Olecranon Bursitis

Olecranon bursitis is a common cause of painless elbow swelling from repetitive friction of the olecranon against a firm surface or traumatic impact. Patients most often present with a painless swelling at the dorsal tip of the elbow, described as "a golf ball" or "goose egg" (Fig. 30-17). With trauma-induced swelling, pain and a hematoma may be present. Pain, redness, warmth, and lymphadenopathy may accompany septic bursitis. ROM loss, instability, neurovascu-lar compromise, and strength loss are uncommon. On examination, there is a soft, fluctuant area of swelling directly over the olecranon. Diagnostic studies are generally not necessary to make a diagnosis of olecranon bursitis. However, plain radiographs should be obtained if trauma preceded the bur-sitis or fracture or dislocation is suspected.

Treatment includes compression, ice, and avoidance of impact at the olecranon. NSAIDs may help to reduce swelling. If the fluid collection is large or infection is suspected, aspiration of the bursa can be done in the office with a large-bore needle under sterile conditions. The bursa fluid should be clear and straw colored but may be bloody in a

Olecranon bursa

Olecranon bursa

Figure 30-17 A, Relation of the olecranon bursa to the skin and olecranon. B, Photograph of an enlarged olecranon bursa.

(From Singer KM, Butters KP: Olecranon bursitis. in Delee JC, Drez D [eds]. Orthopedic Sports Medicine: Principles and Practice, vol 1. Philadelphia, Saunders, 1994, pp 890,892.)

Figure 30-17 A, Relation of the olecranon bursa to the skin and olecranon. B, Photograph of an enlarged olecranon bursa.

(From Singer KM, Butters KP: Olecranon bursitis. in Delee JC, Drez D [eds]. Orthopedic Sports Medicine: Principles and Practice, vol 1. Philadelphia, Saunders, 1994, pp 890,892.)

traumatic injury. If an infection is not suspected clinically once the fluid is withdrawn, a corticosteroid can be injected. Corticosteroids should never be injected if infection is a possibility. Oral antibiotics can be started if an infection is present. A local incision and drainage (I&D) may be required in the presence of an infection and abscess. Aspiration does not replace compression wrap, ice, and avoidance of impact. Fluid may reaccumulate but should decrease. Serial aspirations are an option in a recurrent aseptic bursitis, but bursec-tomy is occasionally needed for definitive treatment.

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