Olecranon Bursitis

What is Olecranon Bursitis?

Olecranon bursitis is an accumulation of fluid over the tip of the elbow. The fluid fills up the olecranon bursa. Bursa are small fluid filled sacs found throughout the body in areas that are exposed to friction such as the shoulder and knee cap. Bursitis is a condition in which one of these sacs becomes inflamed or filled with fluid.

How is it caused?

Olecranon bursitis is often “idiopathic” meaning there is no clear cause other than bad luck. It also may be caused by repetitive irritation such as leaning on the elbow. Often patients with olecranon bursitis will have bone spurs in this area. These small pieces of bone can lead to bursitis by causing irritation much like a pebble in your shoe. Other less common causes of bursitis are infection, gout, and rheumatologic disorders.

What is the non-operative treatment?

Most patients with olecranon bursitis will get better without surgery. Our approach is to first try a compressive dressing such as an ACE wrap to decrease fluid accumulation. The pressure of the ACE wrap will gradually push the fluid out of the elbow over a period of weeks. An elbow pad may also be used if the area is getting irritated from leaning on the elbow.

If this is unsuccessful, aspiration (removal of fluid by needle) may be tried.

If symptoms continue after three months of treatment surgical intervention to remove the inflamed bursa is considered.

What is the surgery?

For patients that do not improve with the approach described above surgical treatment may be helpful. At the time of surgery, an Olecranon Bursa Resection is performed meaning the fluid filled sac is removed as well as any bone spurs. This operation may be done with a standard incision which is approximately four inches long or arthroscopically using two small incisions.

What are the risks of surgery?

The most common complications of Olecranon Bursa Resection are:

  1. The problem comes back again in the future. This is particularly an issue in patients with inflammatory conditions such as rheumatoid arthritis, where recurrence is as high as 60%.
  2. Wound healing problems and infection.

What is septic olecranon bursitis?

This is when the fluid accumulation is caused by an infection. When this happens the elbow is usually red and very painful. The area may also be hot to the touch. Patients with a septic olecranon burisitis may have fevers and feel ill.

This should be treated with antibiotics and then surgical excision if symptoms do not improve. Sometimes your doctor will draw fluid out of the area to check if it is infected.

References:

  • Herrera FA, Meals RA. Chronic Olecranon Bursitis. Journal of Hand Surgery 2011. Vol 36A. 708-709
  • Stewart NJ, Manzanares JB, Morrey BF. Surgical treatment of aseptic olecranon bursitis. Journal of Shoulder Elbow Surgery 1997; 6:49-54