INJECTION THERAPY FOR OLECRANON BURSITIS

What is olecranon bursitis?

Bursitis of the olecranon causes a lot of swelling (like a golf ball) and pain in the back of the elbow (see images below in article). Bending the elbow aggravates the pain, which is made worse if you lean on the point of the elbow. Swelling is the most common symptom, and it can be quite severe, making it difficult to carry out daily tasks. Swelling may or may not be accompanied by pain.

Olecranon bursitis can occur following a fall onto the point of the elbow or can occur for no reason. If you have redness and significant heat on the elbow the bursa may be infected. If this is the case you must have your elbow assessed by a doctor immediately, to get started on antibiotics. In a majority of cases the pain and swelling resolves spontaneously over many weeks. However, on occasion the pain and swelling can remain. If so, an ultrasound guided procedure can be carried out to drain the fluid and inject a small amount of steroid to reduce pain and ensure the swelling does not return.

What are the symptoms of olecranon bursitis?

The symptoms of an olecranon bursitis are:

  • The back of the elbow is inflamed and swollen.
  • If you bend your elbow or lean on the point of your elbow, you will experience pain.
  • If you have redness and heat along with swelling and pain, you should see a doctor right away because you may have an infected bursa.

What are some additional conditions that are similar to

olecranon bursitis?

  1. Golfer’s elbow
  2. Tennis Elbow
  3. Posterior Interosseus Nerve (PIN) entrapment

Olecranon bursitis vs Tennis Elbow

Tennis elbow is characterised by pain and tenderness on the outside of the elbow, whereas olecranon bursitis is linked with a large swelling towards the back of the elbow, with or without discomfort. Gripping and cocking the wrist aggravates tennis elbow discomfort, but leaning on your elbow aggravates olecranon bursitis.

Anatomy

The olecranon is a prominent bony prominence that creates the pointy bone of your elbow and is placed at the tip of the ulna (long bone of the forearm). The olecranon bursa is a tiny fluid-filled sac that lies directly in front of the olecranon.

Olecranon Bursitis injections

Over 150 bursae can be found throughout the body. They are designed to;

  • Reduce the amount of friction. Bursa Reduce the amount of friction that occurs during movement. These small fluid-filled sacs are commonly seen between tendons or between the tendon and the bone, allowing for recurrent fluid movement without abrasion. The pes anserine bursa of the knee, for example.
  • Areas at risk of direct impact should be protected. Bursae are created to protect bone prominences from direct collision, minimising the risk of injury. Consider the olecranon bursa of the elbow, which is addressed in this article.

Bursa is capable of doing their professional duties admirably. The bursa, on the other hand, can become inflamed and unpleasant if it is subjected to repetitive movements for lengthy periods of time, or if movement patterns are poorly managed, or if it is subjected to direct impact. Bursitis refers to an inflamed bursa, which is a common source of musculoskeletal pain.

The olecranon bursa protects the olecranon bone from direct impact while also allowing fluid free movement of the olecranon beneath the elbow skin. Del Buono et al (2012) found that olecranon bursitis is most common in men between the ages of 30 and 60, and that it is caused by:

  • Apply firm pressure on the elbow. Students elbow is a condition that is caused by lengthy durations of weight-bearing through the elbow while working at a desk.
  • An unexpected direct blow to the elbow’s tip.
  • The bursa is susceptible to infection due to its superficial position, resulting in septic olecranon bursitis (Riley et al., 2016).
  • The olecranon bursa can become inflamed as a result of rheumatological disorders including gout or rheumatoid arthritis (Sayegh et al., 2014).

How is olecranon bursitis diagnosed?

Because olecranon bursitis can be aseptic (i.e., without infection) or septic (i.e., infected), a precise diagnosis is essential for safe and effective treatment. Your GP, an orthopaedic consult, or a physiotherapist can all diagnose olecranon bursitis. Because septic bursitis necessitates immediate medical attention, an accurate assessment is required to ensure the suitable treatment approach is chosen.

