Olecranon Bursitis – What You Need To Know

Introduction To Olecranon Bursitis

Olecranon bursitis occurs when the bursa, a fluid-filled sac located over the olecranon process (the bony tip of the elbow), becomes inflamed. The olecranon bursa acts as a cushion, allowing the skin to move smoothly over the bony structure of the elbow. However, due to its position right beneath the skin, this bursa is highly vulnerable to inflammation from various causes, particularly trauma.

This trauma can be acute, caused by a single impact like a blow to the elbow or repetitive, stemming from activities that involve prolonged pressure or friction on the elbow, such as leaning on hard surfaces for extended periods. Another significant cause is infection; when bacteria infiltrate the bursa, it can lead to septic bursitis. Around one-third of olecranon bursitis cases are septic, meaning they involve infection. At the same time, the other two-thirds are classified as non-septic or aseptic bursitis, where inflammation occurs without infection.

Non-septic bursitis is generally more common and often less concerning medically. However, it can still lead to considerable pain and swelling. Prompt medical intervention is crucial in cases of septic bursitis, as infections can spread and become severe if not properly treated.

Anatomy of The Bursae Around The Olecranon

The olecranon is the bony prominence at the tip of the elbow, an extension of the ulna—the longer of the two bones in the forearm. Structurally, the olecranon functions as a lever arm for muscles, facilitating the powerful extension and flexion of the elbow joint, which is critical for lifting, pushing, and supporting body weight. Overlying the olecranon is the olecranon bursa, a small, fluid-filled sac that plays a crucial role in reducing friction as the skin and other soft tissues move across the bone beneath.

A bursa, by definition, is a thin, slippery sac lined with synovial tissue and filled with a minimal amount of lubricating fluid positioned between tissues to facilitate smooth, low-friction movement. Bursae are found throughout the body, especially where tendons, muscles, or skin frequently move over bones. The olecranon bursa cushions the skin from the hard, underlying bone at the elbow tip, allowing the joint to bend and extend without irritation.

When the olecranon bursa becomes irritated, often from direct trauma or prolonged pressure, it can become inflamed and filled with excess fluid. This swelling results in what is clinically recognised as olecranon bursitis, a visible and sometimes painful condition at the elbow’s point. The buildup of fluid leads to swelling, tenderness, and restricted movement as the increased friction interferes with the otherwise smooth gliding action of the bursa over the olecranon.

How Common Is Olecranon Bursitis?

Olecranon bursitis is a relatively common condition, particularly affecting the back of the elbow. It can cause pain, swelling, and discomfort, impacting daily activities like writing, lifting, or even bending the elbow. The olecranon and prepatellar bursae (located at the elbow and knee, respectively) are the most frequently affected superficial bursae due to their exposure to trauma and pressure, making them more susceptible to inflammation and infection.

The true prevalence of olecranon bursitis is likely underestimated, as many individuals with mild or chronic cases don’t seek medical care, opting to manage symptoms on their own. However, in hospital settings, cases of olecranon bursitis are estimated to account for approximately 0.01% to 0.1% of admissions. While the exact incidence rate in the general population is not fully established, this condition is most commonly observed in men between 30 and 60 years of age but can also affect children and adults across a wide age range.

What Causes Olecranon Bursitis?

Olecranon bursitis typically arises from two primary causes: non-infectious inflammation (non-septic bursitis) and infection (septic bursitis). In non-septic cases, trauma or repetitive minor injuries to the elbow cause irritation and inflammation of the bursa. These injuries can lead to bleeding within the bursa or release inflammatory mediators, prompting fluid buildup and noticeable swelling at the elbow tip. Here are some common causes:

• Acute trauma, such as a fall onto a hard surface or direct impact during sports, can quickly trigger inflammation. For individuals undergoing long-term hemodialysis, mechanical factors like resting the back of the elbow against surfaces during treatment can also contribute to irritation and inflammation in the bursa. Repetitive microtrauma from regular activities—like leaning the elbow against a hard surface when writing or typing—can also cause chronic irritation.
• Certain occupations present a heightened risk for olecranon bursitis. For example, plumbers and heat pump technicians often work in positions where they lean heavily on their elbows, leading to repeated pressure and increasing the likelihood of bursitis. Additionally, specific medications, such as sunitinib used in treating renal cell carcinoma, have been linked to olecranon bursitis as a side effect.
• Underlying inflammatory diseases, such as rheumatoid arthritis, gout, or pseudogout, can also predispose individuals to bursitis. In these cases, systemic inflammation or crystal deposition within the bursa exacerbates irritation, leading to more persistent swelling and discomfort.

What Are The Symptoms of Olecranon Bursitis?

Olecranon bursitis often presents as a noticeable swelling at the back of the elbow, ranging from painless to mildly tender. Patients frequently report that leaning on the elbow or pressing it against surfaces, like a table while writing, can worsen the discomfort. The degree of pain varies—acute cases from infection or trauma may bring sudden and pronounced pain. In contrast, more chronic cases of repeated irritation are often less tender but can still limit movement and comfort.

The hallmark sign of olecranon bursitis is the protruding appearance of the swollen elbow, making it easy to bump accidentally, given its enlarged profile. This repeated bumping can be frustrating and even painful, especially as the swelling makes the elbow more susceptible to impact.

