Olecranon Bursitis Clinical Presentation

Updated: Sep 23, 2021
  • Author: J Michael Wieting, DO, MEd, FAOCPMR, FAAOE; Chief Editor: Stephen Kishner, MD, MHA  more...
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Presentation

History

Patient history may include the following findings:

  • Focal swelling at the posterior elbow, usually noticed by the patient
  • If the condition is painful, it often is exacerbated by pressure, such as when the patient leans on the elbow, or can be associated with prolonged elbow flexion over 90°; the patient may report pain at the affected site, although sometimes the swelling is painless, especially in cases of noninflammatory, aseptic bursitis
  • If the condition is painful, there will likely be an associated range-of-motion (ROM) loss in the elbow, especially in the presence of acute trauma or infection
  • 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)
  • Episodes of acute swelling are likely due to trauma or infectious/inflammatory etiologies, while episodes of gradual onset are likely secondary to chronic irritation
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Physical Examination

Classically, olecranon bursitis presents with a well-demarcated, fluctuant posterior elbow swelling that appears as a “goose egg” over the olecranon process (see the image below).

Olecranon bursitis seen with the elbow extended. F Olecranon bursitis seen with the elbow extended. Focal swelling at the olecranon is more visible with the elbow extended than in the flexed position. Image courtesy of UMDNJ-New Jersey Medical School, www.DoctorFoye.com, and www.TailboneDoctor.com.

Other findings in olecranon bursitis include the following:

  • Vital signs may reveal fever, but generally only with cases of advanced/systemic infection
  • The area around the olecranon may be warm and erythematous, particularly with infectious etiologies
  • Skin inspection may reveal abrasion or contusion if trauma recently occurred
  • Upon inspection of the elbow, rheumatoid nodules may be found in patients with rheumatoid arthritis (see the image below); firm “bumps” or “lumps” due to residual scar tissue may be felt as swelling recedes, especially with even mild trauma to the elbow; these nodules may persist or resolve spontaneously
  • In patients with systemic inflammatory processes (eg, rheumatoid arthritis) or a crystal deposition disease (eg, gout, pseudogout), evidence of focal inflammation at other sites or inflammation extending distally in the forearm (if associated cellulitis is present) may be revealed
  • The affected site may be tender to palpation; however, pain is variable. Severe pain is often due to a traumatic or infectious cause; in painful cases of olecranon bursitis, pressure on the tip of the elbow may interfere with sleep
  • Elbow ROM usually is normal, but occasionally the end range of elbow flexion is slightly limited because of pain or, in chronic cases, due to bursal thickening; this decreased ROM may interfere with performance of basic activities of daily living, such as dressing, bathing, and grooming
  • Sensation should not be impaired, distal pulses should be intact, and other joints should not be affected
  • The inflamed bursa should be measured and demarcated on subsequent encounters in order to assess progress/resolution, or lack thereof, based upon the treatment modality selected
  • Rheumatoid arthritis. Rheumatoid nodules at the el Rheumatoid arthritis. Rheumatoid nodules at the elbow. Photograph by David Effron MD, FACEP
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