Olecranon bursitis

Olecranon bursitis describes inflammation of the fluid-filled bursa overlying the olecranon process at the proximal ulna. The bursa reduces friction between the elbow and overlying tissues. It may be caused by trauma, infection, or systemic inflammatory conditions such as gout or rheumatoid arthritis. Also referred to as 'student's elbow', it often results from repetitive leaning on hard surfaces. Bursitis may be septic or non-septic.

Epidemiology

• More common in men
• Typically affects adults aged 30–60

Causes

• Repetitive trauma - writers and students leaning on elbows, plumbers, miners
• Direct trauma
• Infection – usually Staphylococcus aureus; more common in patients with diabetes, alcohol misuse, steroid use or renal impairment
• Gout, rheumatoid arthritis, or idiopathic causes

Presentation

• Swelling over the olecranon process (100%)
• Non-septic cases: may be painless, with variable tenderness and mild erythema
• Septic cases: typically more painful, often with fever and pronounced erythema
• Elbow movement usually preserved but may be painful at extremes of flexion

Signs

• Fluctuant, well-circumscribed swelling at the posterior elbow
  • sometimes described as a 'golf ball on the end of the elbow'
• Tenderness and warmth over the bursa
• Fever and overlying skin changes suggest possible infection
• Tophi or joint effusions if due to gout or rheumatoid arthritis