Bursitis is inflammation or swelling of the bursa (a sac filled with liquid) that acts as a cushion between the tendons and bones.
Olecranon bursitis is a common ailment characterised by the elbow appearing to have a golf ball sitting underneath the skin. The condition occurs at the pointed part of the elbow when the soft sac that sits between bone and skin (the olecranon bursa) becomes inflamed.
The olecranon bursa’s job is to reduce friction and assist joint movement in the elbow. To assist with this, bursas contain small amounts of fluid that help them lubricate the area. When a bursa becomes irritated, that fluid accumulates and the bursa enlarges.
Bursitis at the elbow can range in size from anywhere from a peanut size up to as large as a tennis ball. The larger a bursa grows, the more likelihood it will cause pain and restrict movement.
What causes olecranon bursitis?
Elbow bursitis can occur due to a number of factors including:
- Prolonged pressure such as leaning on the elbow for long periods of time on hard surfaces (such as a desk).
- Trauma such as a hard knock to the tip of the elbow caused by a fall or injury.
- Infection after an injury or insect bite breaks the skin.
- Diseases such as rheumatoid arthritis, diabetes or gout.
Certain occupations or activities can increase the likelihood of developing bursitis at the elbow. For example, plumbers and some construction workers are often required to crawl using their elbows, which over time can cause irritation.
Symptoms of olecranon bursitis
The most common first symptom of bursitis in the elbow is swelling. Depending on how loose the skin on the back of the elbow is, this swelling may not be noticed for some time. However, as the swelling continues, the bursa begins to stretch and cause pain. This pain often gets worse when additional pressure is put on the elbow, such as when bending it. If the bursa becomes infected, it causes redness, tenderness and warmth in the elbow. Infected bursas can also cause fever, and can sometimes break open and spread bacteria into the bloodstream.
How is elbow bursitis diagnosed?
After discussing your symptoms and medical history, orthopaedic surgeon Dr James McLean will conduct a physical examination of your elbow. If sufficient evidence of bursitis exists, tests may end there. However, if Dr McLean suspects a foreign body or bone spur as a potential cause of bursitis, he may order an X-ray to investigate further. Blood tests also may be ordered if the condition is linked to another cause such as arthritis or gout. If the elbow is red or unusually warm to the touch, the possibility of infection must be assessed. To do this, a small sample of fluid is extracted from the bursa with a needle and examined by a pathologist.
Treatment options for bursitis
Non-invasive treatments are preferred wherever possible to reduce the symptoms of olecranon bursitis. These may include:
- Anti-inflammatory medication such as ibuprofen
- Draining fluid with a needle
- Applying elbow pads or an elbow wrap
- Resting the area as much as possible
- Gentle mobilising exercises
- Antibiotics (if an infection is present)
If these options fail to resolve the condition, elbow surgery may be required.
Surgical treatment options
Depending on the size of the lesion, the bursa may be removed through endoscopic surgery performed by Dr McLean. Also known as ‘keyhole surgery’, endoscopy is a minimally invasive procedure that offers faster recovery times and less risk of infection than traditional open cut methods. The procedure itself is usually performed under a general anaesthetic as day surgery. During the procedure, small specialised instruments are inserted through a 6cm cut at the back of the elbow. A tiny lighted camera is also inserted, which allows Dr McLean to view the elbow from the inside on a monitor, which he uses to perform the surgery internally.
If the lesion is large, a rotational skin flap may be required to close the empty space that is left after the bursa is removed. In this case, a larger incision will be required to allow appropriate healing and prevent recurrence of the lesion.
After the bursa is removed, the instruments are carefully removed, the incision is closed, and the wound is dressed. The surgery usually takes less than an hour, with patients returning home later that day. The elbow can be used immediately after surgery and often a compression bandage is applied to prevent fluid accumulating under the skin. During the recovery period, the body will form a new bursa to assist the smooth motion of skin over the olecranon bone.
Most patients return to their normal activities within 2 weeks. Those whose employment involves manual labour may need to return to light duties only for a period of time.
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