eMedicine Specialties > Physical Medicine and Rehabilitation > Upper Limb Musculoskeletal Conditions

Olecranon Bursitis: Follow-up

Author: Patrick M Foye, MD, FAAPMR, FAAEM, Associate Professor of Physical Medicine and Rehabilitation, Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, Director of Coccyx Pain Service (Tailbone Pain Service: www.TailboneDoctor.com), University of Medicine and Dentistry of New Jersey, New Jersey Medical School
Coauthor(s): Todd P Stitik, MD, Professor, Department of Physical Medicine and Rehabilitation; Director, Outpatient Occupational/Musculoskeletal Medicine, UMDNJ-New Jersey School of Medicine
Contributor Information and Disclosures

Updated: Sep 30, 2009

Follow-up

Further Outpatient Care

  • Icing of the posterior elbow for 15-20 minutes at a time, several times per day, is recommended during the acute period (2-5 days).
  • A compressive wrap using an elastic wrap or elastic sleeve is helpful.
  • Excessive pressure over the elbow should be avoided.
  • If possible, further trauma to the affected joint should be avoided.
  • The use of elbow pads to cushion the region from further trauma should be considered.
  • For cases with repeated recurrence, the use of a posterior plaster splint should be considered in order to limit elbow motion for 1-2 weeks following aspiration.
  • The patient should return for re-evaluation within approximately 2 weeks. At that time, assessment should be made for re-accumulation of the fluid, any persistent drainage, or any signs of infection.
  • The decision whether to treat with empiric antibiotics depends on the perceived likelihood of infection, based on the history, physical examination, and analysis of the bursal aspirate.

Deterrence

  • Further trauma to the affected site, including acute trauma (such as that caused by contact sports) and repetitive minor traumas, should be avoided.
  • Excessive pressure over the elbow should be avoided.
  • The use of elbow pads to cushion the region from further trauma should be considered, even if the pads are employed only initially, until the acute inflammation is resolved.

Complications

Prognosis

  • In the absence of infection, most patients respond very well to 1 or, perhaps, 2 aspirations, with or without corticosteroid injection.

Patient Education

  • The most important aspect of patient education is ensuring that the patient knows to immediately report any signs or symptoms of persistent drainage or infection, particularly if a corticosteroid injection has been administered.
  • For excellent patient education resources, visit eMedicine's Arthritis Center. Also, see eMedicine's patient education article Bursitis.

Miscellaneous

Medicolegal Pitfalls

  • Corticosteroids should never be injected into a site that appears to be infected or through skin that appears to be infected.
  • In the presence of significant trauma, radiographs should always be checked for fractures before treatment commences.
  • In the absence of a traumatic etiology, consideration should be given to analyzing the aspirated fluid for infection and crystals.
  • When aspiration/injection is performed, aseptic techniques should be used to minimize the chance of causing iatrogenic infection. Septic olecranon bursitis due to Mycobacterium smegmatis has been reported after intrabursal steroid injection.18
  • The medial approach to the olecranon bursa should be avoided, since a misdirected needle could damage the ulnar nerve.

Special Concerns

  • Pregnancy - Aspiration of the bursa and corticosteroid injection can be performed during pregnancy. Oral NSAIDs should be avoided.
  • Pediatric patient - Informed consent should be obtained from the parent or legal guardian before aspiration or injection is performed.
  • Elderly patient with history of side effects from NSAIDs - It is necessary to be cautious when using NSAIDs in elderly patients. COX-2 inhibitors may be indicated.
  • Patient with diabetes - Some patients with diabetes may experience a transient elevation in blood glucose levels after corticosteroid injection.
 
Acknowledgments

Debra Ibrahim, 4th year medical student, New York College of Osteopathic Medicine, Class of 2008, assisted with the 2007 revision of this manuscript.

Jason Lee, 4th year medical student, St. George's University School of Medicine, Class of 2010, assisted with the most recent revision of this manuscript.



More on Olecranon Bursitis

Overview: Olecranon Bursitis
Differential Diagnoses & Workup: Olecranon Bursitis
Treatment & Medication: Olecranon Bursitis
Follow-up: Olecranon Bursitis
Multimedia: Olecranon Bursitis
References
Further Reading
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References

  1. Snider RK. Olecranon bursitis. In: Snider RK, ed. Essentials of Musculoskeletal Care. Rosemont, Ill: American Academy of Orthopaedic Surgeons; 1997:156-9.

