- Author: J Michael Wieting, DO, MEd, FAOCPMR, FAAPMR; Chief Editor: Stephen Kishner, MD, MHA more...
Olecranon bursitis, a relatively common condition, is inflammation of the subcutaneous synovial-lined sac of the bursa overlying the olecranon process at the proximal aspect of the ulna (see the images below). The bursa cushions the olecranon and reduces friction between it and the skin, especially during movement. The superficial location of the bursa, between the ulna and the skin at the posterior tip of the elbow, makes it susceptible to inflammation from acute or repetitive (cumulative) trauma. Less commonly, inflammation results from infection (septic bursitis). Many cases are idiopathic, however. (See Etiology, Workup, Treatment, and Medication.)[1, 2, 3, 4, 5]
The bursa allows the skin to glide freely over the olecranon process, thereby preventing tissue tears. As previously stated, the superficial location of the olecranon bursa makes it susceptible to inflammation from acute or repetitive trauma.
Acute injuries during sports activities can include any action that involves direct or repetitive minor trauma to the posterior elbow (eg, landing on the olecranon process during a fall onto a hard floor or an artificial-turf playing field).
Common causes of olecranon bursal inflammation that are unrelated to sports activities include repetitive microtrauma (eg, the elbow constantly rubbing against a table during writing).
Bursal infection, a less common cause of olecranon bursitis, can result from abrasion or laceration at the affected site or from seeding from hematogenous spread via bacteremia. Inflammation can also be cause by a systemic inflammatory process (eg, rheumatoid arthritis) or a crystal-deposition disease (eg, gout, pseudogout). Patients are also at increased risk if they have diabetes mellitus, uremia, a history of intravenous drug abuse, alcohol abuse, or long-term use of steroids.[6, 7, 8, 9, 10, 11]
In patients on long-term hemodialysis treatment, uremia or a mechanical insult (such as resting the posterior elbow during hemodialysis treatment) is thought possibly to cause bursitis. Inflammation of the bursa can also be an adverse effect of the drug sunitinib, which is used to treat patients with renal cell carcinoma.
Larsen et al reported a case of bacillus Calmette-Guérin (BCG) olecranon bursitis developing from disseminated BCG infection, the result of BCG treatment for superficial bladder cancer.
In the absence of infection, most cases of olecranon bursitis respond very well to a series of 1-2 joint aspirations (with or without corticosteroid injection) combined with additional treatment. Some patients may experience recurrence of olecranon bursitis, in which even a relatively minor bump causes a significant effusion to return at this site.
Complications of olecranon bursitis include progressive or persistent pain with associated difficulty in using the affected upper extremity. Potential complications of aspiration/injection include the following:
Allergic reaction (to the corticosteroid)
Swelling - This may recur, particularly if the patient does not maintain adequate pressure or icing at the site or if an infection was present at the time of the initial aspiration
Infection - The clinician should use appropriate techniques, including aseptic techniques, to minimize the chance of iatrogenic infection
Persistent drainage through the injection tract
Ulnar nerve injury - This theoretically may occur if a medial approach is used for the aspiration/injection
Transient elevation of blood glucose levels - This may occur after corticosteroid injection in a diabetic patient
Cardiac arrhythmia - This potentially can result from intravascular injection, due to the local anesthetic component
Peripheral nerve dysfunction - This is possible if the injection is administered near or within a major nerve
Compromised wound healing
Gastric, hepatic, and renal adverse effects from NSAIDs and narcotic analgesics
The patient should be educated regarding olecranon bursitis’s diagnosis, causative factors, and treatment plan. 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 given. Diabetic patients should be told that they may experience a transient increase in blood glucose levels.
Patients should be informed that a corticosteroid usually does not begin to provide symptomatic improvement until a few days after the injection. Patients should also understand that they may experience a mild, transient increase in symptoms during the window of time when the local anesthetic has worn off but the steroids have not begun to have a therapeutic effect. For patient education information, see the Arthritis Center, as well as Bursitis.
Snider RK. Olecranon bursitis. Snider RK, ed. Essentials of Musculoskeletal Care. 2nd ed. Rosemont, Ill: American Academy of Orthopaedic Surgeons; 1997. 156-9.
McGee DJ. Elbow joints. Orthopedic Physical Assessment. 2nd ed. Philadelphia, Pa: WB Saunders Co; 1992. 143-167.
Strakowski JA, Wiand JW, Johnson EW. Upper limb musculoskeletal pain syndromes. Braddom RL, ed. Physical Medicine and Rehabilitation. Philadelphia, Pa: WB Saunders Co; 1996. 756-82.
