Snapshot A 54-year-old plumber reports left elbow swelling for the past few months. The swelling has worsened and became more painful over the last week. He works 12 hours a day and spends a lot of time on his knees and elbows when repairing pipelines. On examination, he has no fever. There is a red and tender swelling of the left posterior elbow. Introduction Clinical definition inflammation of the olecranon bursa septic or nonseptic Epidemiology Demographics male >> female 30-60 years of age the most common superficial bursitis Location the bursa that overlies the olecranon process at the proximal aspect of the ulna Risk factors sports diabetes uremia manual jobs with elbow use chronic hemodialysis requires prolonged pressure on the elbow Etiology Trauma Underlying systemic inflammatory disorder Avulsed osteophyte Infection (20% of cases) Pathogenesis nonseptic bursitis acute trauma or repetitive trauma causes inflammation of the olecranon bursa septic bursitis infection from microorganisms transferred via trauma to the skin overlying the bursa Associated conditions rheumatoid arthritis crystalline diseases e.g., gout or pseudogout Presentation Symptoms pain or fever may suggest an infectious etiology Physical exam swelling over affected elbow tenderness to palpation erythema, ecchymosis, or abrasions of the skin normal range of motion Imaging Radiography indication to assess for olecranon fracture or osteophyte findings swollen bursa, fracture, or olecranon spurs Studies Labs indicated only when septic bursitis is suspected ↑ white blood cell count ↑ erythrocyte sedimentation rate Needle aspiration of bursa with Gram stain and culture indication if septic bursitis is suspected Making the diagnosis most cases are diagnosed based on clinical exam and laboratory evaluation Differential Diagnoses Gout distinguishing factor negatively birefringent needle-shaped crystals under polarized light Treatment Conservative physical therapy indications nonseptic bursitis not always indicated, but can be helpful to accelerate recovery rest and ice indication nonseptic bursitis Medical systemic antibiotics based on culture and sensitivity indication septic bursitis nonsteroidal anti-inflammatory drugs (NSAIDs) indication pain management injected corticosteroids indications nonseptic bursitis management of pain refractory to NSAIDs Non-operative joint needle aspiration and drainage indication nonseptic bursitis can help accelerate recovery septic bursitis along with systemic antibiotics Operative bursectomy indication only reserved for severe cases that are refractory to all other options Complications Bursa rupture Osteomyelitis Prognosis Nonseptic bursitis responds very well to 1-2 joint aspirations