OLECRANON BURSITIS

Question 1

Definition:

Answer 1

(1) Olecranon bursa is superficially located on extensor side of elbow making it susceptible
to irritation and inflammation.
(2) May occur secondary to trauma, inflammation or infection.
(3) Trauma may vary from a direct blow to excessive leaning on elbows.
(4) May be caused from rheumatoid arthritis (RA), gout or other systemic inflammatory
process.
(5) May result from septic bursitis (primary infection), or develop as a secondary
complication of aseptic bursitis.

Question 2

Clinical Symptoms

Answer 2

(1) Sudden (infection or trauma) or gradual (chronic) swelling in the affected area.
(2) Pain ranges in severity.
(3) Limited ROM from pain and or pressure.
(4) As the mass diminishes in size patient may feel firm lumps or nodules that result from
scar tissue.

Question 3

Physical Exam

(1) Visual
(2) Palpation
(3) ROM
(4) Muscle Test
(5) Neurovascular
(6) Special Tests
(7) Diagnostic Tests

Answer 3

Visual 
(a) May be large mass over elbow 
 Palpation 
(a) Tenderness over the elbow 
 ROM 
(a) Elbow flexion and extension may be limited by pain 
 Muscle Tests 
(a) 4-5/5 
 Neurovascular 
(a) Typically unremarkable 
Special Test 
(a) None
 Diagnostic Tests 
(1) Aspiration maybe be diagnostic and therapeutic
(a) Laboratory testing of aspirate for WBC count, crystals, gram stain and culture 
(2) Radiographs needed to rule out fracture of olecranon process

Question 4

Treatment

Answer 4

(1) Light duty focused on activity modification to include avoiding hyperflexion against
hard surfaces
(2) Mild cases:
(a) NSAIDs
(b) Pressure wrap
(c) Ice
(3) Moderate to severe cases should undergo aspiration of fluid - refer for orthopedic
evaluation
(4) Septic olecranon bursitis requires organism specific antibiotics - refer for treatment
(a) Are there signs of infection?

Question 5

Referral Decisions/Red Flag

Answer 5

(1) Septic bursitis or recurrence of fluid despite repeated aspirations