Morgan WJ. Elbow and forearm. Steinberg GG, Akins C, Baran D, eds. Orthopaedics in Primary Care. 3rd ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 1998. 70-98.
Brinker MR, Miller MD. The adult elbow. Fundamentals of Orthopaedics. Philadelphia, Pa: WB Saunders Co; 1999. 153-64.
Wasserman AR, Melville LD, Birkhahn RH. Septic bursitis: a case report and primer for the emergency clinician. J Emerg Med. 2009 Oct. 37(3):269-72. [Medline].
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. 2006 Jan. 143(1):70-7. [Medline]. [Full Text].
Wessolossky M, Haran JP, Bagchi K. Paecilomyces lilacinus olecranon bursitis in an immunocompromised host: case report and review. Diagn Microbiol Infect Dis. 2008 Jul. 61(3):354-7. [Medline].
Turan H, Serefhanoglu K, Karadeli E, Timurkaynak F, Arslan H. A case of brucellosis with abscess of the iliacus muscle, olecranon bursitis, and sacroiliitis. Int J Infect Dis. 2009 Nov. 13(6):e485-7. [Medline].
Malkin J, Shrimpton A, Wiselka M, Barer MR, Duddridge M, Perera N. Olecranon bursitis secondary to Mycobacterium kansasii infection in a patient receiving infliximab for Behcet's disease. J Med Microbiol. 2009 Mar. 58:371-3. [Medline].
Gregory T, Mir O, Medioni J, Augereau B, Oudard S. Olecranon bursitis in patients treated with sunitinib for renal cell carcinoma. Med Oncol. 2010 Jun. 27(2):446-8. [Medline].
Larsen BT, Smith ML, Grys TE, Vikram HR, Colby TV. Histopathology of Disseminated Mycobacterium bovis Infection Complicating Intravesical BCG Immunotherapy for Urothelial Carcinoma. Int J Surg Pathol. 2015 May. 23 (3):189-95. [Medline].
Schumacher HR. Arthrocentesis, synovial fluid analysis, and synovial biopsy. Schumacher HR, ed. Primer on Rheumatic Diseases. 10th ed. Atlanta, Ga: Arthritis Foundation; 1993. 67-72.
Blankstein A, Ganel A, Givon U, Mirovski Y, Chechick A. Ultrasonographic findings in patients with olecranon bursitis. Ultraschall Med. 2006 Dec. 27(6):568-71. [Medline].
Olsen NK, Press JM, Young JL. Bursal injections. Lennard TA, ed. Physiatric Procedures in Clinical Practice. Philadelphia, Pa: Hanley & Belfus; 1995. 36-43.
Degreef I, De Smet L. Complications following resection of the olecranon bursa. Acta Orthop Belg. 2006 Aug. 72(4):400-3. [Medline].
Ogilvie-Harris DJ, Gilbart M. Endoscopic bursal resection: the olecranon bursa and prepatellar bursa. Arthroscopy. 2000 Apr. 16(3):249-53. [Medline].
Baumbach SF, Lobo CM, Badyine I, et al. Prepatellar and olecranon bursitis: literature review and development of a treatment algorithm. Arch Orthop Trauma Surg. 2014 Mar. 134(3):359-70. [Medline].
Rhyou I, Park K, Kim K, Lee J, S Kim. Endoscopic Olecranon Bursal Resection for Olecranon Bursitis. J Hand Surg Asian-Pac. 2016 Jun. 21:167-72.
Kim JY, Chung SW, Kim JH, et al. A Randomized Trial Among Compression Plus Nonsteroidal Antiinflammatory Drugs, Aspiration, and Aspiration With Steroid Injection for Nonseptic Olecranon Bursitis. Clin Orthop Relat Res. 2016 Mar. 474 (3):776-83. [Medline].
Green SM. Nonsteroidal anti-inflammatory drugs (NSAIDs). Tarascon Pocket Pharmacopoeia 2000. Loma Linda, Calif: Tarascon; 2000. 11-2.
Perez C, Huttner A, Assal M, Bernard L, Lew D, Hoffmeyer P, et al. Infectious olecranon and patellar bursitis: short-course adjuvant antibiotic therapy is not a risk factor for recurrence in adult hospitalized patients. J Antimicrob Chemother. 2010 May. 65(5):1008-14. [Medline]. [Full Text].
Lennard TA. Fundamentals of procedural care. Physiatric Procedures in Clinical Practice. Philadelphia, Pa: Hanley & Belfus; 1995. 1-13.
Wasserzug O, Balicer RD, Boxman J, Klement E, Ambar R, Zimhony O. A cluster of septic olecranon bursitis in association with infantry training. Mil Med. 2011 Jan. 176(1):122-4. [Medline].