eMedicine Specialties > Sports Medicine > Upper Limb

Olecranon Bursitis

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
Todd P Stitik, MD, Professor, Department of Physical Medicine and Rehabilitation; Director, Outpatient Occupational/Musculoskeletal Medicine, UMDNJ-New Jersey School of Medicine; Scott F Nadler, DO, Assistant Director of Occupational/Musculoskeletal Medicine, Assistant Professor of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey, Director of Sports Medicine, University Hospital

Updated: Mar 27, 2009

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.

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)

Differential Diagnoses

Elbow and Forearm Overuse Injuries
Gout
Gout and Pseudogout
Olecranon Fractures
Triceps Tendon Avulsion

Other Problems to Be Considered

Fracture of the olecranon process of the ulna
Olecranon traction osteophyte (with or without avulsion)
Presence of infection (the most important consideration)
Rheumatoid arthritis
Synovial cyst of the elbow joint
Triceps tendinitis/tear

Workup

Laboratory Studies

• Serum studies are usually only necessary in olecranon bursitis if the clinician suspects an underlying condition, which includes the following⁶ : 
  • Infection (complete blood cell [CBC] count, including the differential count of white blood cells [WBCs], C-reactive protein [CRP], erythrocyte sedimentation rate [ESR])
  • Rheumatoid arthritis (rheumatoid factor, ESR, CRP)
  • Gout (check uric acid level)
• If infection is suspected (due to the presence of fever, redness, previous puncture wounds, or cellulitis), the olecranon bursa should be aspirated and the fluid sent for immediate Gram staining for bacteria and cell count (WBCs, red blood cells), as well as cultures. 
  • An immediate Gram stain for bacteria is helpful to quickly determine if bacterial infection is present. If the Gram stain is positive for bacteria, antibiotics should be started immediately and no corticosteroids should be injected into the bursa.
  • Even if the Gram stain is negative or initially unavailable, there are situations in which it may be prudent to avoid local corticosteroid injection, and, instead, start antibiotics immediately after the culture is obtained, to prevent worsening of the infection.⁷ For example, antibiotics may seem to be indicated based on the mechanism of injury (eg, abrasion or puncture), on the physical examination findings that are suggestive of infection (eg, fever, significant local redness and warmth), or on the gross appearance of the aspirated fluid (eg, turbid, purulent).
  • The leukocyte count can be used to help determine if the fluid is infectious or merely inflammatory. Within synovial aspirates, WBC counts are classified as follows:
    • Normal – Less than 200 WBCs/µL
    • Noninflammatory – 200-2000 WBCs/µL
    • Inflammatory – 2000-100,000 WBCs/µL
    • Septic – More than 100,000 WBCs/µL
• Bacterial culture and sensitivity testing of the aspirate can then be performed to ensure the relevant bacteria are sensitive to the chosen antibiotic. These results can guide the modification of antibiotics in cases of bacterial infection.
• After an acute injury, blood may be found within the aspirate, indicating a hemorrhagic bursitis (see Image 5 or below).
  

  

  Olecranon bursitis aspiration of a hemorrhagic effusion. Image ©2007, by Patrick M. Foye, MD, UMDNJ New Jersey Medical School.

  
  
• Analysis for crystals may reveal monosodium urate crystals in patients with gout, calcium pyrophosphate crystals in pseudogout, or hydroxyapatite crystals (see Image 10 or below).
  

  

  Gout. Polarizing microscopy needles of urate.

  
  

Imaging Studies

• Radiographs of the elbow should be performed to assess for a possible olecranon fracture if significant trauma occurred or if an avulsed osteophyte is present at the triceps insertion into the olecranon, which is fairly common (see Image 9).
• In atypical cases, a magnetic resonance imaging (MRI) study may be indicated to help exclude concomitant pathology, such as a stress fracture, triceps tendinopathy or tear, or the rare case of osteomyelitis/abscess or tumor.⁸

Procedures

• Bursal aspiration remains the criterion standard to differentiate between septic and aseptic olecranon bursitis.
• The olecranon bursa can be aspirated using an 18-gauge needle that is inserted through a posterolateral approach, via an oblique needle angle or zigzag approach. As opposed to a direct, perpendicular approach that is used for most joint aspirations, this technique creates a longer needle tract through the skin and subcutaneous layers, thus minimizing the risk of fistula formation (see Image 4 or below).
  

