Stewart NJ, Manzanares JB, Morrey BF. Surgical treatment of aseptic olecranon bursitis. J Shoulder Elbow Surg. 1997 Jan-Feb;6(1):49-54. doi: 10.1016/s1058-2746(97)90070-7. PMID: 9071682.
6. Kerr DR, Carpenter CW. Arthroscopic resection of olecranon and prepatellar bursae. Arthroscopy. 1990;6(2):86-8. doi: 10.1016/0749-8063(90)90003-v. PMID: 2363785.
7. O’Connor FG, Wilder RP, Sobel JR. Overuse injuries of the elbow. J Back Musculoskelet Rehabil. 1994 Jan 1;4(1):17-30. doi: 10.3233/BMR-1994-4107. PMID: 24571993.
8. Dutton’s Orthopaedic Examination, Evaluation, And Intervention 3rd Edition.