  2. Wasserman AR, Melville LD, Birkhahn RH. Septic bursitis: a case report and primer for the emergency clinician. J Emerg Med. Jul 20 2007;[Medline].

  3. Lass-Flörl C, Mayr A. Human protothecosis. Clin Microbiol Rev. Apr 2007;20(2):230-42. [Medline]. [Full Text].

  4. Wagner C, Iking-Konert C, Hug F, et al. Cellular inflammatory response to persistent localized Staphylococcus aureus infection: phenotypical and functional characterization of polymorphonuclear neutrophils (PMN). Clin Exp Immunol. Jan 2006;143(1):70-7. [Medline]. [Full Text].

  5. Senécal L, Leblanc M. Olecranon bursitis in chronic haemodialysis patients. Nephrol Dial Transplant. Sep 2001;16(9):1956-7. [Medline]. [Full Text].

  6. Wessolossky M, Haran JP, Bagchi K. Paecilomyces lilacinus olecranon bursitis in an immunocompromised host: case report and review. Diagn Microbiol Infect Dis. Jul 2008;61(3):354-7. [Medline].

  7. Turan H, Serefhanoglu K, Karadeli E, et al. A case of brucellosis with abscess of the iliacus muscle, olecranon bursitis, and sacroiliitis. Int J Infect Dis. Apr 23 2009;[Medline].

  8. Malkin J, Shrimpton A, Wiselka M, et al. Olecranon bursitis secondary to Mycobacterium kansasii infection in a patient receiving infliximab for Behcet's disease. J Med Microbiol. Mar 2009;58:371-3. [Medline].

  9. Blankstein A, Ganel A, Givon U, et al. Ultrasonographic findings in patients with olecranon bursitis. Ultraschall Med. Dec 2006;27(6):568-71. [Medline].

  10. Floemer F, Morrison WB, Bongartz G, et al. MRI characteristics of olecranon bursitis. AJR Am J Roentgenol. Jul 2004;183(1):29-34. [Medline]. [Full Text].

  11. Tran N, Chow K. Ultrasonography of the elbow. Semin Musculoskelet Radiol. Jun 2007;11(2):105-16. [Medline].

  12. Olsen NK, Press JM, Young JL. Bursal injections. In: Lennard TA, ed. Physiatric Procedures in Clinical Practice. Philadelphia, Pa: Hanley & Belfus; 1995:36-43.

  13. Schumacher HR. Arthrocentesis, synovial fluid analysis, and synovial biopsy. In: Schumacher HR, ed. Primer on Rheumatic Diseases. 10th ed. Atlanta, Ga: Arthritis Foundation; 1993:67-72.

  14. Degreef I, De Smet L. Complications following resection of the olecranon bursa. Acta Orthop Belg. Aug 2006;72(4):400-3. [Medline].

  15. Weinstein PS, Canoso JJ, Wohlgethan JR. Long-term follow-up of corticosteroid injection for traumatic olecranon bursitis. Ann Rheum Dis. Feb 1984;43(1):44-6. [Medline]. [Full Text].

  16. Cardone DA, Tallia AF. Diagnostic and therapeutic injection of the elbow region. Am Fam Physician. Dec 1 2002;66(11):2097-100. [Medline].

  17. Green SM. Nonsteroidal anti-inflammatory drugs (NSAIDs). In: Tarascon Pocket Pharmacopoeia 2000. Loma Linda, Calif: Tarascon; 2000:11-2.

  18. Friedman ND, Sexton DJ. Bursitis due to Mycobacterium goodii, a recently described, rapidly growing mycobacterium. J Clin Microbiol. Jan 2001;39(1):404-5. [Medline]. [Full Text].

  19. Brinker MR, Miller MD. The adult elbow. In: Fundamentals of Orthopaedics. Philadelphia, Pa: WB Saunders; 1999:153-64.

