eMedicine Specialties > Physical Medicine and Rehabilitation > Upper Limb Musculoskeletal Conditions
Olecranon Bursitis
Updated: Sep 30, 2009
Introduction
Background
Olecranon bursitis is inflammation of the bursa overlying the olecranon process at the proximal aspect of the ulna.1 The bursa is located between the ulna and the skin at the posterior tip of the elbow. (See images below and Images 1-3.)
Olecranon bursitis, shown here with the elbow flexed. Image courtesy of UMDNJ-New Jersey Medical School, www.DoctorFoye.com, and www.TailboneDoctor.com.
Olecranon bursitis seen with the elbow extended; the focal olecranon swelling is more visible than it is when the elbow is flexed. Image courtesy of UMDNJ-New Jersey Medical School, www.DoctorFoye.com, and www.TailboneDoctor.com.
Olecranon bursitis seen with the elbow extended. Image courtesy of UMDNJ-New Jersey Medical School, www.DoctorFoye.com, and www.TailboneDoctor.com
Pathophysiology
Normally, the olecranon bursa prevents tissue tears by providing a mechanism with which the skin can glide freely over the olecranon process. Bursal inflammation may be caused by a variety of mechanisms. Owing to its superficial location, this bursa is susceptible to inflammation from either acute or repetitive (cumulative) trauma. Less commonly, inflammation may result from infection (septic bursitis).2,3,4 (See image below and Image 4.)
Olecranon bursogram: this image shows a needle injecting contrast material into the olecranon bursa, under fluoroscopic guidance. Although olecranon bursa aspiration/injection usually does not require fluoroscopy or contrast, employing fluoroscopy here demonstrates the outline of the involved bursa. Image ©2005, by Patrick M. Foye, MD, UMDNJ: New Jersey Medical School.
Frequency
United States
This condition is relatively common.
Mortality/Morbidity
- Generally, no mortality is associated with this condition.
- Pain at the posterior elbow may cause morbidity, limiting some functional activities, such as writing. Complications of aspiration/injection include recurrence, infection, and persistent drainage.
Race
No racial predisposition is recognized.
Sex
No predisposition for either sex is recognized.
Age
This condition occurs in children and adults. In patients on long-term hemodialysis treatment, uremia or a mechanical factor (such as resting the posterior elbow during hemodialysis treatment) is thought possibly to cause the inflammation.5
Clinical
History
- Focal swelling at the posterior elbow is usually noticed by the patient.
- The patient may report pain at the affected site, although sometimes the swelling is painless.
- Pain often is exacerbated by pressure, such as when the patient leans on the elbow or when the patient rubs the elbow against a table while writing with the ipsilateral hand.
- Chronic recurrent swelling usually is not tender.
- Frequent bumping of the swollen elbow may occur because the elbow protrudes farther than normal.
- The patient may report a history of isolated trauma (eg, contusion) or repetitive microtrauma (such as constant rubbing of the elbow against a table while writing).
- Onset may be sudden if the condition is secondary to infection or acute trauma.
- Onset may be gradual if olecranon bursitis is secondary to chronic irritation.
Physical
- The most classic finding is posterior elbow swelling that is very clearly demarcated, appearing as a goose egg over the olecranon process.
- The affected site may be tender to palpation.
- The area may be warm and red, particularly with infection.
- Skin inspection may reveal abrasion or contusion if trauma recently occurred.
- Vital signs may reveal fever, but generally only with advanced infection.
- Elbow range of motion (ROM) usually is normal, but occasionally the end range of elbow flexion may be slightly limited because of pain.
- Patients with systemic inflammatory processes (eg, rheumatoid arthritis) or crystal deposition disease (eg, gout, pseudogout) may reveal evidence of focal inflammation at other sites.
- Upon inspection of the elbow, rheumatoid nodules may be found in patients with rheumatoid arthritis.
- If there is a history of trauma, elbow pain during active or passive ROM may increase the clinician's suspicion of fracture of the olecranon process.
Causes
- Acute trauma (such as falling onto a hard floor or a playing field with artificial turf and landing on the olecranon process)
- Minor cumulative trauma, such as repetitive rubbing of the olecranon region against a desktop during writing
- Infection resulting from abrasion or laceration at the site or owing to seeding from hematogenous spread by bacteremia6,7,8
- Inflammation as part of a systemic inflammatory process (eg, rheumatoid arthritis) or a crystal deposition disease (eg, gout, pseudogout)
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 |
| Next Page » |
References
Snider RK. Olecranon bursitis. In: Snider RK, ed. Essentials of Musculoskeletal Care. Rosemont, Ill: American Academy of Orthopaedic Surgeons; 1997:156-9.
Wasserman AR, Melville LD, Birkhahn RH. Septic bursitis: a case report and primer for the emergency clinician. J Emerg Med. Jul 20 2007;[Medline].
Lass-Flörl C, Mayr A. Human protothecosis. Clin Microbiol Rev. Apr 2007;20(2):230-42. [Medline]. [Full Text].
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].
Senécal L, Leblanc M. Olecranon bursitis in chronic haemodialysis patients. Nephrol Dial Transplant. Sep 2001;16(9):1956-7. [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. Jul 2008;61(3):354-7. [Medline].
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].
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].
Blankstein A, Ganel A, Givon U, et al. Ultrasonographic findings in patients with olecranon bursitis. Ultraschall Med. Dec 2006;27(6):568-71. [Medline].
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].
Tran N, Chow K. Ultrasonography of the elbow. Semin Musculoskelet Radiol. Jun 2007;11(2):105-16. [Medline].
Olsen NK, Press JM, Young JL. Bursal injections. In: Lennard TA, ed. Physiatric Procedures in Clinical Practice. Philadelphia, Pa: Hanley & Belfus; 1995:36-43.
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.
Degreef I, De Smet L. Complications following resection of the olecranon bursa. Acta Orthop Belg. Aug 2006;72(4):400-3. [Medline].
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].
Cardone DA, Tallia AF. Diagnostic and therapeutic injection of the elbow region. Am Fam Physician. Dec 1 2002;66(11):2097-100. [Medline].
Green SM. Nonsteroidal anti-inflammatory drugs (NSAIDs). In: Tarascon Pocket Pharmacopoeia 2000. Loma Linda, Calif: Tarascon; 2000:11-2.
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].
Brinker MR, Miller MD. The adult elbow. In: Fundamentals of Orthopaedics. Philadelphia, Pa: WB Saunders; 1999:153-64.
Lennard TA. Fundamentals of procedural care. In: Lennard TA, ed. Physiatric Procedures in Clinical Practice. Philadelphia, Pa: Hanley & Belfus; 1995:1-13.
McGee DJ. Elbow joints. In: Orthopedic Physical Assessment. 2nd ed. Philadelphia, Pa: WB Saunders; 1992:143-67.
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.
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.
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
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