  

  Needle aspiration of olecranon bursitis. Image ©2007, by Patrick M. Foye, MD, UMDNJ New Jersey Medical School.

  
  
  • Aspiration can be helpful diagnostically; any cloudy fluid should be sent for an immediate Gram stain and leukocyte count, as well as a culture, with tests for antibiotic sensitivity. No corticosteroids should be given until these tests prove negative.
  • Aspiration can also be therapeutic because it relieves the swelling.
  • If the clinician is confident that no infection is present, a corticosteroid injection can be considered (eg, immediately after aspiration of the fluid).
• The injection should be on the lateral side of the elbow to avoid the ulnar nerve. The target injection site is the soft-tissue center of the triangle that is formed by the lateral olecranon, the head of the radius, and the lateral epicondyle. As with most injections, the physician should first aspirate to ensure that the needle is not in a blood vessel, and then inject using a slow, but consistent pressure.⁹

Treatment

Acute Phase

Rehabilitation Program

Physical Therapy

In general, physical and occupational therapy are not needed for olecranon bursitis. In some cases of nonseptic bursitis, however, the physician may recommend a course of physical or occupational therapy to speed the patient's recovery time. Individuals who exhibit olecranon bursitis are often advised to apply the RICE (ie, rest, ice, compression, elevation) method of treatment.

Physical therapy modalities (eg, phonophoresis, electrical stimulation) may also be helpful to further reduce pain and inflammation, although these modalities are not necessary for most patients with this condition.¹⁰ The therapist can also educate the patient and present compensatory strategies for resting the involved upper extremity while healing is occurring. If the patient's condition becomes severe and does not respond to conservative treatment, surgery may be indicated. For patients who undergo bursectomy (bursal excision), postoperative physical therapy may be recommended for regaining or maintaining ROM and strength of the elbow.

Medical Issues/Complications

• Complications of the disease process in olecranon bursitis include persistent pain and an associated decreased functional use of the affected upper extremity.

• Potential complications of aspiration/injection include the following:

• Swelling: This may recur, particularly if the patient does not maintain adequate pressure or icing at the site or if 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 causing iatrogenic infection.

• Persistent drainage

Surgical Intervention

Usually, no surgical intervention is required in cases of olecranon bursitis; however, very severe cases may require bursectomy. A study by Ogilvie-Harris and Gilbart demonstrated endoscopic bursal resection relieves pain symptoms in patients with olecranon bursitis.¹¹  Fortunately, most cases of olecranon bursitis respond to nonsurgical treatment.

Consultations

• Consultation with a physiatrist (physical medicine and rehabilitation physician) or with an orthopedic surgeon may be considered by physicians without the training, comfort, or procedural office supplies that are necessary for joint aspiration.
• Consultation with a rheumatologist may be helpful if the clinical findings are consistent with inflammatory arthropathy.
• Consultation with an orthopedic surgeon is required if a fracture is present, if the patient has a very severe case of recalcitrant bursitis that requires excision (bursectomy), or if septic bursitis is present for which incision and drainage is required.

Other Treatment

• Oral nonsteroidal anti-inflammatory drugs (NSAIDs) are used in the treatment of olecranon bursal inflammation.¹²
• Glucocorticoid injection can be used to treat this condition (see Procedures). A retrospective study by Weinstein et al showed that in 47 patients with traumatic olecranon bursitis, almost all cases resolved via aspiration with or without an intrabursal glucocorticoid injection.⁷ The 25 patients who received a glucocorticoid injection (20 mg of triamcinolone) in addition to the bursal aspiration had much more rapid resolution of their olecranon bursitis condition, usually within 1 week, compared with those who did not receive the injection. However, glucocorticoid injection seemed to be more highly associated with complications, such as infection and skin atrophy.⁷
• The posterior elbow should be iced 15-20 minutes at a time, several times per day, during the acute inflammatory period of 2-5 days.
• A compressive wrap using an elastic wrap or an elastic sleeve should be applied, but the application of excessive pressure over the elbow should be avoided (see Image 6 or below).
  

  

  After fluid is removed from the olecranon bursa, an elastic, tubular, compressive sleeve can be used to minimize reaccumulation of the fluid. Image ©2007, by Patrick Foye, MD, UMDNJ New Jersey Medical School.

