A Patient's Guide to Olecranon Bursitis
 |
Introduction
Olecranon bursitis is the inflammation of a small
sac of fluid located on the tip of the elbow. This inflammation
can cause many problems in the elbow.
|
This guide will help you understand
• how olecranon bursitis develops
• why the condition causes problems
• what can be done for olecranon bursitis
Anatomy
 Where
is the olecranon bursa, and what does it do?
A bursa is a sack made of thin, slippery tissue. Bursae
occur in the body where ever skin, muscles, or tendons need to slide
over bone. Bursae are lubricated with a small amount of fluid inside
that helps reduce friction from the sliding parts.
The olecranon bursa is located between the tip, or point,
of the elbow (called the olecranon) and the overlying skin. This
bursa allows the elbow to bend and straighten freely underneath
the skin as we use our arm.
Causes
How does olecranon bursitis develop?
Bursitis is the inflammation of a bursa. The olecranon bursa
can become irritated and inflamed in a number of ways.
In some cases, a direct blow or a fall onto the elbow can damage
the bursa. This usually causes bleeding into the bursa sack, because
the blood vessels in the tissues that make up the bursa are damaged
and torn. In the skin this would simply form a bruise, but in a
bursa blood may actually fill the bursa sack. This causes the bursa
to swell up like a rubber balloon filled with water.
The blood in the bursa is thought to cause an inflammatory reaction.
The walls of the bursa may thicken and remain thickened and tender
even after the blood has been absorbed by the body. This thickening
and swelling of the bursa is referred to as olecranon bursitis.
Click to view a common cause of
olecranon bursitis.
Olecranon bursitis can also occur over a longer period of time.
People who constantly put their elbows on a hard surface as part
of their activities or job can repeatedly injure the bursa. This
repeated injury can lead to irritation and thickening of the bursa
over time. The chronic irritation leads to the same condition in
the end--olecranon bursitis.
The olecranon bursa can also become infected. This may occur without
any warning, or it may be caused by a small injury and infection
of the skin over the bursa that spreads down into the bursa. In
this case, instead of blood or inflammatory fluid in the bursa,
pus fills it. The area around the bursa becomes hot, red, and very
tender.
Click to view pus-filled bursa
sac.
Symptoms
What does olecranon bursitis feel like?
Olecranon bursitis causes pain and swelling in the area at the
tip of the elbow. It may be very difficult to put the elbow down
on a surface due to the tenderness and swelling. If the condition
has been present for some time, small lumps may be felt underneath
the skin over the olecranon. Sometimes these lumps feel as though
something is floating around in olecranon bursa, and they can be
very tender. These lumps are usually the thickened folds of bursa
tissue that have formed in response to chronic inflammation.
 The
bursa sack may swell and fill with fluid at times. This is usually
related to your activity level, and more activity usually causes
more swelling. Over time the bursa can grow very thick, almost like
an elbow pad on the olecranon.
Finally, if the bursa becomes infected, the elbow becomes swollen
and very tender and warm to the touch around the bursa. You may
run a fever and feel chills. An abscess, or area of pus,
may form on the elbow. If the infection is not treated quickly,
the abscess may even begin to drain, meaning the pus begins to seep
out.
Diagnosis
How do doctors identify the condition?
The diagnosis of olecranon bursitis is usually obvious from the
physical examination. In cases where the elbow swells immediately
after a fall or other injury to the elbow, X-rays may be necessary
to make sure that the elbow isn't fractured. Chronic olecranon bursitis
is usually also easy to diagnose without any special tests.
If your doctor is uncertain whether or not the bursa is infected,
a needle may be inserted into the bursa and the fluid removed. This
fluid will be sent to a lab for tests to determine whether infection
is present, and if so, what type of bacteria is causing the infection
and what antibiotic will work best to cure the infection.
Treatment
What can be done for olecranon bursitis?
Nonsurgical Treatment
Olecranon bursitis that is caused by an injury will usually go
away on its own. The body will absorb the blood in the bursa over
several weeks, and the bursa should return to normal. If swelling
in the bursa is causing a slow recovery, a needle may be inserted
to drain the blood and speed up the process. There is a slight risk
of infection in putting a needle into the bursa.
Click to view needle inserted
to drain blood.
View animation of simple surgical
excision.
Chronic olecranon bursitis is sometimes a real nuisance. The swelling
and tenderness gets in the way and causes pain. This can create
a hardship both at work and during recreational activities. Treatment
usually starts by trying to control the inflammation. This may include
a short period of rest. Medications such as ibuprofen and aspirin
may be suggested by your doctor to control the inflammation and
swelling. An elbow pad may be useful in making it easier to put
the elbow on hard surfaces.
If the bursa remains filled with fluid, a needle may be inserted
and the fluid drained. During the drainage procedure, if there is
no evidence of infection, a small amount of cortisone may be injected
into the bursa to control the inflammation. Again, there is a small
risk of infection if the bursa is drained with a needle.
Your doctor may also prescribe professional rehabilitation where
the problems that are causing your symptoms will be evaluated and
treated. Your physical therapist may suggest the use of heat, ice,
and ultrasound to help calm pain and swelling.
If an infection is found to be causing the olecranon bursitis,
the bursa will need to be drained with a needle--perhaps several
times over the first few days. You will be placed on antibiotics
for several days. If the infection is slow to heal, the bursa may
have to be drained surgically.
To drain the bursa surgically, a small incision is made in the
skin, and the bursa is opened. The skin and bursa are kept open
by inserting a drain tube into the bursa for several days. This
allows the pus to drain and helps the antibiotics clear up the infection.
Surgery
Surgery is sometimes necessary to remove a thickened bursa that
has not improved with any other treatment. Surgical removal is usually
done because the swollen bursa is restricting your activity.
To remove the olecranon bursa, an incision is made over the tip
of the elbow. Since the bursa is outside of the elbow joint, the
joint is never entered. The thickened bursa sack is removed, and
the skin is repaired with stitches. You may be placed into a splint
to rest the elbow and prevent it from moving for a few days. This
is to allow the wound to begin to heal and to prevent bleeding into
the area where the bursa was removed.
Click to view incision.
Click to view thickened bursa
sack removed.
Click to view finished surgery.
Some type of bursa will probably grow back after surgery, because
the skin needs to slide over the olecranon smoothly. The body will
form another bursa as a response to the movement of the olecranon
against the skin during the healing phase. If all goes well, the
bursa that returns after surgery will not be thick and painful,
but more like a normal bursa.
Rehabilitation
What should I expect after treatment?
Chronic olecranon bursitis will usually improve over a period of
time from weeks to months. The fluid-filled sack is not necessarily
a problem, and if it does not cause pain, it is not always a cause
for alarm or treatment. The sack of fluid may come and go with variation
in activity. This is normal.
If surgery is required, you and your doctor will come up with a
plan for your rehabilitation. You will have a period of rest, which
may involve using crutches. You will also need to start a careful
and gradual exercise program. Patients often work with a physical
therapist to direct the exercises for their rehabilitation program.
|
