The olecranon, or tip of the elbow, has a small fluid-filled sac just outside of it to serve as sort of a shock absorber when putting the elbow against hard objects or to prevent friction during elbow range of motion. It is normally very thin. When it is inflamed, the bursa can become large and swollen. Typically olecranon bursitis manifests as swelling, although the amount of swelling in front of the olecranon can become uncomfortable. Typically it is not red or warm unless it is an infected bursa, which happens occasionally.
Most patients with olecranon bursitis do not remember any specific inciting event. It is often seen in truck drivers who rest their elbows against the window or in car drivers or riders who rest their elbows against the windows or center console.
Treatment for olecranon bursitis
Most of the time the treatment for olecranon bursitis is symptomatic. I usually recommend that patients try icing the elbow to decrease the inflammation and possibly try anti-inflammatory medications. I try to avoid drawing fluid off, if possible. In my experience, very little fluid is actually withdrawn, and it often comes right back. Also multiple attempts at draining the fluid potentially increases the risk of infecting the bursa, leading to a septic bursitis that often requires urgent surgery. Sometimes draining the fluid off and injecting cortisone one time to try to keep the inflammation from returning is an option.
Surgery for olecranon bursitis
Occasionally nonsurgical treatments including rest, ice, anti-inflammatory medications, avoiding direct pressure on the bursa, and even repeat attempts at drainage are unsuccessful. In this case surgery can be useful. Typically the surgery involves making a small incision over the bursa and removing the entire bursa. This is usually done in hospitals or surgery centers to minimize the chance of infection. It also does not usually require full general anesthesia but can often can be done with a combination of local anesthesia and sedation or a regional nerve block. Removing the bursa surgically usually successfully resolves the problem.
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