Olecranon bursitis

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Alternate names

  • Elbow bursitis

Definition

  • The olecrenon bursa is synovial membrane located immediately posterior to the olecranon bone of the elbow. The bursa's function is to allow the bony olecranon to glide smoothly across the overlying tissues with flexion and extension of the elbow. Olecranon bursitis refers to inflammation of the bursa.

Etiology

  • The etiology of olecranon bursitis is usually secondary to trauma, underlying inflammatory conditions or infection. Trauma can lead to bleeding within the bursa and the release of inflammatory mediators that predispose it to recurrence.
  • It can also be associated with inflammatory conditions such as rheumatoid arthritis, psoriatic Arthritis, and gout, or chronic medical conditions such as diabetes, alcoholism or HIV.

Epidemiology

  • Olecranon bursitis is relatively common. There is no mortality associated with this condition. Pain in the posterior elbow causes morbidity, with a limitation of activities. It typically affects men between the ages of 30 and 60 years.Two-thirds of cases are nonseptic and occur when repeated trauma or sports injuries lead to bleeding into the bursa or release of inflammatory mediators.
  • Two-thirds of cases are nonseptic and occur when repeated trauma or sports injuries lead to bleeding into the bursa or release of inflammatory mediators.
  • Olecranon bursitis occurs in both children and adults.
  • There is no predisposition to sex or race.
    Olecrenon bursitis

Signs and symptoms

  • Presents as swelling overlying the olecranon process. As the swelling progresses, it can restrict elbow movement.
  • The appearance of the bursitis is characteristically round or "golf ball" shape given the fluid's confinement within the bursa.
  • If bursitis occurs due to underlying infection, it is usually associated with erythema and tenderness.
  • It can also be associated with systemic features such as fever and malaise.

Diagnosis

  • The diagnosis of olecranon bursitis is often made by clinical evaluation alone without the aid of objective diagnostic testing. However, diagnostic tests become very important when considering the risk of alternative diagnoses or the presence of infection.
  • Bursal aspiration and analysis are considered to be the gold standard in diagnosis. This is particularly important when underlying infection is being considered. When evaluating to rule out infection, fluid should be sent for cell count, Gram stain, culture and sensitivity tests, and crystal examination.

Management

  • The treatment for bursitis depends largely on whether it is infective or noninfective. Acute noninfective bursitis is self-limited. It can be managed conservatively with rest, ice, and the use of NSAIDs. Application of elastic bandage has also been shown to help prevent swelling.
  • In those with repeated episodes, bursectomy can be considered. The presence of an underlying bone spur is indicative of risk for repetitive recurrence. Patients with a known spur and more than one recurrence should, therefore, be considered for surgical excision of the offending spur. Persistently recurring bursitis without a spur present may benefit from surgical excision of the bursa.
  • Infective bursitis requires treatment with antibiotics, particularly with antimicrobials targeted against streptococcal and staphylococcal organisms. Aspiration and drainage are highly recommended including disruption of any present loculation. Oral antibiotics are sufficient with no benefit of any dose of intravenous (IV) antibiotics noted. Treatment with oral antibiotics for 7 days is sufficient as there is no evidence of decreased recurrence with longer courses of treatment.

Differential diagnosis

  • Among other diagnoses, one might consider cutaneous abscess, hematoma, olecranon fracture, other elbow fracture, cellulitis, tendon rupture, septic arthritis, gouty arthritis, neoplasm, or ligament rupture.

Prognosis

  • Olecrenon bursitis is relatively benign.
  • The progression to systemic infection from infectious bursitis in the average healthy patient is a very low risk. In fact, there may be a greater chance of spontaneous remission with no treatment in the young healthy patient compared to the risk of progression to systemic disease.

References


Latest research - Olecranon bursitis

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