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Disorders (other than fractures and dislocations) > Olecranon Bursitis What is Olecranon Bursitis? Most often associated with tennis, baseball, racquetball players, runners and office workers, injuries to the elbow can happen to anyone over time. Elbow joints can be injured or torn by excessive force, such as lifting a very heavy object while doing yard-work, or repeated everyday friction caused by shoveling dirt or snow, and throwing out the garbage on a daily basis, or playing sports competitively. Olecranon bursitis, also known as elbow bursitis, is an inflammation of a bursa, a synovial fluid-filled sac surrounding tendons and parts of joints. A bursa contains a lubricating fluid that allows smooth gliding between muscles or tendons and bones that move back and forth across each other. There are cushioning bursae in the elbow, hip, knee, shoulder, and other joints of the body. The bursa in the elbow is located between the skin and the tip of the ulna, the long bone in the lower arm that meets the olecranon, the bony prominence of the elbow. Design of the Elbow? Basically, the elbow is designated as a hinge joint that is made up of the humerus (upper arm bone), the ulna (lower arm bone) and the radius (lower arm bone). A small amount of rotation and more specifically hinge are accomplished by the interaction and the unique positioning of the bones in the joint. This rotation is easily detected during activities like eating, with the hand being delivered to the mouth. The ulnar collateral ligament located on the inner or medial side of the elbow provides the elbow’s primary stability. We have covered the basics; more specifically the elbow consists of three bones with three articulations/junctions. The trochlea of the humerus, which joins with the olecranon of the ulna, and actually sets the limits on flexion; the bending movement that can decrease the angle between the bones of the elbow - and extension; the unbending movement that can increase the angle between the bones of the elbow at the joint. The humeroulnar joint and the medial joint surface combined limit the function here to be a true hinge joint. The radiocapitellar joint provides stability while acting as the pivot for axial load. The ulnar collateral ligament is the primary stabilizing ligament of the elbow. This stability is beneficial for activities like lifting large objects. The wrist extensor elbow also helps to stabilize the elbow. Commonly, the elbow sees overuse in motion. Another very important structure within the elbow joint is the bursa, or lubricated sac of synovial fluid that protects the muscles and elbow as they move against each other. As we age, elbow joints can be subject to a great deal of wear and bursitis, resulting in the gradual degeneration of the tissue. Activities requiring any form of repetitive movement, chronic misuse, or repetitive stress may cause injury. Causes of Olecranon Bursitis? Nicknamed “student’s elbow,” olecranon bursitis often occurs to people who lean on a table or desk for long periods of time, putting pressure on the elbow joint. Irritation, injury, or pressure on a bursa can cause inflammation resulting in swelling and pain. Because of its position, the elbow can easily be bumped or irritated, and infections often occur from small puncture wounds. The swelling associated with olecranon bursitis may develop gradually, representing a chronic condition. It may also occur suddenly as the result of infection or traumatic injury. Pain is usually more intense and the motion of the elbow more limited when bursitis occurs because of an injury or infection. The onset of olecranon bursitis may be the result of an injury to the elbow joint from a sport such as baseball, tennis, racquetball, or running. It may also arise due to frequent irritation or friction on the elbow from everyday household jobs such as yard work, shoveling dirt or snow, or house painting. Bursitis can also be caused by the inflammation of crystal deposits in the synovial fluid (as in gout and pseudogout) as well as by rheumatoid diseases such as rheumatoid arthritis. On rare occasions, the bursa can become infected with bacteria. This condition is known as septic bursitis. Symptoms of Olecranon Bursitis? Olecranon bursitis does not usually occur in a perfectly healthy elbow. Most elbows with olecranon bursitis have a history of other injuries. Diagnosis and treatment involves addressing these related conditions such as arthritis, bursitis, and tendonitis, as well. There are signs of swelling, redness, and pain in the elbow joint. The size of the swollen mass may be as large as 6 cm over the bony part of the elbow. The skin may be abraded or even lacerated. Redness and heat at the injured site indicate the possibility of infection. Acute olecranon bursitis arising from injury or infection is usually extremely tender to the touch. Chronic, recurrent bursitis swells but is less painful. You may experience difficulty putting on long-sleeved shirts because of the size of the swollen elbow. As the mass recedes, you may feel “lumps” that hurt when the elbow is bumped. These lumps (nodules) are scar tissue left when the fluid recedes and are sometimes referred to as bits of “gravel.” The good news is that it is outside of the elbow joint. Treatment of Olecranon Bursitis? Your doctor will examine your elbow, inquire about your medical history, and establish whether the bursitis is chronic or acute. Blood tests and x-rays may provide more specific information. A needle and syringe is often used to get a sample of fluid from the bursa. Culturing this fluid helps determine the cause of the bursitis and the presence or absence of infection. If your symptoms are the result of an injury, there is the possibility of an olecranon fracture. If olecranon bursitis is the diagnosis, your doctor will probably recommend conservative treatment methods to control pain and promote healing in the elbow. The treatment regimen known as R.I.C.E. can be very effective in some cases. Rest, ice, compression, and elevation are components of this treatment. It is very important to rest the injury, as