Updated: 12/13/2018

Olecranon Bursitis

Review Topic
  • 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.
  • 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
  • Prognosis
    • nonseptic bursitis responds very well to 1-2 joint aspirations
  • 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
  • Radiography
    • indication
      • to assess for olecranon fracture or osteophyte
    • findings
      • swollen bursa, fracture, or olecranon spurs
  • 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
  • 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
  • Bursa rupture
  • Osteomyelitis

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