What Is Olecranon Bursitis?
A bursa is a small, thin-walled sac lined with synovial membrane that produces fluid to reduce friction between overlying skin and underlying bone. The olecranon bursa sits directly over the pointed bony prominence at the back of the elbow (the olecranon). Under normal circumstances it is flat and barely perceptible. When inflamed, it fills with fluid and produces the characteristic soft swelling at the elbow tip.
Olecranon bursitis is relatively common and can occur at any age, including in children and adolescents who participate in contact sport or activities involving prolonged leaning on hard surfaces.
Traumatic
A direct blow to the elbow or chronic repetitive pressure (e.g. leaning on a desk) causes irritation and fluid accumulation. Sometimes called “student’s elbow” or “miner’s elbow.”
Septic (Infected)
Bacteria — most commonly Staphylococcus aureus — enter via a skin break or haematogenous spread, causing an infected bursa that requires prompt treatment.
Inflammatory
Conditions such as gout, rheumatoid arthritis, and pseudogout can cause bursitis as part of a broader crystal or inflammatory arthropathy.
Distinguishing Septic from Non-septic Bursitis
This distinction is the most clinically important step in assessing olecranon bursitis, as the two conditions require different treatments. Non-septic bursitis is generally managed conservatively, whereas septic bursitis requires antibiotic therapy and often drainage.
- Non-septic bursitis — typically painless or mildly uncomfortable swelling; overlying skin is normal in colour and temperature; no systemic features
- Septic bursitis — warm, erythematous (red) overlying skin; tender fluctuant swelling; may have fever and raised inflammatory markers; history of preceding skin break or abrasion
- Bursal aspiration — sending fluid for Gram stain, culture, cell count, and crystal analysis is the most reliable way to differentiate septic from non-septic bursitis when there is clinical uncertainty
Treatment
The majority of cases of olecranon bursitis resolve with appropriate conservative management.
- Non-septic bursitis — protective elbow padding to avoid further trauma, compression bandaging, and avoidance of aggravating activities. Aspiration can reduce the swelling rapidly and a corticosteroid injection may be considered for recurrent or refractory non-septic cases
- Septic bursitis — oral antibiotics covering Staphylococcus aureus (e.g. flucloxacillin) are commenced promptly. Serial aspiration is performed to monitor the fluid. Intravenous antibiotics and surgical drainage or bursectomy are required if there is no response to conservative measures or if frank abscess formation is present
- Inflammatory bursitis — management of the underlying condition (gout, RA) in conjunction with local aspiration and anti-inflammatory treatment
- Surgical bursectomy — excision of the bursa is reserved for chronic, recurrent, or refractory cases. It is an elective procedure performed through a small incision over the olecranon and is generally well tolerated
Most patients with non-septic olecranon bursitis recover fully with conservative management within four to eight weeks. Recurrence can be minimised by addressing the precipitating cause and using protective padding during at-risk activities.
Discuss Elbow Bursitis
For a personalised assessment and treatment plan, contact Dr. Pirpiris’s rooms at Cabrini Medical Centre, Malvern.
📞 Call 03 9508 9600