Olecranon bursitis

• Olecranon bursitis:

  • Also called, miners elbow or students elbow
  • Olecranon bursa = sac overlying olecranon process of elbow
  • When this bursa is irritated there is thickening of the wall and increased fluid produced within the bursa causing swelling
• More common in:

  • Young middle aged men
  • Occupations involving elbow trauma/pressure e.g. gardeners, carpet layers, students
  • Athletes who play sports that involve elbow movement/impact on the elbow
• Can be classified as:

  • Non-septic (most common)
  • Septic (when bacteria enters bursa)
• Non-septic causes:

  • Trauma or overuse - single blow to elbow or repeated microtrauma e.g. leaning on elbow
  • Systemic conditions e.g. gout (urate crystal deposition) or RA (rheumatoid nodules in the bursa)
• Septic bursitis risk factors:

  • Trauma - superficial bursa in area prone to injury makes it more likely to get infected than other bursae
  • Iatrogenic - aspiration/infiltration of bursa
  • pre-existing bursal disease
  • Immunodeficiency
  • Most common causative organism = staphylococcus aureus
• When to suspect:

  • Swelling over elbow that appears over several hour to several days - fluctuant swelling, can be painless or tender
  • Movement of elbow painless except at full flexion when swollen bursa compressed
  • Risk factors e.g. trauma, overuse, penetrating injury, history of bursal disease, history of RA or gout
• Features suggesting septic bursitis:

  • Painful
  • Red
  • Hot
  • Swelling that's progressively worsening
  • Local cellulitis
  • Laceration over bursa
  • Fever
  • Immunocompromised
• Complications (more likely with septic):

  • Fistulae - if ruptures or after incision and drainage
  • Infective complications =
  • Osteomyelitis
  • Septic arthritis
  • Sepsis - immunocompromised people
• General management of both types:

  • Rest and reduced activity - avoid trauma/direct pressure on elbow
  • Ice
  • Compressive bandaging if tolerated
  • Paracetamol and/or NSAID
• Non-septic management:

  • Reassure should respond to conservative treatment but to come back if worsening or signs of infection
  • Consider aspiration if large effusion to improve function and comfort
  • If no response to conservative measures or aspiration consider steroid injection into bursa
  • Refer if no response after 2 months
• Septic bursitis management:

  • Aspirate fluid and treat empirically with oral antibiotics
  • 1st line = Flucloxacillin, clarithromycin if penicillin allergic
  • Course 1-4 weeks
  • Review every few days to monitor effectiveness
  • Admit or refer if response inadequate or complications e.g. septic joint, extensive cellulitis
  • Manage associated conditions e.g. RA or gout
  • In recurrent septic bursitis may require surgical excision of bursa
• Prognosis:

  • Non-septic: typically benign course and responds to conservative management
  • Septic: usually resolves without need for surgical drainage if treated with aspiration and appropriate antibiotics
  • Can get recurrence especially in non-septic bursitis due to recurrent minor trauma and in those where it is linked to occupation they may need to modify activities/use protection
• Aspiration:

  • Pus - indicates infection
  • Straw coloured - infection less likely
  • Blood stained - trauma, infection, inflammatory causes (RA, gout)
  • Milky fluid - gout or pseudogout