Olecranon Bursitis

• Olecranon Bursitis

  Inflammation and swelling of the bursa over the elbow
• Olecranon

  The bony lump at the elbow, part of the ulna bone
• Bursae

  Sacs created by synovial membrane filled with a small amount of synovial fluid, found at bony prominences to reduce friction between bones and soft tissues during movement
• Bursitis

  Inflammation of a bursa, causing thickening of the synovial membrane and increased fluid production, leading to swelling
• Causes of bursitis

  • Friction from repetitive movements or leaning on the elbow
  • Trauma
  • Inflammatory conditions (e.g., rheumatoid arthritis or gout)
  • Infection (septic bursitis)
• Olecranon bursitis is sometimes called "student's elbow" due to prolonged leaning on the elbow while studying, resulting in friction and mild trauma leading to bursitis. It can also occur in occupations requiring leaning on the elbow, such as plumbers or drivers
• Occupations that require leaning on the elbow

  • Plumbers
  • Drivers
• Typical presentation of olecranon bursitis

  • Swollen
  • Warm
  • Tender
  • Fluctuant (fluid-filled)
• Features of infection in bursitis


  • Hot to touch
  • More tender
  • Erythema spreading to the surrounding skin
  • Fever
  • Tachycardia
  • Hypotension
  • Confusion
• Important differential diagnosis

  Septic arthritis
• Features of septic arthritis

  • Swelling in the joint (rather than the bursa)
  • Painful and reduced range of motion in the elbow
• Aspiration of fluid from the bursa when infection is suspected

  1. Pus indicates infection

  2. Straw-coloured fluid indicates infection is less likely

  3. Blood-stained fluid may indicate trauma, infection, or inflammatory causes

  4. Milky fluid indicates gout or pseudogout
• Aspiration procedure

  1. Fluid sent to the lab for microscopy and culture

  2. Examination for crystals (gout and pseudogout)

  3. Gram-staining for bacteria
• Management options for olecranon bursitis

  1. Rest

  2. Ice

  3. Compression

  4. Analgesia (e.g., paracetamol or NSAIDs)

  5. Protecting the elbow from pressure or trauma

  6. Aspiration of fluid

  7. Steroid injections in problematic cases where infection is excluded
• Management when infection is suspected

  1. Aspiration of fluid for microscopy and culture

  2. Antibiotics
• First-line antibiotics recommended by NICE CKS

  • Flucloxacillin
  • Clarithromycin
• Management for systemically unwell patients

  1. Admission to hospital

  2. Bloods (including lactate)

  3. Blood cultures

  4. IV antibiotics

  5. IV fluids
• August 2021


  Last updated