Introduction
Background
Olecranon bursitis is a condition in which there is inflammation of the bursa that overlies the olecranon process at the proximal aspect of the ulna (see Images 1-3 or below).
Olecranon bursitis is shown in a patient with the elbow flexed. Image © 2007 by Patrick Foye, MD, UMDNJ New Jersey Medical School.
Olecranon bursitis is shown in a patient with the elbow extended. Image © 2007 by Patrick Foye, MD, UMDNJ New Jersey Medical School.
Olecranon bursitis is shown close up in a patient, with the elbow extended. Image © 2007 by Patrick Foye, MD, UMDNJ New Jersey Medical School.
The bursa is located between the ulna and the skin at the posterior tip of the elbow; because of its superficial location, the olecranon bursa is susceptible to inflammation from a variety of mechanisms, primarily either acute or repetitive (cumulative) trauma. Less commonly, the inflammation may be due to infection (septic bursitis).1,2,3,4,5
For excellent patient education resources, visit eMedicine's Arthritis Center. Also, see eMedicine's patient education articles Bursitis and Tendinitis.
Frequency
United States
Olecranon bursitis is a relatively common condition.
Functional Anatomy
Based on its location between the ulna and the skin at the posterior tip of the elbow, the olecranon bursa functions to provide a mechanism for the skin to glide freely over the olecranon process, thereby preventing tissue tears.
Sport-Specific Biomechanics
Bursal inflammation may be caused by a variety of mechanisms. Due to the superficial location of the olecranon bursa, it is susceptible to inflammation that is caused by acute or repetitive trauma (see Images 1-3). Acute injuries during sports activities can include any action that involves direct trauma to the posterior elbow (eg, falls). 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). Less commonly, the inflammation may be due to infection (septic bursitis).
Clinical
History
- Patients with olecranon bursitis usually notice focal swelling at the posterior elbow.
- Pain at the affected site is usually reported; however, the swelling is sometimes painless.
- Pain is often exacerbated by pressure (eg, leaning on the elbow, rubbing against a table when writing with the ipsilateral hand).
- Chronic recurrent swelling is usually not tender.
- Frequent bumping of the swollen elbow occurs because it protrudes further than it normally would.
- A history of isolated trauma (eg, contusion) or repetitive microtrauma may be present.
- The onset of bursal inflammation may be sudden if it is secondary to infection or acute trauma.
- The onset of bursal inflammation may be gradual if it is secondary to chronic irritation.
Physical
- The most classic finding of bursal inflammation is posterior elbow swelling, which is clearly demarcated by its appearance as a goose egg over the olecranon process (see Image 3 or below).
Olecranon bursitis is shown in a patient with the elbow extended. Image © 2007 by Patrick Foye, MD, UMDNJ New Jersey Medical School.
- Tenderness to palpation is noted at the affected site.
- The affected area may be warm and red, particularly in cases in which infection is present.
- Skin inspection may reveal abrasion or contusion if there was recent trauma.
- The patient's vital signs may reveal fever, but fever generally occurs only with advanced infection.
- The affected elbow's range of motion (ROM) is usually normal, but occasionally the end-range of elbow flexion may be slightly limited due to 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
Gout. Radiograph of erosions with overhanging edges.
{{mediacaption:1651609_4}}Rheumatoid nodules can be present on inspection of the elbow in rheumatoid arthritis.
Arthritis, Rheumatoid. Rheumatoid nodules at the elbow. Photograph by David Effron MD, FACEP
- Elbow pain during active or passive ROM may increase the clinical suspicion of an olecranon process fracture if a history of trauma exists.
Olecranon fracture.
Causes
Bursal inflammation may be caused by a variety of mechanisms. Due to the superficial location of the olecranon bursa, it is susceptible to inflammation caused by acute or repetitive trauma, and less commonly, infection.
- Acute trauma (eg, falling onto a hard floor or an artificial-turf playing field and then landing on the olecranon process)
- Minor cumulative trauma (eg, repetitively rubbing the olecranon region against a desktop during writing)
- Infection caused by abrasion or laceration at the affected site or by seeding from hematogenous spread via bacteremia
- Inflammation as part of systemic inflammatory process (eg, rheumatoid arthritis) or 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
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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].
Barham GS, Hargreaves DG. Mycobacterium kansasii olecranon bursitis. J Med Microbiol. Dec 2006;55(pt 12):1745-6. [Medline].
Blankstein A, Ganel A, Givon U, Mirovski Y, Chechick A. Ultrasonographic findings in patients with olecranon bursitis. Ultraschall Med. Dec 2006;27(6):568-71. [Medline].
Damert HG, Altmann S, Schneider W. [Soft-tissue defects following olecranon bursitis: treatment options for closure] [German]. Chirurg. Aug 7 2008;epub ahead of print. [Medline].
Degreef I, De Smet L. Complications following resection of the olecranon bursa. Acta Orthop Belg. Aug 2006;72(4):400-3. [Medline].
Jin W, Lee JH, Yang DM, et al. Olecranon bursitis communicating with an olecranon cyst in rheumatoid arthritis. J Ultrasound Med. Jun 2007;26(6):857-61. [Medline].
Further Reading
Related eMedicine Topics
- Bursitis [in the Emergency Medicine section]
- Bursitis [in the Orthopedic Surgery section]
- Elbow and Forearm Overuse Injuries [in the Sports Medicine section]
- Overuse Injury [in the Physical Medicine and Rehabilitation section]
National Guidelines Clearinghouse
- Elbow (acute & chronic). Work Loss Data Institute - Public For Profit Organization. 2003 (revised 2008 May 28). 161 pages. NGC:006555
- ACR Appropriateness Criteria® chronic elbow pain. American College of Radiology - Medical Specialty Society. 1998 (revised 2005). 5 pages. [NGC Update Pending] NGC:004605
Keywords
olecranon bursitis, bursitis, tendinitis, elbow pain, olecranon, student's elbow, draftsman's elbow, swollen/inflamed elbow, painful elbow