  
  
• Avoiding further trauma to the olecranon bursa is the key to recovery and preventing recurrence. Consider use of elbow pads to cushion the elbow.

Recovery Phase

Medical Issues/Complications

Medical issues and complications of olecranon bursitis during the recovery phase are the same as those listed for the acute phase (see Acute Phase, Medical Issues/Complications).

Other Treatment (Injection, manipulation, etc.)

For cases of olecranon bursitis in which there is repeated recurrence, consider use of a posterior plaster splint to limit elbow motion for 1-2 weeks following aspiration. For severely recalcitrant cases, consider referral to an orthopedic surgeon for possible bursal excision.

Medication

Oral NSAIDs can be helpful to reduce the pain and inflammation of olecranon bursitis, but these products probably should be avoided if joint aspiration reveals a hemorrhagic bursitis. Injectable corticosteroid can be beneficial in cases in which the history, physical examination, and joint aspiration do not raise a significant suspicion for infection. Various oral NSAIDs can be used, but none holds a clear distinction as the drug of choice (DOC).

Empiric antibiotic selection is based upon the suspected source of the microorganisms (skin flora with local invasion via puncture or abrasion vs hematogenous spread from a primary infection at another body site). Antibiotic selection is further modified by the results of the culture and sensitivity. Initial antibiotic selection would also be directed by the result of the Gram stain of the aspirate. Antibiotic treatment may start with a broad-spectrum antibiotic; then, when the culture results are available, the antibiotic regimen may be modified as appropriate.

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

NSAIDs can help decrease pain and inflammation. Various oral NSAIDs can be used, but none holds a clear distinction as the DOC. Choice of NSAID is largely a matter of convenience (eg, how frequently doses must be taken to achieve adequate analgesic and anti-inflammatory effects) and cost.

Ibuprofen (Motrin, Advil, Nuprin, NeoProfen)

Commonly used NSAID. Many doses are available, either with or without a prescription.

Dosing

Adult

200-800 mg PO tid/qid

Pediatric

<6 months: Not established

6 months to 12 years: 4-10 mg/kg/dose PO tid/qid

>12 years: Administer as in adults.

Interactions

May increase the retention of sodium and fluid and may raise the blood pressure in patients on ACE inhibitors and diuretics; may increase the risk of bleeding (eg, GI) among individuals who are already taking alcohol, aspirin, corticosteroids, heparin, or warfarin

Contraindications

Documented hypersensitivity; aspirin/NSAID-induced asthma; relative contraindications: use caution in elderly patients or patients with a history of GI bleed, hypertension, or CHF

Precautions

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

To minimize side-effect risk, avoid administering multiple NSAIDs concurrently; caution needed in patients who are on anticoagulants or systemic corticosteroids and in patients with a bleeding disorder or significant alcohol use

Ketoprofen (Actron, Orudis, Oruvail)

For the relief of mild to moderate pain and inflammation. Small dosages are initially indicated in small and elderly patients and in those with renal or liver disease. Doses over 75 mg do not increase therapeutic effects. Administer high doses with caution, and closely observe the patient for response.

Dosing

Adult

25-50 mg PO q6-8h prn; not to exceed 300 mg/d

Pediatric

<3 months: Not established
3 months to 12 years: 0.1-1 mg/kg PO q6-8h
>12 years: Administer as in adults.

Interactions

Coadministration with aspirin increases the risk of inducing serious NSAID-related side effects; probenecid may increase the concentrations and, possibly, the toxicity of NSAIDs; may decrease the effect of hydralazine, captopril, and β -blockers; may decrease the diuretic effects of furosemide and thiazides; monitor PT duration closely (instruct patients to watch for signs of bleeding); may increase the risk of methotrexate toxicity; phenytoin levels may be increased when administered concurrently.

Contraindications

Documented hypersensitivity; aspirin/NSAID-induced asthma; caution in elderly patients or patients with a history of GI bleed, hypertension, or CHF

Precautions

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Caution in patients with CHF, hypertension, and decreased renal and hepatic function; caution in the presence of anticoagulation abnormalities or during anticoagulant therapy

Corticosteroid Preparation for Focal Injection

In contrast to the widespread systemic distribution of an oral anti-inflammatory drug, a local corticosteroid injection can achieve focal placement of a potent anti-inflammatory agent at the site of maximal tenderness or inflammation.^1,3,9,10,13

When corticosteroid injections are used, a variety of corticosteroid preparations are available to choose from. Commonly, the corticosteroid is mixed with a local anesthetic agent before administering the injection. Again, there are various local anesthetic agents to choose from.

