➣ Direct trauma–trauma to olecranon tip (i.e.,falling).
- Common in football
- Associated with artiﬁcial turf
- Common in ice hockey due to elbowing and checking.
➣ Traumatic overuse
- Repetitive trauma
- Leaning on elbows
➣ Infectious or septic
- May have local trauma with secondary infection.
- May co exist with other types of bursitis.
➣ Rheumatoid arthritis.
➣ Crystal line disease.
- Gout may predispose to infectious bursitis.
- Calcium phosphate deposition disease.
■ Symptoms and presentation
➣ General symptoms
- Swelling in olecranon bursa
- Often acute change in size of bursa
- Quite often painless,but annoying
➣ Symptoms associated with infection, rheumatoid arthritis, or crystal line disease.
- Redness over olecranon
- Swelling in to forearm
- May have fever or malaise
- Elbow stiffness
- Drainage from bursa
■ Localized swelling over tip of olecranon.
■ Look for signs of external trauma.
➣ Abrasions with surrounding cellulitis.
- Especially important early.
- Ice hockey players due to elbow pads.
■ Evaluate for signs of infection
➣ Pain more common in septic bursitis
■ Evaluate elbow range of motion
➣ Loss of motion more common in infectious or rheumatoid causes.
- Pain limiting motion.
- Connection of bursa with joint in rheumatoid patients.
■ Compare contra lateral elbow
➣ Loss of motion due to arthritis.
➣ Presence of bony spurs.
➣ Prominent olecranon tip.
➣ Presence of thickened bursa.
➣ Gouty to phior rheumatoid nodules.
■ Radiographs–helpful to exclude fractures in trauma.
➣ Soft tissue swelling
➣ Chondro calcinosis
➣ Olecranon spur associated with traumatic bursitis.
■ Little role for other adjunctive studies.
■ Blood work–not overly helpful for infection unless late.
■ Aspiration and ﬂuid studies helpful in causation and treatment.
➣ Analysis of crystals from aspiration.
■ Olecranon bursitis–diagnosis usually easy and apparent.
■ Chondro calcinosis involving bursa.
■ Trauma and fractures to olecranon or radial head.
■ Acute non infectious bursitis
➣ Many cases resolve spontaneously.
➣ Local pads to prevent trauma.
➣ Decrease use; sling may help.
➣ Compressive wraps.
- Neoprene elbow sleeve.
- Ace wraps.
➣ Aspiration to rule out infection if etiology in doubt,if symptoms signiﬁcant,or if prolonged.
➣ Corticosteroid injection after aspiration.
- More effective resolution.
- May unmask infection.
➣ Presumptive antibiotics for Staphylococcus aureus.
■ Acute septic bursitis
➣ Aspiration and antibiotics.
- Aspiration for cell count,crystals,Gram stain,cultures.
- Oral antibiotics for mild cases.
- Cover for S.aureus.
- IV antibiotics for severe or non responsive cases.
- Generally need 10 days to 2 weeks treatment.
➣ Surgical drainage.
■ Chronic olecranon bursitis
➣ Serial aspiration.
➣ Treat for occult infection.
➣ Injection of corticosteroids into bursa.
■ Rheumatoid olecranon bursitis
➣ Bursa can communicate with elbow joint.
➣ Drainage can reﬂectinfected joint.
➣ More drainage than usual.
➣ Need to treat aggressively.
➣ Recurrence rate very high.
➣ Differentiate from rheumatoid nodules where ulceration common,recurrence common after excision.
■ Indications for surgical drainage
➣ Failed aspiration and antibiotic treatment.
➣ Long standing infections,either recurrent or resistant.
➣ Previous infection,drainage,or surgery.
➣ Desire for removal of bursa.
■ Surgical treatment
➣ Attempt to clear up severe infection.
- Local decompression and drainage.
➣ Longitudinal incision in skin.
➣ Excise all bursal tissue,which may extend proximally or distally.
- Skin can be thin–exercise care with dissection.
➣ Immobilizationa 45◦ ﬂexion with compression for 7–10 days.
- If rheumatoid ,consider longer immobilization.
- Consider drain use in rheumatoid patients,large bursae.
- Secondary aspiration of dead space occasionall necessary.
■ Complications of surgical treatment
➣ Wound problems
➣ Recurrence approximately 10%
■ Many resolve spontaneously with local care and padding.
■ If untreated, there are few long-term problems with chronic bursitis other than annoyance.
■ Infection should be aggressively treated.
■ Overall prognosis is excellent with symptomatic treatment of chronic bursitis and treatment of infection.
■ Most surgical cases do well.
Caveats and Pearls
■ In chronic cases, beware of occult infection and consider addition of oral antibiotics early on.
■ S.aureus is isolated organismin >90%
■ Beware of alaceration over the bursa in ice hockey players,as infection rate is extremely high; cover with antibiotics.
■ Careful surgical technique is critical due to poor blood supply of skin.