Olecranon bursitis - (students elbow, plumber's elbow)

A bursa is a fluid filled sac. There are several bursal sacs around the human body, in the shoulder, knee and elbow - The olecranon bursa sits

over the point of the elbow. It's function is to allow the skin overlying the elbow to move when you place your elbow down on a table top for

example. The bursa is normally only filled with a thin film of fluid to allow the different layers to glide over each other. It becomes

problematic when fluid accumulates in the bursa, causing swelling on the back of the elbow.

 There are several reasons for fluid to accumulate in the olecranon bursa.

•

Trauma - a single blow to the point of the elbow may cause bleeding into the bursa. Repetitive trauma can also cause swelling and

inflammation for eg. students who spend a lot of time resting elbows on a desk.

•

Inflammatory conditions - Rheumatoid arthritis, gout, pseudogout

•

Infection

 Diagnosis

Olecranon bursitis is fairly obvious clinically and presents with a boggy swelling over the point of the elbow. X rays may be used if a history of

trauma is offered to exclude a fracture. X rays may also be used if infection is suspected to see if the infection involves the bone (ulna).

Treatment

Treatment depends on the cause.

Acute trauma - The swelling of acute bleeding into an olecranon bursa can be impressive, reaching the size of a golf ball on the point of the

elbow. Once an x ray fracture has been excluded, treatment is purely symptomatic with RICE:

 R - rest,

 I- Ice,

 C-Compression (gentle compression),

 E- Elevation.

Repetitive trauma - Chronic thickening and swelling of the olecranon bursa follows repetitive trauma and leaning on the point of the elbow.

Treatment is to avoid leaning on the point of the elbow or use elbow pads .

 Inflammatory conditions - Rheumatoid arthritis, and gout may cause acute inflammation of the bursa, treatment involves treatment of the

underlying condition and reduction of the inflammation. Using RICE, NSAID's, on occasion steroid injection (once infection excluded).

 Infection - Infection of the olecranon bursa often responds to antibiotics.

Surgery

Surgery is only rarely indicated for olecranon bursitis, often only in recurrent cases. It involves a general anaesthetic and a 5cm wound over

the point of the elbow. The bursa is dissected free from the underlying skin and the wounds closed.