Methylprednisolone (Depo-Medrol, Medrol, Solu-Medrol, Kenalog)

Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing increased capillary permeability. Commonly used for injections into bursae or joints.

Dosing

Adult

10 mg (1 mL) intralesionally; often mixed with a few mL lidocaine

Pediatric

Not established

Interactions

Local corticosteroid injections are not known to have the same degree of medication interactions as those seen with oral or other systemic administration of corticosteroids.

Contraindications

Documented hypersensitivity; skin infection at the site of injection; use caution when performing injections in any patient who is on anticoagulants or who has a history of bleeding disorders, due to the risk of hemorrhage or local bruising

Precautions

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Never inject corticosteroids through an infected area of skin; diabetic patients may sometimes experience a transient elevation of blood glucose levels after a local corticosteroid injection.

Follow-up

Return to Play

The athlete with olecranon bursitis may be expected to return to play without restrictions when he/she has demonstrated resolution of symptoms and any positive physical examination findings (eg, swelling, tenderness to palpation), as well as shown adequate performance in sports-specific practice drills without recurrence of symptoms or physical examination findings.

Complications

Complications of olecranon bursitis include progressive or persistent pain with associated difficulty in using the affected upper extremity. Potential complications due to focal corticosteroid injection include bleeding, bruising, infection, and allergic reactions. Transient elevation of blood glucose levels may occur after corticosteroid injection in a diabetic patient. Intravascular injection could potentially cause cardiac arrhythmia due to the local anesthetic component. Peripheral nerve dysfunction is possible if the injection is administered near or within a major nerve.

Prevention

Avoid excessive pressure over the elbow. Avoid further trauma, if preventable. If an athlete plays contact sports, there may be no way to guarantee avoidance of further trauma to the site. Consider the use of elbow pads to cushion the region from further trauma.

Prognosis

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 the nonsurgical treatments outlined above (see 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.

Education

The patient should be educated regarding the nature of the diagnosis, causative factors, and treatment plan for olecranon bursitis. 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 instructed that they may experience a transient increase in blood glucose levels.

Patients should be informed that symptomatic improvement from the corticosteroid usually does not begin to take effect until a few days after the injection. Patients should also understand that they may experience a transient mild increase in symptoms during the window of time when the local anesthetic has worn off but when the steroids have not begun to have a therapeutic effect.

Miscellaneous

Medicolegal Pitfalls

• Never inject corticosteroids into a site or through skin that appears infected.
• In the presence of significant trauma, always check radiographs for the presence of fractures before proceeding with treatment.
• In the absence of trauma, have the aspirated fluid analyzed for infection and crystals.
• Avoid using the medial approach to the olecranon bursa because a misdirected needle could damage the ulnar nerve.
• When aspiration/injection is performed, the clinician should use aseptic techniques to minimize the chance of causing iatrogenic infection of the bursa. Septic olecranon bursitis due to Mycobacterium smegmatis has been reported after intrabursal steroid treatment.¹⁴

Special Concerns

• Pregnancy: Both aspiration of the bursa and corticosteroid injection can be performed during pregnancy. Oral NSAIDs, however, should be avoided, especially in the last trimester.
• Pediatric population: Obtain written informed consent from the patient's parent or legal guardian before proceeding with any aspiration or injection.
• Geriatric population: Be cautious with the use of NSAIDs in elderly patients.
• Patients with diabetes: Some diabetic patients may experience a transient elevation in blood glucose levels after corticosteroid injection.

Multimedia

Media file 1: Olecranon bursitis is shown in a patient with the elbow flexed. Image © 2007 by Patrick Foye, MD, UMDNJ New Jersey Medical School.

Media file 2: Olecranon bursitis is shown in a patient with the elbow extended. Image © 2007 by Patrick Foye, MD, UMDNJ New Jersey Medical School.

Media file 3: Olecranon bursitis is shown close up in a patient, with the elbow extended. Image © 2007 by Patrick Foye, MD, UMDNJ New Jersey Medical School.

