Updated: 12/27/2021

Olecranon Bursitis

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  • 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
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