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Olecranon Bursitis

What Is It, Causes, and More

Author: Anna Hernández, MD

Editors: Alyssa Haag, Emily Miao, PharmD

Illustrator: Abbey Richard

Copyeditor: David G. Walker


What is olecranon bursitis?

Olecranon bursitis, also known as elbow bursitis, refers to the inflammation of the bursa overlying the olecranon process, which is the bony tip of the elbow. Healthy bursae are small, fluid-filled sacs lined with a thin synovial membrane that secretes a lubricating synovial fluid. This fluid provides a smooth, frictionless surface that prevents soft tissues, such as tendons, ligaments, or skin, from rubbing on nearby bone. Normally, the olecranon bursa is flat and contains a small amount of synovial fluid; however, if it becomes irritated or inflamed, more fluid can accumulate, resulting in bursitis.

What causes olecranon bursitis?

Most cases of olecranon bursitis occur as a result of mild but repeated trauma to the bony tip of the elbow. Such trauma is more common in people who engage in occupational and recreational activities that involve putting a lot of pressure on the elbows, which may include individuals who spend a lot of time leaning over their elbows (e.g., students, carpenters, plumbers) and athletes who frequently land with their elbows onto hard surfaces (e.g., wrestlers, volleyball players). In other cases, inflammation may develop as a result of a systemic inflammatory condition, such as rheumatoid arthritis or gout. Finally, it is also possible that the inflammation is due to an infection of the bursa, which is called septic olecranon bursitis. Infection of the olecranon bursa typically occurs when microorganisms gain entry to the bursa through a cut, scrape, puncture, bug bite, or other trauma to the skin but may also occur due to spreading of a nearby infection.

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What are the signs and symptoms of olecranon bursitis?

Olecranon bursitis typically causes swelling of the elbow. Most often, the swollen bursa protrudes significantly, giving the appearance of a “popeye elbow.” As the swelling continues, the bursa may begin to stretch, which causes pain. The pain often worsens with direct pressure on the back of the elbow or when bending the elbow. If the swelling grows large enough, there may even be decreased range of motion due to restricted elbow movement. In cases of septic olecranon bursitis, these aforementioned symptoms may be accompanied by signs of infection, such as fever and skin that is red and warm to the touch.

How do you diagnose olecranon bursitis?

Diagnosis of olecranon bursitis is generally based on the clinical findings of the physical examination. However, additional laboratory tests, often including a bursal aspiration, may be needed to differentiate septic from non-septic olecranon bursitis. A bursal aspiration is a procedure that involves removing a small amount of fluid from the bursa with a needle. Subsequent analysis of the bursal fluid can assist in ruling out a bursal infection, as well as other medical conditions, such as gout. In addition, removal of a small amount of bursal fluid, which occurs during a bursal aspiration, can help relieve the pressure and pain caused by the swollen bursa.

How do you treat olecranon bursitis?

Most cases of olecranon bursitis are noninfectious and can be treated with conservative measures. These include protecting the olecranon bursa with an elbow pad, avoiding activities that can lead to inflammation or irritation of the bursa, applying ice to the affected area, and taking anti-inflammatories (e.g., NSAIDs) to relieve the pain. Additionally, holding the elbow in full extension can help alleviate the pain. In the unlikely case that bursitis persists despite these measures, a bursal aspiration or surgery to remove the bursa may be performed (i.e., bursectomy). This surgery is generally performed as an outpatient procedure and does not disturb any muscle, ligament, or joint structure.

On the other hand, septic olecranon bursitis is a medical emergency that requires prompt antibiotic treatment along with drainage of the infected bursal fluid. If these treatments do not work, urgent surgery may be needed to remove the entire bursa and prevent the infection from spreading to nearby tissues.

Will olecranon bursitis go away?

Most cases of noninfectious olecranon bursitis are mild and go away spontaneously or with conservative treatment measures. However, septic olecranon bursitis is a serious and potentially life-threatening condition that can lead to severe complications, including sepsis or septic shock, and always requires medical treatment to resolve.

What are the most important facts to know about olecranon bursitis?

Olecranon bursitis refers to the inflammation of the olecranon bursa, a fluid-filled sac located on the bony tip of the elbow. The majority of cases of olecranon bursitis occur when the bursa becomes irritated or inflamed as a result of repeated trauma to the elbow; however, inflammation may also occur due to other medical conditions or infection of the bursa. Diagnosis is based upon clinical findings, which typically includes pain and swelling on the back of the elbow. Treatment of noninfectious olecranon bursitis consists of conservative measures, including elbow protection, rest, ice, and compression; while septic olecranon bursitis is a medical emergency that requires broad-spectrum antibiotics as well as drainage of the infected bursal fluid as treatment. In severe cases of septic bursitis, removal of the entire bursa may be necessary to resolve the infection completely.

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Related links

Bursitis
Anatomy of the elbow joint
Anatomy clinical correlates: Arm, elbow, and forearm
Rheumatoid arthritis
Gout

Resources for research and reference

Baumbach, S. F., Lobo, C. M., Badyine, I., Mutschler, W., & Kanz, K.G. (2013). Prepatellar and olecranon bursitis: Literature review and development of a treatment algorithm. Archives of Orthopaedic and Trauma Surgery, 134(3), 359–370. DOI:10.1007/s00402-013-1882-7 

Todd, D. (2020). Bursitis: An overview of clinical manifestations, diagnosis, and management. In UpToDate. Retrieved August 6, 2021, from https://www.uptodate.com/contents/bursitis-an-overview-of-clinical-manifestations-diagnosis-and-management

Williams, C.H., Jamal, Z., & Sternard, B.T. Bursitis. In StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK513340/