It is not uncommon for me to see patients who have been struggling to find the right olecranon bursitis treatment.
Olecranon bursitis is a condition caused by acute or chronic inflammation of the olecranon bursa. The olecranon bursa is a thin fluid filled sac that lies under the skin at the tip of the elbow and helps to reduce friction as the olecranon (tip of the elbow) and triceps tendon glide under the skin as the elbow straightens and bends. When olecranon bursitis occurs, the bursa lining becomes thickened and inflamed and the cells of the lining produce more fluid so the bursa swells.
In an acute bursitis the bursa becomes thickened, inflamed, and swollen and can be associated with pain. The size of the bursa may increase or decrease and once the acute episode is over the bursa usually shrinks back to its original size. In some cases bursitis may be recurrent so that the patient experiences brief flares of inflammation from time to time. In some cases the bursa can become persistently swollen even after the inflammation settles.
WHAT ARE THE CAUSES OF OLECRANON BURSITIS?
Olecranon bursitis has several causes. The most common cause I see in my practice is repeated direct trauma from leaning on the tips of the elbow and this could be due to work or certain sports. In some cases trauma causes the bursa to swell and bugs can get in through broken skin and cause infection of the olecranon bursa.
An acute olecranon bursitis that is infected will be painful and swollen with overlying skin redness. The pain and swelling may cause reduced elbow movement and patients may feel generally unwell and may experience fevers. Redness may track up the arm towards the armpit as the infection spreads.
Other causes of recurrent olecranon bursitis include inflammatory conditions such as gout and rheumatoid arthritis.
Chronic olecranon bursitis usually occurs after recurrent episodes and can be due to repeated direct trauma or systemic conditions such as gout.
WHAT IS THE BEST OLECRANON BURSITIS TREATMENT?
In acute cases the focus is treating the inflammation. Patients can use ice packs, non-steroidal anti-inflammatory drugs (NSAIDs), and avoidance of leaning on the tip of the elbow. The elbow joint gets stiff easily so it is important to keep the joint moving gently. In some cases a compression bandage may be applied to help reduce swelling.
In cases of infected olecranon bursitis it is important to treat the inflammation but also to start antibiotics to control the infection. In severe cases of infection patients may need admission for intravenous antibiotics and rarely surgery may be needed if the bursa ruptures or infection is uncontrolled.
In cases of chronic enlargement of the olecranon bursa surgery may be required to excise the bursa. It is important to excise all the bursa tissue to prevent complications, and for this reason we don’t tend to operate on acutely inflamed cases.
SHOULD I HAVE MY OLECRANON BURSA ASPIRATED OR INJECTED?
Recent studies have shown no advantage to aspiration or injection with steroids. Injection or aspiration of an olecranon bursa is risky as the injection tract may not heal and a chronic discharging sinus may form. A sinus connects the bursa to the outside world and this can allow bacteria into the bursa and can result in severe infection. Aspiration removes fluid but doesn’t treat the cause of the bursitis so it is most likely that the bursal cells will continue to produce fluid and the swelling would recur. For this reason we do not recommend aspiration or injection as an olecranon bursitis treatment.
WHAT IS AN EXCISION OF OLECRANON BURSA?
In cases of chronically swollen bursas we often recommend an excision of olecranon bursa operation. This is an operation to remove the bursa from the back of the elbow. This operation can be performed under general anaesthetic but we recommend that patients have this surgery done awake under regional anaesthetic. (Read more about awake shoulder and elbow surgery here)
To excise an olecranon bursa we make a cut over the back of the elbow, directly over the bursa, excise the whole bursa, suture the skin and apply a pressure bandage. The surgery is relatively quick (30-45 minutes), and is done as a day case. We allow our patients to use the elbow straight away after the regional anaesthetic block wears off (within 24 hours), however, the pressure bandage needs to remain in place for 5 days so that blood does not fill the space left by the bursa. You can read more about post-operative elbow recovery here.
After an excision of olecranon bursa, recovery is quick, patients can resume a desk base job as soon as pain allows and manual jobs can re-start once the stitches have been removed at 2 weeks. The main risk of olecranon excision surgery is haematoma/seroma from blood or tissue fluid filling the space where the bursa was removed. The pressure bandage reduces this risk. Other less common risks include wound healing problems, infection, and recurrence of swelling.
If you are looking for olecranon bursitis treatment please get in touch.