Olecranon bursitis (nonseptic)

Background

• Inflamation of the bursal cavity superficial to the olecranon
• Majority of cases are not infectious, but inflammation can be from infection (septic bursitis)
• Also known as "student's elbow" or "baker's elbow"
• Often caused by repeated minor trauma from external pressure to elbow
• There is controversy regarding initial diagnosis and treatment

Clinical Features

Olecranon bursitis, nonseptic

Differential Diagnosis

Elbow Diagnoses

Radiograph-Positive

• Distal humerus fracture
• Radial head fracture
  • Essex-Lopresti fracture
• Capitellum fracture
• Olecranon fracture
• Elbow dislocation

Radiograph-Negative

• Biceps tendon rupture/dislocation
• Lateral epicondylitis
• Medial epicondylitis
• Olecranon bursitis (nonseptic)
• Pronator teres syndrome
• Septic bursitis

Pediatric

• Nursemaid's elbow
• Supracondylar fracture
• Lateral epicondyle fracture
• Medial epicondyle fracture
• Olecranon fracture
• Radial head fracture
• Salter-Harris fractures

Evaluation

Workup

• Xrays if trauma, may consider for all to rule out bone spur as causative agent (although not emergent)
• Initial aspiration is controversial. There is currently no consensus on the optimal diagnosis strategy for prepatellar bursitis. The majority of patients studied did receive an aspiration of fluid (82%), but those patients had a significantly higher rate of complications (persistent infection, secondary infection in initially aseptic bursae) than patients treated with antibiotics alone.
  • If any signs of infection, must aspirate to rule out septic bursitis
  • If no signs of infection:
    • May consider initial conservative (no aspiration) treatment for several days
    • Some sources suggest aspiration for all cases

Diagnosis

• Bursal fluid on exam
• Non-erythematous
• FROM
• Negative axial load

Management

• Acute
  • Avoid trauma and excessive pressure
  • RICE & NSAIDs
• Chronic = surgery

Disposition

• Outpatient management

See Also

• Bursitis
• Elbow Diagnoses