- What it is
- Swelling of the bursa at the point of the elbow
- Causes
- Pressure, single blow, infection, gout, RA
- First-line
- Activity modification, padding, NSAIDs
- Surgical
- Bursectomy (rare; for chronic or infected cases)
What olecranon bursitis is.
The olecranon bursa is a small sac of fluid that sits between the skin and the bony point of the elbow (the olecranon). Its normal job is to allow the skin to glide smoothly over the bone. When the bursa becomes inflamed, fluid accumulates and a visible, often soft and fluctuant, swelling appears at the back of the elbow.
Causes.
- Pressure-related — sustained leaning on the elbow over months or years (the original "student's elbow" or "truck driver's elbow"). The most common cause.
- Traumatic — a single direct blow or fall onto the point of the elbow.
- Infective (septic bursitis) — bacterial infection of the bursa, often via a small break in the overlying skin. Warmth, redness, fever and severe pain suggest infection.
- Inflammatory — gout, calcium pyrophosphate disease, or rheumatoid arthritis can cause bursitis.
The most important question: is it infected?
Most olecranon bursitis is non-infective and settles with conservative treatment. Septic bursitis is the diagnostic challenge: clinical examination is not always reliable, and bursal aspiration with fluid sent for microscopy and culture is the definitive test if infection is suspected. Septic bursitis requires antibiotics, often hospital admission, and occasionally surgical washout. Non-infective bursitis is managed without antibiotics.
Treatment.
Non-infective bursitis
- Activity modification — avoiding the provoking pressure.
- Padding the elbow when pressure is unavoidable.
- Short course of NSAIDs if appropriate.
- Aspiration — controversial; can give symptomatic relief but the fluid commonly re-accumulates.
Chronic recurrent bursitis
When the bursa is repeatedly symptomatic despite conservative measures, surgical bursectomy (removal of the bursa) is an option. The procedure is small (day surgery) but the recovery requires careful skin care to avoid wound problems.
Septic bursitis
Suspected septic bursitis is treated as an urgent matter — aspiration for culture, empirical antibiotics, and (if not settling) surgical washout. Septic bursitis should not be aspirated or injected in the rooms by the surgeon without a coordinated antibiotic and follow-up plan.
Frequently asked questions.
Will it go away on its own?
Most non-infective olecranon bursitis settles with activity modification and padding over weeks. Chronic recurrent bursitis is less likely to resolve and may need surgical bursectomy.
Should I have it drained?
Aspiration is controversial in non-infective bursitis — the fluid commonly re-accumulates. It is essential if infection is suspected, for diagnostic culture.
How do I know if it's infected?
Warmth, redness, fever, severe pain, and a skin break overlying the bursa are the warning signs. If any of these are present, see a doctor urgently.
Will surgery cure it?
Bursectomy is effective in chronic recurrent non-infective bursitis. The main risk is wound healing problems, particularly in patients who continue to lean on the elbow during recovery.
What if it's gout?
Gout can cause olecranon bursitis. Aspiration and crystal analysis confirms the diagnosis. Treatment is directed at the underlying gout.
References.
- Sayegh ET, Strauch RJ. Treatment of olecranon bursitis: a systematic review. Arch Orthop Trauma Surg. 2014;134(11):1517–1536.
- Reilly D, Kamineni S. Olecranon bursitis. J Shoulder Elbow Surg. 2016;25(1):158–167.