The olecranon is the large bony prominence located at the tip of the ulna (long bone of the forearm) and forms the pointy bone of your elbow.  Lying just in front of the olecranon is a small fluid-filled sac called the olecranon bursa.

There are over 150 bursae located throughout the body.

They are designed to:

  • Reduce friction. Bursa reduce the friction created during movement. These small fluid-filled sacs are often located between tendons or between tendon and bone allowing repetitive fluid movement without abrasion. For example, the pes anserine bursa of the knee
  • Protect areas at risk of direct impact. Bursa are formed to protect bony prominences, reducing the chance of injury from direct impact. For example, the olecranon bursa of the elbow discussed within this article.

Bursa are able to fulfil their job role very well. However, if the bursa is subjected to repetitive movements over prolonged periods, or if movement patterns are poorly controlled, or they are subjected to direct impact they can become inflamed and painful. An inflamed bursa is termed bursitis and is a common site of musculoskeletal pain.

The olecranon bursa is designed to protect the olecranon bone from direct impact and to allow fluid free movement of the olecranon underneath the skin of the elbow.

Olecranon bursitis is most commonly observed in males age between 30 and 60 years old (Del Buono et al 2012) and regularly occurs due to:

  • Direct pressure on the elbow. This condition is often called students elbow and is associated with prolonged periods of weight-bearing through the elbow when working at a desk.
  • Sudden direct impact to the tip of the elbow.
  • Due to its superficial location the bursa is a susceptible to becoming infected causing a septic olecranon bursitis (Riley et al., 2016).
  • Rheumatological conditions such as gout or rheumatoid arthritis can cause the olecranon bursa to become inflamed (Sayegh et al., 2014).

How is olecranon bursitis diagnosed?

Olecranon bursitis can either be aseptic (without infection) or septic (infected) and therefore an accurate diagnosis is crucial if it is to be treated safely and effectively.  A diagnosis of olecranon bursitis can be made by your GP, an orthopaedic consult or by a physiotherapist. An accurate assessment is essential to ensure the correct treatment plan is selected as septic bursitis requires urgent medical assistance.

What are the symptoms of olecranon bursitis?

  • Pain with direct pressure either during weight-bearing or when touching the area.
  • Swelling at the posterior aspect (back) of the elbow. In some cases, the olecranon bursa can become significantly swollen resulting in a large fluid-filled bulge. As shown in above image.

If the olecranon bursa is septic the following symptoms may be present:

  • The skin over the olecranon may become red.
  • Increased temperature. Between 63 and 100% of all patients with olecranon bursitis have a red and hot elbow (Del Buono et al 2012).
  • In some cases, you may feel unwell. Look in on bursitis and a fever may be the sign of an infected bursa.

(If you experience all three of these symptoms it is strongly advised that you make an appointment with your GP).

Assessment involves a series of questions. Direct questioning is essential to help formulate a diagnosis.  Assessment includes a full medical history (assessing for possible rheumatological causes for your pain or infection), how your pain started (due to direct trauma or gradual onset after scratching your elbow) and what factors aggravate and ease your symptoms.

A physical examination is also required and involves close inspection of the skin overlying the olecranon. Your clinician may palpate (feel) your elbow which may be painful. Elbow strength and movement are also routinely tested.

Although the most common cause of olecranon bursitis is aseptic secondary to direct pressure or trauma your clinician may request further investigations.

Further investigations may include:

  • Blood tests may be requested to rule out suspected infection or a systemic inflammatory conditions such as rheumatoid arthritis [cornerstone article] or gout.
  • Bursal aspiration [cornerstone article]. If a septic olecranon bursitis is suspected a small amount of bursal fluid is removed using a needle and sent to pathology lab for investigation.
  • Diagnostic musculoskeletal ultrasound imaging is an evidence-based imaging modality which is been proven to be effective at assessing bursal pathology. Research has revealed diagnostic ultrasound as a highly effective imaging tool for diagnosing inflammatory arthritic conditions such as gout (Fernandez et al. 2017 and Villaverde et al. 2014) and is therefore an appropriate imaging technique used to differentially diagnose the cause of olecranon bursitis.

At Complete we have a team of experts who are dual trained as physiotherapists and musculoskeletal sonographers. During your initial assessment your clinician will be able to clinically assess your elbow and perform a diagnostic musculoskeletal ultrasound [cornerstone article] scan therefore, providing you with an accurate diagnosis of your pain.