In cases where bursitis arises from a singular trauma, symptoms typically start abruptly, with more intense swelling and discomfort. By contrast, when the cause is repetitive microtrauma or chronic irritation, the onset is gradual, with symptoms developing over time.

How Is Olecranon Bursitis Diagnosed?

The diagnosis of olecranon bursitis primarily relies on a clinical assessment, with physicians basing their conclusions on the patient’s history and a physical examination of the affected elbow. Key indicators include the presence of localised swelling, tenderness, and whether there’s any redness or warmth that could signal an infection.

If there’s any doubt about whether the bursitis is septic (infected) or non-septic (non-infected), fluid aspiration from the bursa is the diagnostic gold standard. During this procedure, a sample of the bursal fluid is drawn and analysed in a lab. Important factors examined include the colour of the fluid, cell counts, glucose concentration, presence of crystals, and any signs of bacteria under a gram stain. This analysis provides crucial information, enabling the clinician to rule out infection or other underlying causes like crystal-induced inflammation.

While blood tests are generally not helpful in diagnosing olecranon bursitis directly, they can sometimes be ordered to support findings, especially if there’s a high suspicion of infection. In cases where the diagnosis is unclear, treatment for septic bursitis may be initiated as a precaution until the culture results from the aspirated fluid are available.

The Best Way To Treat Olecranon Bursitis

Treatment for olecranon bursitis typically involves a combination of lifestyle adjustments, anti-inflammatory medications, physical therapy, and, in more severe cases, minimally invasive procedures.

For chronic, non-infectious olecranon bursitis, the first line of treatment is activity modification—reducing or avoiding movements that place pressure on the elbow, such as leaning or frequent use during repetitive tasks. Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, naproxen, or celecoxib are often prescribed for a few weeks to manage pain and reduce inflammation. However, these don’t resolve the underlying issue. Ice application, 2-3 times daily for 20-30 minutes, helps control swelling effectively. However, it’s essential to avoid heat, as it can worsen inflammation.

In persistent cases, a corticosteroid injection into the bursa may be considered to reduce swelling. However, these injections carry potential side effects, including infection risk, skin atrophy, and chronic pain. They are generally reserved for cases unresponsive to other treatments. If infection is suspected, corticosteroid injections should be avoided.

For septic (infected) olecranon bursitis, prompt medical intervention is crucial. Aspiration of the bursa by drawing out the fluid with a needle can help relieve pressure and allow the fluid to be tested to identify the infection’s cause. Antibiotics are then prescribed based on lab findings to treat the infection and prevent bacteria from spreading to the bloodstream. 

In cases resulting from acute trauma, aspiration may also be needed to drain excess fluid or blood from the bursa, and a regimen of ice and NSAIDs will aid in reducing inflammation. Physical therapy may benefit patients who experience muscle tightness or impaired movement, helping to restore normal range and function.

Newer adjunct therapies have shown promise in managing chronic bursitis. High Power Laser (HPL) Therapy, for instance, uses focused light energy to penetrate deeply into tissues, increasing blood flow, accelerating inflammatory waste removal, and enhancing cellular energy production (ATP). This promotes tissue repair, with some studies on similar conditions indicating up to a 40-60% improvement in pain and function after consistent sessions over several weeks.

Extracorporeal Shockwave Therapy (ESWT) is another emerging option. Originally used to treat chronic tendinopathies, ESWT involves applying acoustic waves to stimulate tissue repair, reduce inflammation, and improve blood flow. Studies on chronic musculoskeletal conditions suggest a 60-80% success rate in reducing pain and improving function, with patients who haven’t responded to standard care often experiencing significant improvement after several treatments.

These newer, non-invasive therapies offer additional options for cases where traditional measures alone may not be fully effective, enhancing outcomes for patients with challenging or recurrent olecranon bursitis.

Conclusion

In summary, olecranon bursitis is an inflammatory condition impacting the bursa at the elbow’s tip, which functions as a cushion, allowing smooth movement between skin and bone. Due to its exposed location, the olecranon bursa is particularly vulnerable to trauma—whether from direct injury or repetitive, prolonged pressure on the elbow. This irritation can lead to fluid buildup within the bursa, resulting in visible swelling, discomfort, and restricted movement.

Olecranon bursitis cases may be non-septic, with no infection, or septic, where bacterial infection infiltrates the bursa and warrants immediate intervention. Diagnosis typically relies on clinical examination, while aspiration and lab analysis of bursal fluid confirm whether 

infection is present. Treatment approaches vary based on the severity and cause, with non-septic bursitis often managed conservatively through NSAIDs, activity modification, and ice application. For septic cases, antibiotics are essential, often combined with aspiration to clear the infected fluid. Emerging therapies, including High Power Laser and Extracorporeal Shockwave Therapy, show potential for chronic cases, offering additional relief and function improvement. Patients with olecranon bursitis can recover significantly and regain comfort and mobility through tailored treatments.

Proactively addressing olecranon bursitis improves comfort and enhances

overall mobility and quality of life. If you have any questions regarding olecranon bursitis or are experiencing elbow pain, don’t hesitate to contact Severn Clinics at 04 385 6446. Our dedicated team is here to assist you in navigating your path to recovery and restoring your well-being.