THE CLINICAL SYNDROME

• It is possible for olecranon bursitis to develop gradually as a result of repetitive irritation of the olecranon bursa or acutely as a result of trauma or infection.

• Both scenarios have the potential to cause the condition.

• The olecranon bursa can be found in the back of the elbow, specifically in the space that is created by the olecranon process of the ulna and the skin that covers it.

• It is possible for it to take the form of a single bursal sac, but in some patients it can also take the form of a multisegmented series of loculated sacs.

• These bursae have the potential to become inflamed, enlarged, and even infected if they are used improperly or for an extended period of time.

• Because of the significant swelling that is often associated with olecranon bursitis, the patient may feel that they are unable to wear shirts with long sleeves and may express their frustration with this.

• The olecranon bursa is susceptible to injury in the event of either a single severe blow or a series of smaller, more frequent blows.

• Patients who play sports like hockey or who fall directly onto the olecranon process often sustain acute injuries as a result of direct trauma to the elbow.

• This can cause the olecranon process to become fractured.

• The olecranon bursa is susceptible to inflammation and swelling if it is subjected to repeated pressure from leaning on the elbow.

• This type of pressure can occur when working at a drafting table for long periods of time.

• Extremely infrequently, acute olecranon bursitis can be precipitated by gout or a bacterial infection.

• In the event that the inflammation of the olecranon bursa continues for an extended period of time, rice bodies, cords, and calcification of the bursa, which results in residual calcified nodules called grave, are all potential outcomes.

SIGNS AND SYMPTOMS

• Patients who suffer from olecranon bursitis, which is also known as dialysis elbow, frequently complain of swelling and pain with any movement of the elbow, but especially with extension.

• This is especially the case when the elbow is extended.

• The discomfort is localized to the region of the olecranon, and patients frequently report experiencing referred pain above the elbow joint.

• In many cases, the patient is more concerned about the swelling than the pain that they are experiencing.

• An examination of the patient's physical condition reveals that there is localized tenderness over the olecranon as well as swelling of the bursa, which may be extensive.

• The pain can be reproduced by both passive extension and resisted flexion, as well as by any pressure that is applied over the bursa.

• Infection of the bursa is typically accompanied by fever as well as chills.

TESTING

• In most cases, olecranon bursitis is diagnosed solely on the basis of clinical symptoms and signs.

• If the patient has a history of elbow trauma or if arthritis of the elbow is suspected, plain radiographs of the posterior elbow are an appropriate diagnostic procedure to perform.

• Calcification of the bursa and the structures that are associated with it can also be seen on plain radiographs, which is consistent with chronic inflammation.

• Magnetic resonance imaging and ultrasound imaging should be performed if there is a suspicion of joint instability, to further characterize the nature of masses of the posterior elbow (such as whether they are solid or cystic), and to clarify the diagnosis of olecranon bursitis if there is any uncertainty regarding the condition.

• If collagen vascular disease is suspected, a complete blood count, an automated chemistry profile that measures factors such as uric acid level, erythrocyte sedimentation rate, and anti-nuclear antibody testing should be carried out. In the event that an infection is suspected, it is imperative that an aspiration, Gram stain, and culture of the bursal fluid be performed immediately, immediately followed by treatment with the appropriate antibiotics.

DIFFERENTIAL DIAGNOSIS

• The olecranon bursitis diagnosis is typically very easy to make through clinical examination.

• Rheumatoid nodules or gouty arthritis of the elbow can sometimes make it difficult to understand the full clinical picture.

• It's also possible that you have synovial cysts in your elbow instead of olecranon bursitis.

• Tendinitis that is already present (for example, tennis elbow or golfer's elbow) might call for additional treatment.

• Pyoderma gangrenosa can on occasion have a clinical presentation that is similar to that of olecranon bursitis.

TREATMENT

• Initial treatment for patients suffering from olecranon bursitis consists of a brief course of conservative therapy that may include the use of simple analgesics, nonsteroidal anti-inflammatory drugs (NSAIDs), or cyclooxygenase-2 inhibitors.

• Patients should also wear an elbow protector to prevent further trauma to the affected area.

• The subsequent injection method is a reasonable next step to take if there is no rapid improvement seen as a result of the treatment.

• When treating elbow pain with an injection, it is recommended to wait several days before beginning any physical modalities.

• These modalities include applying local heat and beginning gentle range-of-motion exercises.

• In some cases, the application of a compression dressing after an aspiration can help prevent the reabsorption of fluid.

• To alleviate the pain and functional disability caused by bursitis, surgical removal of the inflamed bursa is occasionally required.

• Exercises that are too strenuous for the patient should be avoided because doing so will make their symptoms even worse.

COMPLICATIONS AND PITFALLS

• If olecranon bursitis is not treated properly, the patient may experience persistent pain and a reduction in the range of motion in their elbow.

• The injection method is risk-free provided that the clinically relevant anatomy is carefully considered before administering the injection.

• Particularly, the ulnar nerve is vulnerable to damage at the elbow; however, it is possible to avoid such damage by maintaining the needle trajectory in the midline.

• In order to prevent infection, sterile technique must be utilized, and universal precautions must be taken in order to lessen the likelihood that the operator will be put in harm's way.

• The most significant risk associated with bursal injection is the possibility of contracting an infection; however, this should be an extremely remote possibility if proper aseptic procedure is followed.

• If pressure is applied to the injection site immediately after the injection, this can help reduce the risk of complications such as ecchymosis and hematoma developing at the site.

• Patients should be warned about the possibility of experiencing a transient increase in pain after receiving an injection into the olecranon bursa, as this affects approximately one quarter of all patients.