What is Olecranon Bursitis?
The olecranon bursa is a type of fluid-filled sac found right behind the pointy bone of the elbow. The role of this sac is to smooth out the movements of the elbow bone over the tissue around it when bending or extending the elbow. Olecranon bursitis refers to a condition where this sac becomes inflamed. Because it sits close to the skin and doesn’t have a lot of blood supply, it can be easily hurt or infected.
Often, doctors are able to diagnose olecranon bursitis simply by examining the patient, without needing any special diagnostic tests. However, these tests become especially important if the doctor is considering other possible conditions, or if they’re worried about an infection.
What Causes Olecranon Bursitis?
Olecranon bursitis, a condition which causes swelling near the elbow, is usually caused by injury, inflamed conditions, or infection. Injury can lead to blood entering the fluid-filled sac near your elbow, known as the bursa, and release substances that cause inflammation and increase the chances of the problem happening again.
This condition can also be associated with other inflammatory conditions such as rheumatoid arthritis (a chronic autoimmune disorder that primarily affects joints), psoriatic arthritis (a type of arthritis that affects some people with psoriasis), and gout (a form of arthritis characterized by severe pain, redness, and tenderness in joints).
On top of this, it can be linked with chronic medical conditions such as diabetes, alcoholism, or HIV. Infections that cause bursitis usually happen due to small injuries that allow typical skin bacteria to enter the body. They typically do not happen through the bloodstream because blood flow to this area is not very strong.
Risk Factors and Frequency for Olecranon Bursitis
Olecranon bursitis is a fairly common condition that causes pain at the back of the elbow, and often limits activity. It isn’t deadly and usually affects men between 30 and 60 years old. It doesn’t show any particular preference for either sex or any specific race and can happen to both kids and adults. Some common causes include regular elbow trauma or sports injuries, long-term dialysis treatment, conditions like uremia, or due to physical strain from occupations that require a lot of crawling in tight spaces and leaning on the elbows. Conditions like rheumatoid arthritis, gout, pseudogout, or side effects from certain medications like sunitinib for kidney cancer, can also cause it.
- Olecranon bursitis affects many people and causes pain in the back of the elbow.
- It often occurs in men aged 30 to 60.
- The condition affects both sexes and all races similarly.
- It can occur both in children and adults.
- Common causes include regular elbow injuries or sports injuries.
- Other possible causes include long-term dialysis treatment, uremia, and jobs that require lots of elbow leaning and crawling.
- The condition can also be caused by other health issues like rheumatoid arthritis, gout, pseudogout, or as a side effect of certain medications like sunitinib.
Signs and Symptoms of Olecranon Bursitis
Olecranon bursitis is a condition where swelling appears over a bony bump in the elbow (the olecranon). Initially, the swelling won’t affect movement of your elbow and it’s different from swelling within the elbow joint. The swelling usually takes on a round, or ‘golf ball’, shape due to the fluid being trapped within a small area within the joint, known as a bursa.
If the bursitis is caused by an infection, it typically comes with redness and pain, and may also cause general feelings of being unwell, like a fever and fatigue. However, it’s important to note that only about 70% of people with an infection of the bursa will develop a fever, so a lack of fever does not necessarily mean that there isn’t an infection present.
Testing for Olecranon Bursitis
Expert doctors typically diagnose conditions by simply talking to patients about their medical history and conducting a physical exam. But when diagnosing whether the patient has an inflammation of the bursa (a small sac filled with lubricating liquid located at points where muscles and tendons glide over bones), it’s very critical to consider the risk of the inflammation being caused by an infection (known as septic bursitis).
This is where things can get a bit tricky because symptoms and signs of non-infectious and mildly infectious bursitis often overlap and present themselves differently from patient to patient. So, for an average doctor, it’s hard to reliably tell the difference between the two without using tests.
Here, doctors often have to weigh up whether they should conduct an aspiration of the bursa. This is a mild procedure where they use a needle to withdraw the fluid from your bursa for further tests. While it’s mildly invasive, it’s considered the best way to determine the exact cause of your condition.
Especially when an infection is suspected, the fluid drawn from the bursa is sent for various tests. These tests include a cell count, Gram stain (a test that detects bacteria), culture and sensitivity tests (where bacteria are grown to see what’s causing the infection and which antibiotics will work best), and a test to look for crystals. Some believe that differences in glucose concentrations between the serum (liquid portion of your blood) and the bursal fluid are significantly larger in septic cases. However, this hasn’t been proven to be correct.
When diagnosing septic bursitis, doctors will also monitor a patient’s vital signs closely for any signs of a severe body-wide infection (systemic sepsis). They may also order blood tests as necessary.
Treatment Options for Olecranon Bursitis
Bursitis, an inflammation of the small fluid-filled bags called bursae that act as cushions at joints, can be either noninfective (caused by regular wear and tear, or injuries), or infective, when it’s caused by an infection.
Starting with noninfective bursitis, these cases usually get better on their own. Things you can do at home to speed up your recovery include resting the affected area, applying cold packs, and taking anti-inflammatory medicines like NSAIDs to reduce pain and inflammation. An elastic bandage can also help prevent swelling. Sometimes, doctors might suggest a corticosteroid injection to reduce symptoms but be aware that this treatment carries a small risk – about 10% – of infection. A quarter of people treated this way may still have some swelling after two months, and in some cases, symptoms may persist for six months. If you get bursitis frequently, your doctor might suggest a procedure called a bursectomy, where they remove the inflamed bursa. People whose bursitis is caused by a bone spur often benefit from surgical removal of that spur.
On the other hand, if bursitis is due to an infection, more aggressive therapy is needed. This involves antibiotics, especially those that are effective against bacteria called streptococci and staphylococci. Your doctor may recommend drainage of fluid from the bursa and even breaking up any blockages within the bursa. There doesn’t seem to be any benefit of giving these antibiotics through an intravenous (IV) line, so you would be likely to take them orally for about 7 days. Just like with noninfective bursitis, if the infection keeps coming back or doesn’t improve despite treatment, you might need a bursectomy. If you have signs of a more serious infection throughout your body, your doctor will also look for conditions like sepsis or septic shock, which would require more intensive treatment.
What else can Olecranon Bursitis be?
When trying to diagnose olecranon bursitis, which is a condition that causes pain and swelling at the back of the elbow, doctors should also consider other conditions that could cause similar symptoms. These may include:
- Skin abscess (a painful pocket of pus)
- Hematoma (a collection of blood outside of a blood vessel)
- Fracture of the olecranon (the pointed bone at the back of the elbow)
- Other elbow fractures
- Cellulitis (a skin infection)
- Tendon rupture (a tear in the tissue that connects muscle to bone)
- Septic arthritis (a joint infection)
- Gouty arthritis (a form of arthritis caused by excessive uric acid)
- Neoplasm (an abnormal growth, which could be cancerous)
- Ligament rupture (a tear in the tissue that connects bone to bone)
What to expect with Olecranon Bursitis
In people who generally have good health and absence of any major health conditions, particularly those impairing the immune system, a condition known as olecranon bursitis, or swelling in the elbow, is relatively harmless. The chance of this swelling leading to a body-wide infection in the average healthy person is quite low.
Interestingly, in young, healthy individuals there may even be a greater likelihood of this swelling going away on its own without any treatment, compared to it turning into a more serious condition. However, more research is needed to verify this finding. That said, simply observing the condition without any treatment generally carries a greater risk of deformity and other potential issues.
