Olecranon Bursitis

Olecranon bursitis is inflammation and swelling of the superficial bursa between the olecranon and the overlying skin, one of the most commonly affected bursae in the body.

Causes are repeated pressure or friction (student's elbow), direct trauma, infection and crystal disease (gout or pseudogout). It mostly affects men aged 40 to 60, and about one-third of cases are septic.

The key clinical decision is septic or aseptic, because it changes management. Fever is often absent in septic bursitis, so its absence does not exclude infection.

The olecranon bursa is a subcutaneous, synovial-lined sac that lets the skin glide over the olecranon. It does not communicate with the elbow joint, so bursitis does not cause an intra-articular effusion. In chronic or recurrent cases a posterior olecranon spur at the triceps insertion can act as a mechanical irritant.

Causes:

• •Friction or trauma (most common): leaning on the elbow at a desk or at work, or a single direct blow, which may cause haemorrhagic bursitis
• •Septic: Staphylococcus aureus causes around 80% of superficial septic bursitis. Entry is usually through a skin break, such as an abrasion, a bite or a previous aspiration or injection. Diabetes, immunosuppression, alcohol excess and chronic kidney disease increase the risk
• •Crystal: gout is the most common crystal cause, and the bursa is a recognised site for tophi; pseudogout is less common
• •Rheumatoid arthritis: nodules can form at the olecranon
• •Idiopathic in some cases