Olecranon bursitis is inflammation and swelling behind the elbow. It often clears on its own. Treatment may be needed in some cases to reduce the inflammation and clear any build-up of fluid.
What is the olecranon bursa?
The olecranon is the top part of the bone called the ulna. It is the bony part of the back of the elbow - the bit that you lean on.
A bursa is a small sac that contains a small amount of fluid. The fluid is similar to the fluid in joints (synovial fluid). There are several bursae in the body, including one just over the olecranon. Bursae help to make movement smooth between bones which 'stick out' and the overlying skin.
What is olecranon bursitis?
Bursitis means inflammation of a bursa. The bursa at the back of the elbow over the olecranon is the most common bursa to become inflamed. Inflammation causes swelling and extra fluid to be made. This causes a soft lump of fluid to form at the back of the elbow.
What causes olecranon bursitis?
There are a number of possible causes of olecranon bursitis:
- Mild but repeated injury is thought to be the common cause. For example, people who lean on their elbows a lot cause friction and repeated mild injury over the olecranon. (Fancy names have been given to this condition when the cause is clear. For example, when it occurs in people who study whilst leaning on their elbows on a desk, it is called 'student's elbow'. Other names include 'miner's elbow', 'plumber's elbow', etc, when the job involves crawling a lot using elbows.)
- Repeated elbow movements may be a cause in certain athletes. For example those whose sports involve throwing by raising the arm above the head (such as cricket or baseball players, javelin throwers) or weightlifters.
- One-off injury such as a blow to the back of the elbow may set off inflammation.
- Arthritis. One or more bursae may become inflamed as part of a generalised arthritis. (Note: most cases of olecranon bursitis are not associated with arthritis.)
- Infection of a bursa. This may occur if there is a cut in the skin over a bursa, which allows in germs (bacteria). Some illnesses may make infection more likely, for example diabetes or conditions where the immune system does not work as well as normal. There is not always an obvious cause for the infection.
- Unknown (idiopathic). Many cases occur for no apparent reason. However, it is possible that some of these are due to a mild injury that has been forgotten.
What are the symptoms of olecranon bursitis?
You cannot normally feel or see a bursa. If the olecranon bursa is inflamed then it causes a thickness and swelling over the back of the elbow. The bursa may also fill with fluid and it then looks like a small soft ball - a bit like a cyst. Most cases (those not infected or associated with arthritis) are painless, or are only mildly painful. The movement of the elbow joint is not affected.
If the bursa is infected ('septic' olecranon bursitis) then you will usually develop pain, redness and tenderness behind the elbow.
A bursitis associated with arthritis may not be painful itself but you will have other symptoms related to the arthritis, such as joint pains.
How is olecranon bursitis diagnosed?
If you have a straightforward case of olecranon bursitis, the doctor may be able to diagnose it without any tests. However, scans and blood tests are sometimes done to rule out other causes of elbow swelling, such as infection (septic arthritis), gout or rheumatoid arthritis. If you have had a significant injury, an X-ray might be needed to make sure there is no break (fracture).
If infection ('septic olecranon bursitis') is suspected, the fluid in the swelling may be drained (aspirated) by the doctor. A sample is then sent to the laboratory to see which germs (bacteria) are causing the infection.
What is the treatment for olecranon bursitis?
In many cases, olecranon bursitis clears up on its own with simple care such as resting the elbow, avoiding pressure on it, and applying ice packs. Some people find a compression bandage on the elbow makes it more comfortable. As long as there is no infection, over time most cases of olecranon bursitis will then settle on their own.
Other treatments which may be advised in some cases include:
- Anti-inflammatory medication (such as ibuprofen, naproxen, diclofenac, etc) may be prescribed to reduce inflammation and swelling. Paracetamol is another option if the elbow is painful.
- Draining the fluid (aspiration) can be done with a needle and syringe if a lot of fluid builds up. However, the fluid tends to build up again after being drained. Therefore, you may be advised to wear a tight pressure bandage for a while after the fluid has been drained, to prevent it building up again.
- A steroid injection into the bursa may cure the problem. Steroids are good at reducing inflammation. However, steroid injections sometimes cause infection in the bursa.
- Surgery to remove the bursa is an option if the above do not work.
- Antibiotics are needed if the cause of the bursitis is an infection. Normally an antibiotic such as flucloxacillin or erythromycin is used until the results of the tests on the aspirated fluid are available. Then the choice of treatment can be changed if necessary and directed at the exact germs (bacteria) causing the infection. Flucloxacillin and erythromycin treat the most common types of germs which cause olecranon bursitis.
If you protect the elbow from excessive friction and rubbing it may prevent further bouts of bursitis. This may mean using elbow pads if you need to lean on your elbows whilst working.
Dr Tim Kenny
Dr Mary Harding
Dr John Cox