very informative

1. OLECRANON BURSITIS
Dr VVR Choudhary
Mpt (ortho)-svims

2. Introduction
• Olecranon bursitis is an inflammation of the
bursa overlying the olecranon process
between the bone and skin.
Other synonyms for olecranon bursitis are
student’s elbow, miner’s elbow and
draftsman’s elbow.

3. Aetiology
• The common causes of olecranon bursitis are
1. Post-traumatic – acute haemorrhagic bursitis
due to direct trauma.
2. Chronic – repetitive rubbing on hard surfaces.
3. Inflammatory – gout, pseudo-gout, uraemia,
rheumatoid arthritis, pigmented villonodular
synovitis.
4. Infection – pyogenic, tuberculosis.

5. Basic science and history
• Olecranon bursitis is relatively common in adults
but less so in children.
• Normally, the bursa prevents soft-tissue
tears by providing a mechanism for skin to glide
freely over the olecranon process.
• Direct trauma to the area in sports or from injury
leads to acute swelling as the bursa fills up with
blood and effusion .
• There may be associated fractures of the
olecranon spurs.
•

6. • It is important to rule out underlying fractures
and ligament injuries in the differential diagnosis.
• Chronic aseptic bursal swelling is the most
common form of olecranon bursitis.
• It occurs most commonly from repetitive rubbing
of the olecranon on hard surfaces and is often
asymptomatic.
• Inflamed and infected olecranon bursitis is the
most difficult to treat.
• It is often difficult to differentiate septic from
aseptic inflammatory arthritis and often needs
microbiological confirmation

7. EXAMINATION
• Acute post-traumatic bursitis may present as a
tender, fluctuant, fluid-filled swelling with
aspiration yielding haemorrhagic fluid.
• Patients with chronic, aseptic bursitis present
with painless swelling overlying the olecranon
process and often give a history of repetitive
rubbing of the elbows on hard surfaces.

8. • Patients with systemic conditions like
rheumatoid arthritis, gout, uraemia and other
medical conditions may present with painful
swelling of the olecranon bursa(e).
• Septic olecranon bursitis may be primary
(haematogenous spread) or secondary to local
cortisone injections.
• Patients may have local signs of inflammation
with or without discharging sinus, with some
patients presenting with systemic signs of
infection

9. DIFFERENTIAL DIAGNOSIS
• The differential diagnosis of acute bursitis
includes :
underlying fractures and
ligamentous injuries.
Rarely, a synovial
cyst may mimic bursitis of the elbow

10. IMAGING
• Radiographs are mandatory for post-traumatic
onset bursitis to rule out fracture.
• Ultrasound studies may reveal an underlying
abscess or fluid collection.
• MRI may reveal underlying abscess or
osteomyelitis not apparent in the radiographs.

11. Treatment
• Acute post-traumatic bursitis can be treated
conservatively initially with rest, ice, a compression
dressing, elevation and non-steroidal anti-inflammatory
drugs (NSAIDs) to decrease swelling and pain.
• Excessive swelling may need to be aspirated,
• However, in patients not responding to conservative
treatment for a long time, surgical bursectomy may be
indicated.
• Septic bursitis should be treated with aspiration,
intravenous or oral antibiotics, rest, ice, compression,
elevation and occasional splinting.
• Incision and drainage may be needed if aspiration alone
fails to control symptoms

12. • Patients with chronic, aseptic bursitis of
idiopathic aetiology or from repeated rubbing
of the elbow can be given protective pads for
elbows, ice, instructions regarding avoiding
repetitive trauma, NSAIDs and reassurance.
Aspiration and corticosteroid injection have
been shown to result in more rapid
recovery at 6 months than only NSAID
treatment.

13. • .