Presentation
History
Patient history may include the following findings:
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Focal swelling at the posterior elbow, usually noticed by the patient
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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
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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
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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)
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Episodes of acute swelling are likely due to trauma or infectious/inflammatory etiologies, while episodes of gradual onset are likely secondary to chronic irritation
Next:
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. 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:
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Vital signs may reveal fever, but generally only with cases of advanced/systemic infection
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The area around the olecranon may be warm and erythematous, particularly with infectious etiologies
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Skin inspection may reveal abrasion or contusion if trauma recently occurred
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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
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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
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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
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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
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Sensation should not be impaired, distal pulses should be intact, and other joints should not be affected
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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
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Rheumatoid arthritis. Rheumatoid nodules at the elbow. Photograph by David Effron MD, FACEP
Previous
Media Gallery
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Olecranon bursitis, shown here with the elbow flexed. Image courtesy of UMDNJ-New Jersey Medical School, www.DoctorFoye.com, and www.TailboneDoctor.com.
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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.
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Olecranon bursitis seen with the elbow extended. Image courtesy of UMDNJ-New Jersey Medical School, www.DoctorFoye.com, and www.TailboneDoctor.com.
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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 has demonstrated the outline of the involved bursa. Image ©2005, by Patrick M. Foye, MD, UMDNJ: New Jersey Medical School.
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Needle aspiration in olecranon bursitis. Image courtesy of UMDNJ-New Jersey Medical School, www.DoctorFoye.com, and www.TailboneDoctor.com.
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Aspiration of a hemorrhagic effusion in a patient with olecranon bursitis. Image courtesy of UMDNJ-New Jersey Medical School, www.DoctorFoye.com, and www.TailboneDoctor.com.
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After fluid is removed from the olecranon bursa, an elastic, tubular compressive sleeve can be used to minimize reaccumulation of the fluid. Image courtesy of UMDNJ-New Jersey Medical School, www.DoctorFoye.com, and www.TailboneDoctor.com.
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Gout. Radiograph of erosions with overhanging edges.
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Gout. Polarizing microscopy revealing needles of urate.
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Rheumatoid arthritis. Rheumatoid nodules at the elbow. Photograph by David Effron MD, FACEP
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Olecranon fracture.
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