Olecranon bursitis, also called elbow bursitis, is a collection of fluid in the sac behind the elbow. This condition can appear out of nowhere or triggered by an injury such as a fall onto the tip of the elbow. So, how do we manage olecranon bursitis, and is an injection a good option?

Anatomy of elbow bursitis 

olecranon bursitis

A bursa is a thin sac of fluid that allows free movement of the skin over bony prominences, such as the tip of the elbow. In bursitis, the sac walls become inflamed, producing more fluid and a painful bubble at the tip of the elbow. Overall, elbow bursitis is the most common type of bursitis.

Cause of Olecranon bursitis 

Elbow bursitis can form after an injury, such as a fall onto the tip of the elbow. However, in some cases, bursitis can appear out of nowhere. Also, we think people who rest their elbows on hard surfaces for long periods, such as office workers are also at risk. Rarely, bugs can seep through a cut in the skin and cause infected bursitis (also known as septic arthritis). In addition, conditions such as gout or rheumatoid arthritis can increase the risk of infection.

Diagnosis of Olecranon bursitis

Generally, elbow bursitis presents with swelling or a bubble of fluid at the tip of the elbow. People might feel pain if the swelling increases in size or becomes infected. In general, elbow movement is normal unless the bursitis is infected. Other signs of septic arthritis are fevers, chills, redness of the skin, and breaks in the skin over the bursa. If you think you have an infected bursa, you should seek medical attention immediately.

In most cases, your doctor can diagnose olecranon bursitis on clinical examination. However, not all pain and swelling of the elbow is due to bursitis, and other conditions need to be considered.

Overall, if there is any doubt, an ultrasound or MRI will confirm the diagnosis. Generally, ultrasound is cheaper and done simultaneously as a consultation. Sometimes, other tests such as a blood test or testing the sample of fluid may be needed if an infection is suspected.

Treatment of Olecranon bursitis

Overall, most cases can be managed with simple treatments. Rarely do we need to intervene with injections or surgery.

simple treatments

As most cases are caused by pressure on the bursa, it is essential to understand that resting the elbow and preventing pressure on the back of the elbow is critical for success.

Generally, for acute elbow bursitis, we recommend ice (10 mins every 4-6 hours), compression, and NSAIDs (such as ibuprofen). You should not apply ice directly onto the skin; use a towel between the ice and the skin. Wearing an elbow pad will also help.

For suspected infected bursitis, we should treat the infection as well. Generally, high-dose antibiotic tablets will kill the infection. We use antibiotics for about 2-4 weeks. Occasionally, however, people might need to go to a hospital to have antibiotics with a drip.

Invasive treatments 

aspiration of olecranon bursitis

In general, we advise against invasive treatments due to possible risks.

Evidence suggests that removing the fluid) and/or a cortisone injection provides little benefit. Inserting a needle into the bursa can introduce bugs, leading to infected bursitis. Rarely, in cases of a large bursa unresponsive to simple treatments, we might need to drain the fluid. However, we should only perform the drainage in a sterile environment and under ultrasound. You should find a doctor who has experience in ultrasound injections.

Removing the bursa by surgery should is only a last resort. So often, surgery is sold as a ‘quick fix.’ However, like other invasive treatments, there are risks, including wound infection, wound breakdown, and a haematoma (blood collection). Therefore, you should think carefully before undertaking surgery for elbow bursitis.

Other frequently asked questions about Olecranon bursitis: 

How long can elbow bursitis last? 

Generally, elbow bursitis will settle once we remove the cause. However, it can take a few months for the swelling to resolve.

Will a compression sleeve help elbow bursitis? 

Yes. Compression will reduce swelling and protect the bursa from further direct trauma.

Is an injection for olecranon bursitis a risky procedure? 

Yes. Inserting a needle into bursitis can potentially introduce a severe infection. Generally, we suggest you avoid an injection unless you’re tried other simple treatments.

Final word from Sportdoctorlondon about Olecranon bursitis 

Overall, olecranon bursitis is a common swelling at the back of the elbow that is more of a nuisance than a serious condition. Generally, simple treatments such as ice and anti-inflammatory tablets will help. Rarely do we need invasive treatments such as injections or surgery.

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Dr. Masci is a specialist sport doctor in London. 

He specialises in muscle, tendon and joint injuries.

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