Olecranon bursitis refers to inflammation of the olecranon bursa. The olecranon bursa is a subcutaneous sac that overlies the olecranon process and contains a small amount of fluid to prevent injury of subcutaneous tissue and skin from the uncovered bony olecranon.

Clinical presentation

The presentation is with a tender, fluid-filled olecranon bursa. In cases associated with infection, there may also be overlying inflammatory skin changes (e.g., erythema) and systemic symptoms (e.g., fever) ⁴.

Pathology

Etiology

Bursitis can develop secondary to many causes:

• excessive use - e.g., "student's elbow"

• trauma

  • acute trauma

  • repetitive trauma

• infection: septic

• inflammation: rheumatoid arthritis, gouty arthropathy, and CPPD

Radiographic features

Plain radiograph

Lateral radiographs of the elbow reveal soft tissue swelling superficial to the olecranon ⁴. An olecranon spur may also be visible ⁴. A clue to the underlying etiology may also be present, such as traumatic fracture or calcification in gout or CPPD ⁴.

Ultrasound

Ultrasound may show a fluid collection in the olecranon bursa, features of synovial proliferation and/or hyperemia. A small proportion of patients may also show the presence of an associated loose body or features of associated triceps tendinopathy (+/- calcifications) ².

CT

• fluid density at the subcutaneous tissue superficial to the elbow

MRI

Bursal fluid collection has the following features:

• T1: hypointense

• T2: mainly hyperintense

• C+ (Gd): enhancement of bursal margins

Triceps brachii muscle and subcutaneous edema as well as elbow joint effusion may be seen.

Treatment and prognosis

Generally, the condition is self-limiting over weeks and there are generally no chronic sequelae if managed conservatively, which includes supportive treatments such as resting, intermittent icing, compression, and simple analgesics (e.g. acetaminophen, NSAIDs) ^4,6. 

Aspiration of the bursal fluid is generally not required and carries risks (e.g. infection, sinus tract creation), and should be reserved if there is a suspicion of an unusual etiology such as underlying infection ⁴ or perhaps to relieve significant pressure symptoms ⁵.

Intrabursal corticosteroid injection is generally not recommended due to relatively high complication rates (e.g. infection, skin atrophy) ^4-6.

Surgical bursectomy and/or olceranon spur resection (if present) is a treatment of last resort in cases refractory to the aforementioned treatments ^4,5.