Bursitis - Olecranon

Olecranon bursitis is inflammation and swelling behind the elbow. It often clears on its own. Treatment may be needed in some cases to reduce the inflammation and clear any build-up of fluid.

What is the olecranon bursa?

The olecranon is the top part of the bone called the ulna. It is the bony part of the back of the elbow - the bit that you lean on.

A bursa is a small sac that contains a small amount of fluid. The fluid is similar to the fluid in joints (synovial fluid). There are several bursae in the body including one just over the olecranon. Bursae help to make movement smooth between bones which 'stick out' and the overlying skin.

What is olecranon bursitis?

Bursitis means inflammation of a bursa. The bursa at the back of the elbow over the olecranon is the most common bursa to become inflamed. Inflammation causes swelling and extra fluid to be made.

What causes olecranon bursitis?

  • Mild but repeated injury is thought to be the common cause. For example, people who lean on their elbows a lot cause friction and repeated mild injury over the olecranon. (Fancy names have been given to this condition when the cause is clear. For example 'student's elbow' when it occurs in people who study with their elbows leaning on a desk. Other names include 'miner's elbow', 'plumber's elbow', etc, when the job involves crawling a lot using elbows.)
  • One-off injury such as a blow to the back of the elbow may set off inflammation.
  • Arthritis. One or more bursae may become inflamed as part of a generalised arthritis. (Note: most cases of olecranon bursitis are not associated with arthritis.)
  • Infection of a bursa. This may occur if there is a cut in the skin over a bursa, which allows in bacteria.
  • Unknown (idiopathic). Many cases occur for no apparent reason. However, it is possible that some of these are due to a mild injury that has been forgotten.

What are the symptoms of olecranon bursitis?

You cannot normally feel or see a bursa. If the olecranon bursa is inflamed then it causes a thickness and swelling over the back of the elbow. The bursa may also fill with fluid and it then looks like a small soft ball - a bit like a cyst. Most cases (those not infected or associated with arthritis) are painless, or are only mildly painful. The movement of the elbow joint is not affected.

If the bursa is infected ('septic' olecranon bursitis) then you will usually develop pain, redness and tenderness behind the elbow.

A bursitis associated with arthritis may not be painful itself, but you will have other symptoms related to the arthritis such as joint pains.

How is olecranon bursitis diagnosed?

If you have a straightforward case of olecranon bursitis, the doctor may be able to diagnose it without any tests. However, scans and blood tests are sometimes done to rule out other causes of elbow swelling such as infection (septic arthritis), gout or rheumatoid arthritis. If you have had a significant injury, an X-ray might be needed to make sure you have not got a fracture.

What is the treatment for olecranon bursitis?

  • No treatment may be needed. A small painless thickening or swelling is common. It often clears by itself. If a small amount of fluid remains once the inflammation has gone then this can be left alone. However, a large collection of fluid may be unsightly.
  • RICE treatment. You may find the swelling improves with (R)est, (I)ce packs, (C)ompression (wearing a bandage) and (E)levation (keeping the elbow in a raised position).
  • Anti-inflammatory medication (such as ibuprofen, naproxen, diclofenac, etc) may be prescribed to reduce inflammation and swelling.
  • Ultrasound and electrical treatment have helped some people.
  • A steroid injection into the bursa may cure the problem. Steroids are good at reducing inflammation.
  • Aspiration (draining the fluid) can be done with a needle and syringe if a lot of fluid builds up. However, the fluid tends to build up again after being drained. Therefore, you may be advised to wear a tight pressure bandage for a while after the fluid is drained to prevent it building up again.
  • Surgery to remove the bursa is an option if the above do not work.
  • Antibiotics are needed if the cause of the bursitis is an infection.

If you protect the elbow from excessive friction and rubbing it may prevent further bouts of bursitis. This may mean using elbow pads if you need to lean on your elbows whilst working.