Bursitis

Question 1

What is olecranon bursitis?

Answer 1

Inflammation of the olecranon bursa –> the fluid-filled sac overlying the olecranon at the proximal end of the ulna.

Question 2

What is the role of the olecranon bursa?

Answer 2

To reduce friction between the posterior aspect of the elbow joint and the overlying soft tissues.

Question 3

Why is ‘olecranon bursitis’ also known as ‘student’s elbow’?

Answer 3

Because the repetitive mild trauma of leaning on a desk using the elbows is a common cause

Question 4

How is olecranon bursitis categorised?

Answer 4

Septic or non-septic depending on whether an infection is present.

Question 5

Give some causes of olecranon bursitis

Answer 5

1) Repetitive trauma e.g. writers, students, plumbers

2) Direct trauma

3) Infection

4) Gout

5) RA

6) Idiopathic

Question 6

Who is olecranon bursitis caused by infection more common in?

Answer 6

Immunosuppresed e.g. alcohol abuse, diabetes, those taking steroids, renal failure, malignancy.

Question 7

What is the most common organism causing infective olecranon bursitis?

Answer 7

Staph. aureus

Question 8

Key presenting feature of non-septic olecranon bursitis?

Answer 8

Subacute onset of swelling over the olecranon process.

May sometimes also have:
- tenderness
- erythema

Question 9

Clinical features of septic bursitis?

Answer 9

1) swelling
2) pain
3) fever
4) tenderness over the bursa

Question 10

What movement causes pain in olecranon bursitis?

Answer 10

Movement at the elbow joint should be painless until the swollen bursa is compressed in full flexion.

Question 11

Often a clinical diagnosis of olecranon bursitis can be made.

If septic bursitis is suspected, what investigation must be done?

Answer 11

Aspiration of bursal fluid for microscopy (Gram stain and crystals) and culture

Question 12

What colour fluid aspirated in olecranon bursitis indicated:

a) infection
b) non-infective cause
c) trauma
d) gout or pseudogout

Answer 12

a) purulent
b) straw-coloured
c) bloody
d) milky

Question 13

Mx of non-infective olecranon bursitis?

Answer 13

Conservative measures are often sufficient:

• Activity modification
• Ice application
• Compression
• Elevation
• NSAIDs

Question 14

What mx options can be considered in more severe olecranon bursitis?

Answer 14

1) Aspiration

2) Corticosteroid injections

3) Abx if infection suspected

ADMIT any systemically unwell patients.

Question 15

What is an important differential for olecranon bursitis?

Answer 15

Septic arthritis. Consider septic arthritis if there is:

1) Swelling in the joint (rather than the bursa)

2) Painful and reduced range of motion in the elbow