Olecranon Bursitis

Question 1

Anatomy of a Bursa

Answer 1

• small, fluid-filled sac that acts to cushion and as gliding surface to reduce friction between tissues
• between bones, muscles, tendons, skin

Question 2

What is Bursitis

Answer 2

• inflammation or irritation of a bursa
• often occurs near joints that perform frequent repetitive motions

Question 3

Causes

Answer 3

• repetitive motions or positions that put pressure on the bursa
• throwing, lifting overhead, leaning on elbows, kneeling
• injury, trauma to the affected area
• muscle imbalance, poor biomechanics, postural dysfunction
• inflammatory arthritis (rheumatoid, psoriatic arthritis)
• gout, infection, tendonitis, diabetes, thyroid disease

Question 4

Risk factors

Answer 4

• age: becomes more common with aging
• occupations/hobbies: repetitive motion or pressure on bursa
• other medical conditions:

+ systemic diseases: rheumatoid arthritis, gout, diabetes

+ obesity: hip and knee

Question 5

Diagnosis of bursitis

Answer 5

1. x-ray
2. magnetic resonance imaging (MRI)
3. ultrasound
4. aspiration
5. blood tests: confirm or rule out other conditions

Question 6

Treatment

Answer 6

• Aseptic:
• RICE
• anti-inflammatory and pain medication
• injection of steroid
• splints/braces to limit motion
• Septic:
• antibiotics
• repeated aspiration
• removal of bursa

Question 7

Symptom picture

Answer 7

• Acute:
• inflammation, heat
• diffuse pain: deep, burning (at rest or with activity)
• ROM of affected joint restricted
• proximal or distal joints may have reduced ROM if crossed by muscle/fascia that also crosses affected bursa
• Chronic:
• pain/ache with activity or direct compression
• more localized pain
• chronic inflammation, fibrosis, adhesions
• ROM of affected joint less restricted
• muscle atrophy

Question 8

Observation

Answer 8

• Acute;
• swelling, redness over bursa if superficial
• antalgic posture or gait
• Chronic:

postural imbalance

Question 9

Palpation

Answer 9

• Acute:
• muscle spasm in surrounding structures
• hypertonus and trigger points

*Chronic:

• adhesions
• bogginess
• hypertonus and trigger points

Question 10

ROM Testing

Answer 10

• AROM: pain with most directions (acute); pain with one position (chronic)
• PROM: empty end-feel (acute)
• MMT: painful if surrounded by other structures; constant while bursa compressed

Question 11

Massage Therapy

Answer 11

• Acute:
• cold hydrotherapy
• reduce edema
• reduce hypertonus and trigger points in proximal/compensatory muscles
  reduce compression by addressing muscle attachments
• segmental strokes towards bursa
• reduce muscle spasm: gentle joint play
• stroking and gentle muscle squeezing distal to affected area
• pain-free PROM and AROM
• Chronic:
• deep moist heat pre-treatment; contrast post-treatment
• reduce fascial restrictions
• reduce hypertonus and trigger points in proximal/compensatory muscles
• reduce compression by addressing muscle attachments
• increase circulation to distal areas
• joint play to hypo mobile joints
• pain-free PROM and AROM (pin and stretch)

Question 12

Home-care

Answer 12

• Specific to Olecranon bursitis:
• Hydrotherapy: acute: cold; chronic: contrast, heat
• Stretch: to increase length of surrounding tissues

+ biceps brachii, triceps brachii, anconeus

+ fascia over anterior and posterior arm and forearm
- Strengthen: pain-free isometric to isotonic
+ resist elbow extension at various degrees (isometric)
+ supine/standing tricep extensions; push-ups, military press (compound exercises)

• Suggestions for ADL adaptations:
• wheel heavy loads
• take frequent breaks
• maintain healthy weight
• exercise (strong muscles protect affected joints)
• warming up and stretching

Question 13

Contraindications

Answer 13

• avoid on-site techniques when acute (no frictions)
• avoid placing drag on surrounding tissues
• if suspect infective bursitis, refer for medical attention