Chapter 103: Olecranon Bursitis

PATIENT STORY

A 50-year-old man presents with swelling in his posterior right elbow for the last 2 months. He does not have pain at rest but does have discomfort when he rests his elbows on his desk at work. He denies any trauma or fevers. Figure 103-1 demonstrates a 5-cm fluctuant "goose egg" swelling over the olecranon process that is not warm and is mildly tender to palpation. He has full range of motion of 0–150 degrees. His olecranon bursitis was treated with ice, compression, nonsteroidal anti-inflammatory drugs (NSAIDs), and activity modification to avoid leaning on his elbow.

INTRODUCTION

An olecranon bursa is a subcutaneous synovial pouch which functions to reduce friction between the olecranon process and its overlying skin. Historically, enlargement of a bursa has been termed "bursitis," although a true inflammatory process doesn't always exist.¹ Olecranon bursitis can be broadly classified as acute or chronic and aseptic or septic. Differences in clinical presentation help distinguish aseptic from septic olecranon bursitis; however, analysis of fluid may be necessary. Aseptic olecranon bursitis is commonly treated with an elbow pad, NSAIDs, and ice. Septic olecranon bursitis may be treated with antibiotics only or may require surgical drainage in addition to antibiotics.

SYNONYMS

Popeye elbow, student's elbow, baker's elbow.

EPIDEMIOLOGY

The actual incidence of olecranon bursitis is unknown and difficult to quantify, but aseptic bursitis is estimated to be 3–4 times more common than septic bursitis.²

• Peak age of onset is 30 to 60 years.³

• Male predominance.

• 33%–77% have antecedent trauma.²

ETIOLOGY AND PATHOPHYSIOLOGY

Inflammation or degeneration of the bursal sac overlying the olecranon process from:

• Repetitive motion or microtrauma to the elbow.

• Systemic diseases such as gout, pseudogout, diabetes, alcoholism, and rheumatoid arthritis, either directly due to the comorbidity or secondary to immunosuppression from treating it.²

• Infection, typically by Staphylococcus aureus or another Gram-positive organism.

RISK FACTORS

• Acute bursitis—Direct trauma or prolonged pressure on bursa.

• Chronic bursitis—Multiple acute episodes, occupational activities, systemic disorders.

• Septic bursitis—Immunocompromised state, direct inoculation from nearby skin wound, cellulitis, or iatrogenic from an aspiration attempt.

DIAGNOSIS

The diagnosis of olecranon bursitis is made clinically by its typical appearance (Figures 103-1 and 103-2). When necessary, joint aspiration verifies the diagnosis and separates septic from aseptic bursitis.