Olecranon Bursitis: Causes, Symptoms, Diagnosis, and Treatment

What is the fluid build up on my elbow?

Fluid buildup on the elbow is most commonly a condition known as olecranon bursitis, which is the inflammation and swelling of the olecranon bursa, a small, fluid-filled sac located at the tip of the elbow.

Understanding Elbow Fluid Buildup

The human body contains numerous bursae, which are thin, slippery sacs filled with a small amount of synovial fluid. Their primary function is to reduce friction between tissues, such as bones, tendons, and muscles, during movement. The olecranon bursa is strategically positioned between the bony prominence of the elbow (the olecranon process of the ulna) and the skin. While crucial for smooth elbow movement and protection, this superficial location makes it vulnerable to injury and inflammation. When this bursa becomes irritated or inflamed, it produces excess fluid, leading to the noticeable swelling and fluid buildup observed on the elbow.

The Anatomy of the Elbow and Bursae

To fully grasp olecranon bursitis, a brief understanding of elbow anatomy is beneficial. The elbow joint is a hinge joint formed by the humerus (upper arm bone) and the ulna and radius (forearm bones). The very tip of the ulna, which forms the point of the elbow, is called the olecranon process. Overlying this bony prominence is the olecranon bursa. Unlike some other bursae, the olecranon bursa is subcutaneous, meaning it lies directly under the skin, with minimal muscle or fat covering it. This anatomical feature contributes to its susceptibility to direct trauma and pressure.

Causes of Olecranon Bursitis

Fluid buildup in the olecranon bursa can result from several factors, often categorized by their origin:

• Trauma or Direct Impact: A sudden, sharp blow to the tip of the elbow can irritate the bursa, leading to inflammation and fluid accumulation. This is common in falls or sports injuries.
• Repetitive Pressure: Sustained or repeated pressure on the elbow is a very common cause. Activities that involve leaning on the elbows for extended periods, such as studying, desk work, or certain manual labor tasks, can trigger bursitis. This is why it's sometimes colloquially referred to as "student's elbow," "miner's elbow," or "draftsman's elbow."
• Infection (Septic Bursitis): The bursa can become infected if bacteria enter through a cut, scrape, insect bite, or puncture wound near the elbow. This is a more serious form of bursitis, characterized by rapid swelling, significant pain, redness, warmth, and potentially fever.
• Systemic Conditions: Underlying medical conditions can predispose individuals to bursitis. These include:
  • Gout: A form of inflammatory arthritis caused by a buildup of uric acid crystals in the joints.
  • Pseudogout: Similar to gout, but caused by calcium pyrophosphate crystals.
  • Rheumatoid Arthritis: An autoimmune disease that causes chronic inflammation of the joints.
  • Diabetes: Can increase susceptibility to infections, including septic bursitis.

Signs and Symptoms

The presentation of olecranon bursitis can vary depending on the cause and severity, but common signs and symptoms include:

• Swelling: The most prominent symptom is a noticeable lump or swelling at the back of the elbow, which can range from a small, golf-ball-sized bump to a larger, more distended mass.
• Pain: Pain can be mild or severe, often worsening with direct pressure on the elbow, bending the elbow, or extending the arm fully. In cases of septic bursitis, the pain is typically more intense and throbbing.
• Redness and Warmth: The skin over the bursa may appear red and feel warm to the touch, especially if infection is present. This is a critical sign that warrants immediate medical attention.
• Restricted Movement: While full range of motion is often preserved in non-septic cases, severe swelling or pain, particularly with infection, can limit the ability to bend or straighten the arm completely.
• Fever and Chills: These are systemic signs that strongly suggest an infection and indicate septic bursitis.

