What is olecranon bursitis?The olecranon bursa is a structure that is found over the point of the elbow between the underlying skin and overlying bone. Its function is to reduce the friction of the skin over the bone during elbow movement. Sometimes the bursa can become irritated and can swell up as a lump over the tip of the elbow. Even after acute swelling subsides, the bursa may remain thicker than it was previously.
Most commonly olecranon bursitis is related to minor trauma, repetitive overuse or associated inflammatory conditions such as gout or rheumatoid arthritis. Rarely there may be an associated infection; this is more common if there are breaks in the skin overlying the bursa.
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What are the symptoms and signs?Olecranon bursitis is characterised by the development of a swelling over the olecranon process of the elbow. This may occur over a several hours or days. The swelling is often warm to the touch, inflamed, compressible and painful to pressure. Movement at the elbow joint should not be painful, except when bending the elbow, when increased tension in skin will cause pressure on the inflamed bursa.
In cases where there is significant cellulitis (red, angry skin infection), a history of fever or chills, or the patient is prone to infections due to associated medical conditions, there may be an infection associated with the inflamed bursa.
How is olecranon bursitis diagnosed?The diagnosis of non-septic olecranon bursitis is usually a clinical one. If there is a concern about the possibility of associated infection then WBC (White Blood Cell count) and CRP (C-reactive Protein) blood tests can be helpful. Further imaging is not usually necessary, but if there are any unusual or concerning features of the history of the swelling developing, then MRI may be organised.
Other common causes of localised swellings over the olecranon include the nodules associated with rheumatoid arthritis and gouty lumps (tophi). If the swelling is generalised to the whole elbow with severe pain and limited elbow movement then the possibility of septic arthritis must be considered.
How is it treated?Most cases of olecranon bursitis will settle with conservative measures:
- Rest and activity modification
- Compression dressing
- Painkillers, including anti-inflammatories.
If there is evidence of an associated infection then a course of oral (tablet) antibiotic will be prescribed in addition to the above measures.
InjectionsSome patients benefit from aspirating (removing the fluid with a needle) and having an injection placed into the bursa. This is not generally successful but can be used if patients are experiencing on-going symptoms but they are not suitable for surgical treatment.
SurgeryIn the acutely inflamed setting it is generally advisable to avoid surgery, due to wound healing problems, unless an infected olecranon bursitis has progressed to an abscess. In the case of recurrent bouts of olecranon bursitis or a bursa that remains significantly enlarged, after the acute inflammation has settled, surgical excision (removal) of the bursa can be performed. This will usually be performed as a day-case procedure under either general or regional anaesthetic. Sometimes elbows are placed into a half cast (back slab) to protect the wound while it heals. Most people will return to normal day-to-day activities by six weeks following surgery, although there may be some residual tenderness related to the scar for up to three months. Driving can be resumed when comfortable and safe to do so, usually this will be from two weeks onwards following surgery.
What are the potential complications?Most of the potential complications following excision of an olecranon bursa relate to the potential space left behind under the skin once the bursa has been removed and the risk of fluid collecting here or the wound breaking down. In both of these scenarios it may take may take several weeks for the soft tissues to fully settle down and be completely healed. Other potential risks include local infection, swelling, stiffness, scar pain and a small patch of numbness of the skin.
A big thank you to Simon and his team for their care, patience and perseverence looking after me through all stages of both shoulder and elbow surgery.
Since the shoulder stabilisation I have continued my sailing and fitness training without the worry that my shoulder might dislocate; and I don’t have to think twice whether my ulnar nerve will hinder any progression in my sports.
With their amazing help, I’ve been able to get back to sailing competatively and am now a double National champion.
After multiple shoulder dislocations Charlie helped me set a route for recovery, which has been nothing but smooth sailing. Surgery went successfully and I am well on my way to playing the sports I was previously. Would highly recommend.
Simon successfully operated on my frozen left shoulder in 2012 with fantastic results. This year he has overseen and advised treatment for my frozen right shoulder (via hydrodilation injection). His unrivalled experience in orthopaedic shoulder treatments, coupled with his reassuring bedside manner and excellent results, gave me huge confidence throughout. I’m hugely grateful to have my quality of life back and wouldn’t hesitate to recommend his services. Thank you Simon.
I had suffered with a painful shoulder and pins and needles for three years following a right shoulder fracture and failed half joint replacement prior to meeting Mr Pennington. He explained the situation in a way I could relate to and I’m delighted to say my revision shoulder replacement has gone well and for the first time in years I can use my arm and am pain free. I was even able to walk my daughter down the aisle 3 months after surgery! Many thanks.
I would like to thank Charlie Talbot and his team for the operations performed on both my shoulders and also the aftercare put in place after my operations. I have played golf since I was 12 years of age and thought at one point that I would never get back to playing again. Charlie was always very positive and told me that he would get me playing golf again. Well, I have now been playing golf for nearly 2 years. Before surgery I had a handicap of 12 and I am now down to 9, not bad at the age of 68. So many many thanks.
I had PRP injections into my right elbow last year and within 3 months I was pain free, a year on it is more or less 100% better. Fabulous I would recommend it to anyone with Tennis Elbow, in fact I have gone back again this year to get my left elbow done. Thanks Simon.
Mr Pennington I really wanted you to know how very thankful I am for the excellent care & treatment you and your staff gave me. It really meant a lot that you were so clear, friendly & professional and listened to me – so thank you again.
After more than four decades of shoulder problems with a total of three surgeries the full shoulder replacement surgery by Mr. Talbot has changed my life beyond expectations. I am now able bodied for the first time in years and pain free.
Thank you to Mr Boyle and team for the excellent care and attention both before and after Replacement Shoulder surgery, using the Tornier Simpliciti procedure. After very many months of severe pain and lack of movement I was pain free from day one. Now, after nine weeks, the shoulder and arm movement continues to improve, beyond expectation, with physiotherapy and exercise. I am extremely grateful for all the continuing care.
Following two years of recurrent problems with my left shoulder I was recommendedto Consult Mr Neil Pennington. I had the opportunity to have my surgery quickly and at my convenience, this fitted well around my professional and home commitments. The surgery was carried out as a day case procedure and Mr Pennington visited me following the surgery to explain everything. My operation was a minimally invasive procedure so my recovery was straightforward with only a few restrictions; in fact I was encouraged to keep my shoulder moving. I was driving and back to work after 2 weeks – after 2 years of pain and sleep disturbance I found this operation to be life changing! I found Mr Pennington to be a very professional and compassionate surgeon and he is surrounded by a whole team of professionals that gave me the utmost confidence in the care and treatment I received.
I would like to thank Mr. Talbot and the amazing team of nurses, physiotherapists and support staff for their care and support during my recent visit to the Duchy Hospital, Harrogate, for a replacement shoulder. The care and attention I received was unparalleled. The pain free movement I now have has changed my life.