Olecranon Bursitis

THE CLINICAL SYNDROME

Olecranon bursitis may develop gradually due to repetitive irritation of the olecranon bursa or acutely due to trauma or infection. The olecranon bursa lies in the posterior aspect of the elbow between the olecranon process of the ulna and the overlying skin. It may exist as a single bursal sac or, in some patients, as a multisegmented series of sacs that may be loculated in nature. With overuse or misuse, these bursae may become inflamed, enlarged, and, on rare occasions, infected. The swelling associated with olecranon bursitis may at times be quite impressive, and the patient may complain about difficulty in wearing a long-sleeve shirt.

The olecranon bursa is vulnerable to injury from both acute trauma and repeated microtrauma. Acute injuries frequently take the form of direct trauma to the elbow in patients who play sports such as hockey or fall directly onto the olecranon process. Repeated pressure for leaning on the elbow to arise or from working long hours at a drafting table may result in inflammation and swelling of the olecranon bursa. Gout or bacterial infection may rarely precipitate acute olecranon bursitis. If the inflammation of the olecranon bursa becomes chronic, calcification of the bursa may occur with resultant residual nodules called gravel.

Ollecranon bursitis is often caused by repeated pressure on the elbow

SIGNS AND SYMPTOMS

The patient suffering from olecranon bursitis will frequently complain of pain and swelling with any movement of the elbow but especially with extension. The pain is localized to the olecranon area, with referred pain often noted above the elbow joint. Often, the patient will be more concern about the swelling around the bursa than with the pain. Physical examination will reveal point tenderness over the olecranon and swelling of the bursa that at times can be quite extensive. Passive extension and resisted flexion shoulder will reproduce the pain as will any pressure over the bursa. Fever and chills will usually accompany infection of the bursa. If infection is suspected, aspiration, Gram stain, and culture of the bursal fluid followed by treatment with appropriate antibiotics are indicated on an emergency basis.

A case of ollecranon bursitis in a patient with rheumatoid arthritis; a rheumatoid nodule is also shown.

TREATMENT

A short course of conservative therapy consisting of simple analgesics, nonsteroidal anti-inflammatory drugs or cyclooxygenase-2 inhibitors, and an elbow protector to prevent further trauma is a reasonable fist step in the treatment of patients suffering form olecranon bursitis. If the patient does not experience rapid improvement, the following injection technique is a reasonable next step.

The patient is placed in a supine position with the arm fully adducted at the patient’s side and the elbow flexed with the palm of the hand resting on the patient’s abdomen. This injection technique is extremely effective in the treatment of pain and swelling secondary to the olecranon bursitis. Coexisting tendonitis and epicondylitis may also contribute to elbow pain and may require additional treatment with more localized injection of local anesthetic and methylprednisolone acetate steroid.

Low intensity laser therapy as well as a coordinated wellness program is also effective in treating this disorder.

Low Intensity Laser Therapy (LILT)

The low intensity Laser (LILT) sends photons (light) into the injured tissues and can penetrate two to three inches to treat affected areas. It uses a natural enhancement of the cellular machinery that can and has been dynamically measured in published studies to promote healing without burning affected tissue. Once the photons find the injured tissues, they stimulate and energize the cells to repair and strengthen at a remarkable rate. The treatment does not hurt, takes about 30 minutes and is very cost advantageous.

Wellness Program

A wellness program whichindividualizes treatment for age, performance and function has been shown in pilot studies to improve the overall health and well being of the individuals evaluated. A well conceived dietary and supplementary regimen based on scientific age–related decline in certain necessary compounds can improve quality of life, correct the ravages of hormone imbalance, balance critical neurotransmitter function without resorting to powerful drugs for depression that often have unfavorable side-effect profiles and restore vitality and youth in daily exercise routines. Furthermore, when wellness products are utilized with success, individuals often seek less costly interventions including unnecessary surgeries and narcotic options to treat pain. For more information go to www.drpwellness.com.