Olecranon Bursitis

What is it?

Olecranon bursitis is the most common bursitis around the elbow.  A bursa is a soft tissue “cushion” that lies between bone and tendons, ligaments or the skin.  The olecranon is part of the ulna bone of the forearm that makes the ‘point of the elbow’.  The olecranon bursa is located over this bone to allow the skin to move easily over it.  The bursa can become swollen due to inflammation or infection.

What causes it?

Most cases are caused by inflammation. The cause of this is not always known but it may be associated with other conditions such as rheumatoid arthritis and gout. Occasionally the swelling may be caused by infection. In these cases there may be some other symptoms such as fever.

How is it treated?

The first line of treatment is oral anti-inflammatory medication. If infection is suspected a broad-spectrum antibiotic may be prescribed after a specimen has been obtained by aspiration from the bursa to send for microbiological investigation. The needle should not be passes directly into the bursa over the ‘point’ of the elbow as this may lead to a persistent tract into the bursa. It is preferable that the needle is passed obliquely into the bursa from the surrounding healthy tissue.

If these measures fail surgery may be required.

The bursa can be removed through an open cut technique or through a ‘keyhole’ endoscopic technique. The open cut technique requires a longer cut in the skin and is associated with problems with wound healing. The ‘keyhole’ technique is thought to reduce the risk of wound problems.

What can I expect if I have surgery?

The procedure is usually carried out under a general anaesthetic. In most cases it can be performed as a day case with no overnight hospital stay. You can expect to be discharged wearing a bandage and a sling for comfort with tablets for pain control. The wound will typically take ten days to heal and should be kept clean and dry for this time. Bruising around the elbow may track under the skin towards the fingers. Most people can return to driving within two weeks of surgery.

What are the risks of surgery?

The main risks of surgery are problems of wound healing and numbness around the elbow with the open cut technique. There is a risk of wound infection with any technique.
There is a risk of the bursa coming back. This risk is increased if there is a history of rheumatoid arthritis or gout.
With the ‘keyhole’ technique there is a very small risk of injury to the ulna nerve.