  20. Lennard TA. Fundamentals of procedural care. In: Lennard TA, ed. Physiatric Procedures in Clinical Practice. Philadelphia, Pa: Hanley & Belfus; 1995:1-13.

  21. McGee DJ. Elbow joints. In: Orthopedic Physical Assessment. 2nd ed. Philadelphia, Pa: WB Saunders; 1992:143-67.

  22. Morgan WJ. Elbow and forearm. In: Steinberg GG, Akins CM, Baran DT, eds. Orthopaedics in Primary Care. 3rd ed. Baltimore, Md: Lippincott Williams & Wilkins; 1999:70-98.

  23. Strakowski JA, Wiand JW, Johnson EW. Upper limb musculoskeletal pain syndromes. In: Braddom RL, ed. Physical Medicine and Rehabilitation. Philadelphia, Pa: WB Saunders; 1996:756-82.

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Further Reading

Related eMedicine topics:
 Bursitis [Emergency Medicine]
Bursitis [Orthopedic Surgery]
Gout [Ophthalmology]
Gout [Orthopedic Surgery]
Gout [Radiology]
Gout [Rheumatology]
Gout and Pseudogout
Olecranon Bursa Aspiration
Olecranon Bursitis [Sports Medicine]
The Approach to the Painful Joint

Clinical guidelines:
ACR Appropriateness Criteria® chronic elbow pain. American College of Radiology - Medical Specialty Society. 1998 (revised 2008). 8 pages. NGC:006997

Elbow (acute & chronic). Work Loss Data Institute - Public For Profit Organization. 2003 (revised 2008 May 28). 161 pages. NGC:006555

Elbow disorders. American College of Occupational and Environmental Medicine - Medical Specialty Society. 1997 (revised 2007). 67 pages. NGC:005681

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Keywords

olecranon bursitis, bursitis olecranon, bursitis, bursitis elbow, elbow bursitis, elbow bursa, bursa elbow, septic bursitis, posterior elbow swelling, draftsman's elbow, student's elbow, miner's elbow

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Contributor Information and Disclosures

Author

Patrick M Foye, MD, FAAPMR, FAAEM, Associate Professor of Physical Medicine and Rehabilitation, Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, Director of Coccyx Pain Service (Tailbone Pain Service: www.TailboneDoctor.com), University of Medicine and Dentistry of New Jersey, New Jersey Medical School
Patrick M Foye, MD, FAAPMR, FAAEM is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists, and International Spine Intervention Society
Disclosure: Nothing to disclose.

Coauthor(s)

Todd P Stitik, MD, Professor, Department of Physical Medicine and Rehabilitation; Director, Outpatient Occupational/Musculoskeletal Medicine, UMDNJ-New Jersey School of Medicine
Todd P Stitik, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Association of Academic Physiatrists, Phi Beta Kappa, and Physiatric Association of Spine, Sports and Occupational Rehabilitation
Disclosure: Nothing to disclose.

Medical Editor

Robert L Sheridan, MD, Assistant Chief of Staff, Chief of Burn Surgery, Shriners Burns Hospital; Associate Professor of Surgery, Department of Surgery, Division of Trauma and Burns, Massachusetts General Hospital and Harvard Medical School
Robert L Sheridan, MD is a member of the following medical societies: American Academy of Pediatrics, American Association for the Surgery of Trauma, American Burn Association, and American College of Surgeons
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Michael T Andary, MD, MS, Residency Program Director, Professor, Department of Physical Medicine and Rehabilitation, Michigan State University College of Osteopathic Medicine
Michael T Andary, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, and Association of Academic Physiatrists
Disclosure: allergan Honoraria Speaking and teaching; Pfizer Honoraria Speaking and teaching

CME Editor

Kelly L Allen, MD, Regional Medical Director, IMX-Medical Management Services
Disclosure: Nothing to disclose.

Chief Editor

Rene Cailliet, MD, Professor-Chairman Emeritus, Department of Rehabilitation Medicine, University of Southern California School of Medicine; Former Director, Department of Rehabilitation Medicine, Santa Monica Hospital Medical Center
Rene Cailliet, MD is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American Pain Society, Association of American Medical Colleges, International Association for the Study of Pain, and Pan American Medical Association
Disclosure: Nothing to disclose.

 
 
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