Diagnosis

Diagnosing olecranon bursitis typically involves a combination of clinical assessment and, if necessary, diagnostic tests:

• Physical Examination: A healthcare professional will examine the elbow, checking for swelling, tenderness, redness, and warmth. They will also assess the range of motion of the elbow joint.
• Imaging Studies:
  • X-rays: Usually performed to rule out a fracture, bone spur, or other bony abnormalities that might be contributing to the symptoms.
  • Ultrasound: Can effectively visualize the bursa, confirming fluid accumulation and assessing the extent of inflammation.
  • MRI (Magnetic Resonance Imaging): Less commonly used but may be ordered to rule out other soft tissue injuries or complex cases.
• Fluid Aspiration (Bursa Tap): If infection is suspected, a small needle may be used to aspirate (draw out) fluid from the bursa. This fluid is then sent to a laboratory for analysis to identify bacteria, uric acid crystals, or other inflammatory markers. This is crucial for differentiating between septic and non-septic bursitis.

Management and Treatment

Treatment for olecranon bursitis depends on its cause and severity.

Conservative Measures (Non-Septic Bursitis)

For non-infected cases, initial treatment focuses on reducing inflammation and symptoms:

• RICE Protocol:
  • Rest: Avoid activities that put pressure on the elbow.
  • Ice: Apply ice packs to the affected area for 15-20 minutes several times a day to reduce swelling and pain.
  • Compression: Use a compression bandage or sleeve to help reduce swelling, but ensure it's not too tight.
  • Elevation: Keep the elbow elevated above the heart to minimize fluid accumulation.
• NSAIDs (Non-Steroidal Anti-Inflammatory Drugs): Over-the-counter medications like ibuprofen or naproxen can help manage pain and inflammation.
• Padding and Protection: Use elbow pads or cushions to protect the bursa from further irritation, especially during activities that involve leaning on the elbow.
• Activity Modification: Identify and modify activities that exacerbate the condition.

Medical Interventions

If conservative measures are insufficient or if the bursitis is severe or infected:

• Fluid Aspiration: Draining the excess fluid from the bursa can provide immediate relief from swelling and pressure. This is often followed by a compression bandage.
• Corticosteroid Injections: For persistent non-septic bursitis, an injection of corticosteroids into the bursa can powerfully reduce inflammation. This is usually done after aspiration.
• Antibiotics: If the bursitis is infected (septic bursitis), a course of oral or intravenous antibiotics is essential to clear the infection. This is a medical emergency that requires prompt treatment.
• Physical Therapy: Once initial inflammation subsides, a physical therapist can guide exercises to restore range of motion and strengthen surrounding muscles, preventing recurrence.

Surgical Intervention

Surgery (bursectomy) is rarely needed but may be considered for chronic, recurrent, or severely infected cases that do not respond to other treatments. During a bursectomy, the inflamed bursa is surgically removed. The bursa typically grows back normally over a few months.

Prevention Strategies

Preventing olecranon bursitis involves protecting the elbow from undue stress and trauma:

• Use Elbow Pads: Wear elbow pads during sports, work, or activities that involve repetitive contact or pressure on the elbows.
• Avoid Prolonged Leaning: Be mindful of prolonged leaning on hard surfaces. Use cushions or adjust your posture if your job or hobbies require resting on your elbows.
• Proper Technique: In sports or exercises, ensure proper technique to minimize stress on the elbow joint.
• Manage Underlying Conditions: If you have conditions like gout or rheumatoid arthritis, work with your doctor to manage them effectively to reduce the risk of bursitis flares.
• Skin Care: Keep the skin around the elbow clean and address any cuts or scrapes promptly to prevent bacterial entry and infection.

When to Seek Medical Attention

While many cases of olecranon bursitis can be managed conservatively, it's important to seek medical attention if you experience:

• Rapidly worsening swelling, pain, redness, or warmth.
• Fever or chills.
• Inability to move the elbow or arm.
• Persistent symptoms despite conservative home care.
• Any open wound or broken skin near the bursa.

Early diagnosis and appropriate treatment are key to preventing complications and ensuring a swift recovery from fluid buildup on the elbow.