olecranon bursitis

Etiology

• traumatic
  • commonly occurs in association with contact sports
  • may occur with minimal trauma
    • placement of elbow or forearm on hard surface (arm rests)
• inflammatory bursitis
  • gout, pseudogout (CPPD)
  • rheumatoid arthritis
  • infection, especially in patients on hemodialysis
    • Staphylococcus aureus, Streptococcus

Pathology

• aseptic
• septic (40% of elderly)

Clinical manifestations

• posterior elbow warmth, redness & swelling
  • non-infectious olecranon bursitis presents as swelling without erythema or tenderness
• may present with acute swelling secondary to hemorrhage
• aseptic olecranon bursitis generally non-tender
• septic olecranon bursitis generally tender
• normal range of motion
  • ability to flex & extend the elbow precludes intra-articular involvement
• pain & swelling on elbow extension suggest synovitis

Laboratory

• synovial fluid analysis for crystals, gram stain & cell count
• synovial fluid culture as indicated

Differential diagnosis

• epicondylitis

Management

• if infection suspected (pain, erythema, warmth), complete aspiration of fluid using sterile technique (see laboratory)
  • ultrasound guidance may be indicated
  • drainage (repeated if necessary) may be needed for clearance of infection
  • antibiotics if bursa is infected
    • trimethoprim-sulfamethoxazole or doxycycline for MRSA
    • dicloxacillin (MSSA)
  • supportive care (observation) for hemorrhagic olecranon bursitis
• rest, ice & protection preferable to bursa aspiration
  • NSAIDs & rest if non-infectious
  • elbow pads to prevent future occurrences
• avoid glucocorticoid injections

More general terms

• bursitis

Additional terms

• olecranon bursa