Olecranon Bursitis

What is it?

Olecranon bursal fluid accumulation from repeated pressure or direct trauma (non-septic) or bacterial infection (septic)

Commonly affected: Olecranon bursa, olecranon process

How it develops

1. Repetitive Pressure/TraumaResting elbow on desk, falling — repetitive pressure or direct trauma irritates bursa
2. Fluid AccumulationIncreased bursal fluid accumulation → cystic posterior olecranon swelling
3. Non-septic vs SepticNon-septic: chronic repetitive irritation. Septic: S. aureus direct inoculation (through skin wound)
4. Chronic ThickeningWith recurrence, bursal wall thickening and rice body formation possible

Symptoms

• Redness/Fever (Septic)Septic bursitis: redness, warmth, fever, severe pain → antibiotics needed
• Posterior SwellingSoft, round cystic swelling over posterior elbow — mild pain in non-septic
• Tightness with FlexionDiscomfort with full elbow flexion due to swelling tension
• Preserved ROMNormal elbow ROM in non-septic bursitis

How it is examined

• Swelling PalpationSoft, fluctuant cystic swelling palpated over posterior olecranon
• Erythema/Warmth AssessmentSkin redness and warmth → suspect septic bursitis, aspiration and culture needed
• ROM AssessmentMeasure elbow flexion/extension ROM — rule out intra-articular pathology
• Bursal AspirationAspiration when septic suspected → WBC count, culture (WBC >50,000 = septic)

Imaging

To exclude bony pathology and olecranon fracture

• Usually normal
• Chronic: olecranon calcification
• Rice bodies — rare

Used in complex cases or to exclude deep infection

• Olecranon bursal effusion (T2 hyperintense)
• Bursal wall thickening
• Peribursal soft tissue edema (septic)

When surgery is considered

Septic bursitis failing antibiotic treatment, or recurrent non-septic bursitis

Procedures that may be discussed

• Bursectomy
• Septic: incision and drainage (I&D)

Outlook

Non-septic: spontaneous resolution or conservative improvement in weeks-months. Septic: good with antibiotics