If you would like more information or would like to book an appointment please contact us on 0207 4823875 or email injections@complete-physio.co.uk.

How do we treat olecranon bursitis?

Treatment for olecranon bursitis is reliant on an accurate diagnosis and is dependent on whether the bursa is aseptic or septic.

Aseptic olecranon bursitis

The vast majority of patients with aseptic bursitis (the most common cause of symptoms) respond very well managed to conservative management, which includes:

  • Avoidance of aggravating postures including weight-bearing over the elbow.
  • The use of local padding to reduce direct pressure over the olecranon.
  • A short course of nonsteroidal anti-inflammatory medication such as ibuprofen or naproxen (Kennedy et al., 2016).

What if symptoms do not resolve with conservative treatment for a septic olecranon bursitis?

If you have tried conservative management but your symptoms remain persistent for over 3 months and are affecting your ability to complete the following tasks then an ultrasound-guided bursal aspiration and corticosteroid injection [cornerstone article] may be appropriate for you.

  • Sleep at night
  • Complete activities of daily living
  • Work or return to sporting activities

During this procedure an ultrasound scan is used to create real time imagery of your olecranon bursa. This allows accurate needle placement within the bursa. Excess bursal fluid is then aspirated (withdrawn) from the bursa. Research has shown 70.9% of all aseptic olecranon bursitis cases require bursal aspiration (Sayegh et al., 2014).  If required a combination of local anaesthetic (numbing agent) and a small dose of corticosteroid (a strong anti-inflammatory medication routinely used in musculoskeletal medicine) can also be injected at this point. Ultrasound-guided corticosteroid injections are routinely used, within musculoskeletal medicine, for the treatment of bursitis, and is an effective way reducing pain and inflammation associated with this condition (Del Buono et al 2012).  Due to the superficial location of this bursa there is a small risk of post injection complications such as infection and local skin discolouration. However, this is significantly reduced using ultrasound guidance [cornerstone article] due to the increased accuracy of needle placement.

Complete are able to perform a same day service on all ultrasound injections. Our team of highly specialised physiotherapists are fully qualified musculoskeletal sonographers and able to prescribe the most appropriate medication for you before performing an ultrasound-guided injection all within the same appointment. You do not need to be referred or have a prescription from your GP prior to accessing our same day service.

If you would like more information or would like to book an appointment please contact us on 0207 4823875 or email injections@complete-physio.co.uk.

Septic olecranon bursitis

Septic olecranon bursitis is routinely treated using a course of antibiotics and aspiration of the infected fluid within the bursa. Research has shown 82% of all septic bursae require aspiration (Sayegh et al., 2014).  Septic olecranon bursitis requires medical management via your GP or orthopaedic consultant, with the vast majority of septic cases being well resolved with antibiotics and aspiration.  In the rare occasions where this fails to resolve symptoms, surgical management may be required.

Other elbow conditions:

References

Del Buono, A., Franceschi, F., Palumbo, A., Denaro, V. and Maffulli, N., 2012. Diagnosis and management of olecranon bursitis. the surgeon10(5), pp.297-300.

KENNEDY, S.A. and KENNEDY, S.A., 2016. CORR Insights®: A Randomized Trial Among Compression Plus Nonsteroidal Antiinflammatory Drugs, Aspiration, and Aspiration With Steroid Injection for Nonseptic Olecranon Bursitis. Clinical orthopaedics and related research, 474(3), pp. 784-786.

FERNANDES, E.D.A., BERGAMASCHI, S.B., RODRIGUES, T.C., DIAS, G.C., MALMANN, R., RAMOS, G.M. and MONTEIRO, S.S., 2017. Relevant aspects of imaging in the diagnosis and management of gout. Revista Brasileira de Reumatologia, 57(1), pp. 64-72.

REILLY, D., MD and KAMINENI, SRINATH, MBBCH,BSC, FRCS(ORTH), 2016. Olecranon bursitis. Journal of Shoulder and Elbow Surgery, 25(1), pp. 158-167.

SAYEGH, E.T. and STRAUCH, R.J., 2014. Treatment of olecranon bursitis: a systematic review. Archives of orthopaedic and trauma surgery, 134(11), pp. 1517-1536.

VILLAVERDE, V., ROSARIO, M.P., LOZA, E. and PÉREZ, F., 2014. Systematic Review of the Value of Ultrasound and Magnetic Resonance Musculoskeletal Imaging in the Evaluation of Response to Treatment of Gout. Reumatología clínica (English Edition), 10(3), pp. 160-163.