well as to initiate physical therapy as soon any acute pain has subsided. Resting is critical to healing, that means immobilizing the elbow as well. Place no pressure on the elbow until all swelling subsides. Your doctor may prescribe an anti-inflammatory drug or recommend over-the-counter medication, as well as an antibiotic. Anti-inflammatory medication such as non-steroid anti-inflammatory drugs (NSAIDs) are often prescribed for pain relief. In most cases your doctor will aspirate the swollen cyst and apply a compression bandage consisting of a circular piece of foam, 8 cm in diameter, and an elastic wrap. Wrapping the injured site helps prevent liquid from refilling the area. In some cases a splint is used to temporarily immobilize the elbow. Your doctor will probably want to reassess the injury in a week. If your symptoms continue or are acute, your doctor may again remove excess fluid from the bursa with a needle and syringe. Sometimes an injection of a steroid drug, usually cortisone, is used, with local anesthesia to relieve swelling, redness, and pain. It is not unusual for fluid to reaccumulate in the wound, and the liquid in the bursa may need to be removed two or more times. If there is a recurrence of excess fluid despite repeated treatment, your doctor may recommend that you have the bursa surgically removed. This may also be the case in the event of an infection that is unresponsive to antibiotics. Notify your doctor immediately if swelling spreads despite treatment, or if you develop a fever, chills, or increased warmth in the elbow joint. Surgery is normally recommended if the bursa makes it impossible for you to operate your elbow as needed. The timing of surgery also depends on the extent of the damage to the elbow, as evidence suggests that repairing complete tears of the elbow within three months of injury results in a better outcome. Typical surgery for olecranon bursitis involves making a small incision in the elbow. The surgeon first removes any tissue that has degenerated or does not appear healthy. After surgery, your elbow repair is usually protected by a sling and swathe for at least two weeks, and physical therapy is begun after the first week – first using passive exercises, and then moving the elbow and forearm through a more active range of motion. Recovery from Surgery of Olecranon Bursitis? Postoperative pain management consists primarily of oral narcotic analgesics during your hospital stay. Once in awhile intravenous narcotic analgesics are required; these may be given on an as-needed basis or using a PCA (Patient Controlled Analgesia) device. If your surgery was performed under a regional block, your elbow may remain sufficiently numb for the first 8 to 16 hours to require very little in the way of pain medication. Follow your doctor’s guidelines carefully. Resting the elbow is critical to healing. Do not put any pressure on the elbow until swelling subsides. The use of an ice pack for 20 to 30 minutes three or four times day helps relieve pain. Your doctor may prescribe an anti-inflammatory drug or recommend over-the-counter medication. He or she may suggest specific exercises to help you maintain your range of motion in the elbow. Strength in the elbow should be built up gradually with gentle, persistent effort. The doctor and physical therapist will explain the necessity of limiting sudden and stressful movements to the elbow and forearm for several weeks or longer. Activities that involve pushing, pulling, and lifting will not be possible, and even the best surgical repair can be damaged if submitted to undo strain. It will be awhile before you are able to actively lift the arm from your side. During the first three weeks or so after surgery, the elbow may require support from the other arm or a sling. Improvement to the elbow is determined not only by surgery but also by your general condition and rehabilitative effort. In many cases, the elbow and muscles of the elbow have been weakened from prolonged misuse or degeneration, and strengthening them will require a gentle, steady process of changing habitual ways of moving your forearm and elbow. Everyone recovers from injury at a different rate, and return to normal activities must be determined on the basis of how well your elbow recovers, not on the length of time that has passed since the injury occurred. Consider rearranging your activities to avoid those that triggered the bursitis; if this is not possible or desirable, wait at least 3 to 6 weeks before resuming them. Avoid pressure and injury to the elbow joint with the use of protective padding. Possible Complications of Surgery for Olecranon Bursitis? Although surgery for olecranon bursitis is usually without any significant problems, there may occasionally be unforeseen complications associated with anesthesia, including respiratory or cardiac malfunction. The surgery itself may be complicated by infection, injury to nerves and blood vessels, fracture, weakness, stiffness or instability of the joint, pain, inability to repair a tendon, or the need for additional surgeries. Since this is an elective procedure, you should evaluate and compare the surgical risks with the expected benefits. If a significant period of time has passed since olecranon bursitis has occurred in the elbow, it is quite possible that the surrounding tendons and muscles may have contracted and lost their elasticity due to the severity or acuteness of the original injury and subsequent infection. In this case, they may not be able to perform as they had when you were a small child. There are times when the elbow and surrounding tissue has simply worn away, and the remaining tissue may not be sufficient to maintain strong attachments within the elbow. In these circumstances, the surgeon will simply remove all unhealthy tissue and fix any other problems in the elbow. While these measures usually reduce elbow pain, they will probably not increase the strength or motion of the elbow. Motion may possibly decrease as a result. The information provided herein is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting a licensed physician. © 2000 DynoMed.com, LLC, Indianapolis, IN |