Media file 4: Needle aspiration of olecranon bursitis. Image ©2007, by Patrick M. Foye, MD, UMDNJ New Jersey Medical School.

Media file 5: Olecranon bursitis aspiration of a hemorrhagic effusion. Image ©2007, by Patrick M. Foye, MD, UMDNJ New Jersey Medical School.

Media file 6: After fluid is removed from the olecranon bursa, an elastic, tubular, compressive sleeve can be used to minimize reaccumulation of the fluid. Image ©2007, by Patrick Foye, MD, UMDNJ New Jersey Medical School.

Media file 7: Gout. Radiograph of erosions with overhanging edges.

Media file 8: Arthritis, Rheumatoid. Rheumatoid nodules at the elbow. Photograph by David Effron MD, FACEP

Media file 9: Olecranon fracture.

Media file 10: Gout. Polarizing microscopy needles of urate.

References

1. McGee DJ. Elbow joints. Orthopedic Physical Assessment. 2^nd ed. Philadelphia, Pa: WB Saunders Co; 1992:143-167.

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

3. Snider RK. Olecranon bursitis. Essentials of Musculoskeletal Care. 2^nd ed. Rosemont, Ill: American Academy Orthopedic Surgeons; 1997:156-9.

4. Morgan WJ. Elbow and forearm. In: Steinberg GG, Akins C, Baran D, eds. Orthopaedics in Primary Care. 3^rd ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 1998:70-98.

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

6. Schumacher HR. Arthrocentesis, synovial fluid analysis, and synovial biopsy. In: Schumacher HR, Klippel JH, Koopman WJ, eds. Primer on the Rheumatic Diseases. 10^th ed. Richmond, Va: Arthritis Foundation; 1993:67-72.

7. 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].

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

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

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

11. Ogilvie-Harris DJ, Gilbart M. Endoscopic bursal resection: the olecranon bursa and prepatellar bursa. Arthroscopy. Apr 2000;16(3):249-53. [Medline].

12. Green SM, ed. Nonsteroidal anti-inflammatories. Tarascon Pocket Pharmacopoeia. Loma Linda, Calif: Tarascon Publishing; 2000:11-12.

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

14. 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].

15. Barham GS, Hargreaves DG. Mycobacterium kansasii olecranon bursitis. J Med Microbiol. Dec 2006;55(pt 12):1745-6. [Medline].

16. 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].

17. 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].

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

19. 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].

Keywords

olecranon bursitis, bursitis, tendinitis, elbow pain, olecranon, student's elbow, draftsman's elbow, swollen/inflamed elbow, painful elbow

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.

Scott F Nadler, DO, Assistant Director of Occupational/Musculoskeletal Medicine, Assistant Professor of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey, Director of Sports Medicine, University Hospital
Scott F Nadler, DO is a member of the following medical societies: American College of Occupational and Environmental Medicine, American College of Sports Medicine, American Medical Association, Association of Academic Physiatrists, North American Spine Society, and Physiatric Association of Spine, Sports and Occupational Rehabilitation
Disclosure: Nothing to disclose.

Medical Editor

Andrew L Sherman, MD, MS, Associate Professor of Clinical Rehabilitation Medicine, Vice Chairman, Chief of Spine and Musculoskeletal Services, Program Director, SCI Fellowship and PMR Residency Programs, Department of Rehabilitation Medicine, Leonard A Miller School of Medicine, University of Miami
Andrew L Sherman, 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 College of Sports Medicine, American Medical Association, American Paraplegia Society, American Spinal Injury Association, and Association of Academic Physiatrists
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Henry T Goitz, MD, Fellowship Director, Sports Medicine, Department of Orthopedic Surgery, Henry Ford Hospital
Henry T Goitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons and American Orthopaedic Society for Sports Medicine
Disclosure: Nothing to disclose.

CME Editor

Jon B Whitehurst, MD, Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner and Executive Board Member, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital
Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

Chief Editor

Sherwin SW Ho, MD, Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago
Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

Greg Gazzillo, 4th year medical student, New Jersey Medical School–UMDNJ, Class of 2007, assisted with the 2006 revision of this manuscript.

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

Evish Kamrava, 4th year medical student, St. George's University School of Medicine, Class of 2009, assisted with the 2008 revision of this manuscript.

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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

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