Olecranon Bursitis

Olecranon bursitis, the most common cause of swelling in the elbow, is characterized by swelling over the bony prominence at the back of the elbow. It is initially painful but tends to become painless over time. In most cases, it results from inflammation of the bursa tissue caused by repetitive minor trauma, such as those experienced by desk workers.

Treatment for olecranon bursitis often involves protection, ice application, and pain-relief medications.

What is Olecranon Bursitis?

Olecranon bursitis occurs due to inflammation of the olecranon bursa, a protective structure of the elbow joint. It is characterized by swelling and, initially, pain at the back of the elbow. The olecranon bursa is a thin fluid-filled sac located between the bony prominence of the olecranon and the skin.

Functions of the Olecranon Bursa:

• Facilitates smooth gliding of the skin over the bone.

• Protects the joint from impact and trauma.

Under normal circumstances, there is a minimal amount of fluid in this sac. In olecranon bursitis, however, swelling becomes visible even from the outside.

What is the Olecranon?

The olecranon refers to the bony prominence at the back of the elbow, part of one of the forearm bones called the ulna. When you bend your elbow, it is the pointed bone you can feel at the back.

What is a Bursa?

A bursa is a fluid-filled sac located near the joints in our body, acting as a protective cushion. Bursae absorb shock during trauma, preventing joint damage, much like airbags in a car.

What is Bursitis?

Bursitis refers to inflammation and swelling of these fluid-filled sacs, leading to pain. Normally, the fluid within a bursa is minimal and not detectable externally. In bursitis, however, the fluid increases, causing visible swelling and pain.

Causes of Olecranon Bursitis

• Trauma:

  • Repetitive Microtrauma: The most common cause of olecranon bursitis is repetitive microtrauma. Continuous minor injuries can damage the structure of the bursa, leading to inflammation. People who frequently rest their elbows on hard surfaces due to occupational reasons may gradually damage and irritate the bursa tissue, causing it to thicken and swell. This chronic irritation results in olecranon bursitis. A classic example is taxi drivers who rest their elbows on hard armrests while driving for long hours.

  • Acute Trauma: The second most common cause is acute trauma resulting from sudden impact, such as falling on the elbow or striking it against a hard object.

• Infection: In some cases, bacteria or other microorganisms can enter the olecranon bursa through small cuts or abrasions on the skin, causing an infection known as infected olecranon bursitis.

• Rheumatic Diseases: Systemic rheumatic diseases, such as rheumatoid arthritis and gout, can also contribute to the development of olecranon bursitis.

Symptoms of Olecranon Bursitis

• Swelling: Swelling is the first and most noticeable symptom of olecranon bursitis. It often appears suddenly and may gradually increase in size. The swelling can vary in size, ranging from a small lump to the size of a ping-pong ball. Many patients mistake the swelling for a tumor, which can cause unnecessary anxiety.

• Pain: Olecranon bursitis may initially cause pain, but in many cases, the pain subsides over time. If pain persists, it is essential to investigate the possibility of infectious bursitis.

• Redness: In infectious bursitis, the skin over the bursa becomes red, accompanied by pain.

What is Infected Olecranon Bursitis?

In some cases of olecranon bursitis, bacteria or other microorganisms can infect the bursa through the skin, leading to inflammation. This condition is known as infected olecranon bursitis. In such cases, a sample of the bursa fluid must be collected and sent for culture and sensitivity testing. Treatment for infected olecranon bursitis typically requires surgical intervention.

How is Olecranon Bursitis Diagnosed?

A detailed medical history and physical examination are usually sufficient to diagnose olecranon bursitis.

• If bursitis occurs after trauma, an X-ray may be requested to check for bone fractures. The X-ray can also reveal calcium deposits within the bursa.

• If infectious olecranon bursitis is suspected, fluid may be aspirated from the bursa under ultrasound guidance. The sample is sent for laboratory tests, including culture and antibiogram, to identify the causative bacteria and determine the most effective antibiotic treatment.

Treatment of Olecranon Bursitis

Non-Surgical Treatment

The first step in treating olecranon bursitis is to avoid activities that irritate the olecranon region of your elbow and to protect the area. This protection can be achieved by using an elbow brace.

• Ice Application: Applying ice is an effective treatment method for olecranon bursitis.

• Pain Medications: Pain-relieving medications can be taken after consulting your doctor.

Ultrasound-Guided Injection for Olecranon Bursitis

If swelling persists and discomfort does not subside after 4-6 weeks of conservative treatment, fluid may be aspirated from the olecranon bursa under ultrasound guidance. Following aspiration, a corticosteroid injection is administered into the bursa. In most patients, bursitis does not recur after corticosteroid injections.

Who Needs Surgery for Olecranon Bursitis?

Surgery becomes an option if olecranon bursitis recurs despite corticosteroid injections.

How is Olecranon Bursitis Surgery Performed?

The goal of olecranon bursitis surgery is to remove the inflamed bursa. Since the olecranon bursa is located just under the skin, it is easily accessible during surgery.

• The surgical wound is covered with a simple dressing and elastic bandage.

• Patients can usually be discharged on the same day.

• There is no need to immobilize the joint with a splint or cast.

What is the Recovery Process After Olecranon Bursitis Surgery?

• The surgical incision typically heals within 10-14 days.

• Full range of elbow motion is allowed 3-4 days after surgery.

• Patients usually return to normal activities within one month.

• Physical therapy is generally not required.

Conclusion:

Olecranon bursitis often resolves with protection, avoidance of repetitive movements, and ice application. The most critical point in managing olecranon bursitis is to distinguish infected olecranon bursitis from non-infectious types. Infected olecranon bursitis requires surgical intervention for effective treatment.

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