Olecranon Bursitis Clinical Presentation

Updated: Oct 04, 2018
  • Author: J Michael Wieting, DO, MEd, FAOCPMR, FAAPMR; 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 is usually noticed by the patient

  • The patient may report pain at the affected site, although sometimes the swelling is painless, especially in noninflammatory, aseptic bursitis

  • 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 or with associated prolonged elbow flexion over 90°

  • Chronic, recurrent swelling usually is not tender; swelling may have gradual (mostly due to a chronic cause) or acute/sudden (due to trauma or infection/inflammation) onset

  • Frequent bumping of the swollen elbow may occur because the elbow protrudes further 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)

  • The onset may be sudden if the condition is secondary to infection or acute trauma

  • The onset may be gradual if olecranon bursitis is secondary to chronic irritation

Next:

Physical Examination

The most classic finding in olecranon bursitis is posterior elbow swelling that is often fluctuant and that is very clearly demarcated, appearing as a goose egg over the olecranon process (see the image below).

Olecranon bursitis seen with the elbow extended; t 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.

Other findings in olecranon bursitis include the following:

  • The affected site may be tender to palpation; pain is variable; severe pain is often due to a traumatic or infectious cause; pain with pressure on the tip of the elbow may interfere with sleep

  • 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 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

  • Patients with systemic inflammatory processes (eg, rheumatoid arthritis) or a crystal deposition disease (eg, gout, pseudogout) may reveal evidence of focal inflammation at other sites or extending distally in the forearm if there is an associated cellulitis

  • 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 when the elbow is bumped

  • Sensation should not be impaired, distal pulses should be intact, and other joints should not be affected

    Rheumatoid arthritis. Rheumatoid nodules at the el Rheumatoid arthritis. Rheumatoid nodules at the elbow. Photograph by David Effron MD, FACEP
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