What are the symptoms of olecranon bursitis?

  • Direct pressure causes pain when weight is applied to the area or when it is touched.
  • Swelling on the back (posterior) side of the elbow. The olecranon bursa can swell dramatically in some circumstances, resulting in a huge fluid-filled protrusion. As shown in the image above.

The following symptoms may be present if the olecranon bursa is infected:

  • It’s possible that the skin around the olecranon will turn red.
  • The temperature has risen. A red and hot elbow affects between 63 and 100 percent of people with olecranon bursitis (Del Buono et al 2012).
  • You might feel ill in some circumstances. If you have bursitis, a fever could be an indication of an inflamed bursa.

(It is extremely recommended that you see your doctor if you suffer all three of these symptoms.)

A set of questions are used to assess the student. Direct questioning is critical for determining a diagnosis. A detailed medical history (to rule out rheumatological causes for your pain or infection), how your discomfort began (due to direct trauma or gradually after scratching your elbow), and what variables aggravate and relieve your symptoms are all part of the evaluation.

A physical examination is also required, which includes a thorough examination of the skin that covers the olecranon. It’s possible that your clinician will palpate (feel) your elbow, which could be unpleasant. Elbow strength and movement are also checked on a regular basis.

Although the most common cause of olecranon bursitis is aseptic bursitis caused by direct pressure or trauma, your doctor may order additional tests.

Additional research could include:

  • Blood tests may be ordered to rule out an infection or a systemic inflammatory disorder like rheumatoid arthritis or gout [cornerstone article].
  • [Cornerstone article] Bursal aspiration A little amount of bursal fluid is extracted with a needle and sent to a pathology lab for analysis if septic olecranon bursitis is suspected.
  • Diagnostic musculoskeletal ultrasound imaging is an evidence-based imaging method for assessing bursal disease. Diagnostic ultrasound has been shown to be a highly effective imaging tool for diagnosing inflammatory arthritic illnesses like gout (Fernandez et al. 2017 and Villaverde et al. 2014), making it an ideal imaging approach for differentiating diagnosing the source of olecranon bursitis.

We have a team of experts at Joint Injections who are both physiotherapists and musculoskeletal sonographers. Your doctor will be able to clinically check your elbow and perform a diagnostic musculoskeletal ultrasound [cornerstone article] scan during your initial consultation, providing you with an accurate diagnosis of your pain.

 

Treatment

The treatment for olecranon bursitis is depending on whether the bursa is aseptic or septic, and on whether the bursa is aseptic or septic.

Aseptic olecranon bursitis

The vast majority of individuals with aseptic bursitis (the most prevalent cause of symptoms) respond favourably to conservative treatment, which includes the following:

  • Weight-bearing above the elbow, for example, should be avoided.
  • To reduce direct pressure on the olecranon, local cushioning is used.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen for a brief period of time (Kennedy et al., 2016).

What if the symptoms of a septic olecranon bursitis do not improve after conservative treatment?

If you’ve attempted conservative treatment but your symptoms have persisted for more than three months and are interfering with your ability to perform the duties below, an ultrasound-guided bursal aspiration and corticosteroid injection [cornerstone article] may be right for you.

  • At night, sleep
  • Complete daily living activities
  • Work or resumption of athletic pursuits

An ultrasound scan is used to provide real-time imaging of your olecranon bursa during this operation. This enables precise needle placement inside the bursa. The bursa is subsequently aspirated (emptied) of any excess bursal fluid. Bursal aspiration is required in 70.9 percent of all aseptic olecranon bursitis patients, according to research (Sayegh et al., 2014). A local anaesthetic (numbing agent) and a tiny dosage of corticosteroid (a strong anti-inflammatory medication commonly used in musculoskeletal therapy) can also be injected at this stage if necessary. In musculoskeletal medicine, ultrasound-guided corticosteroid injections are commonly used to treat bursitis and are an efficient technique of lowering pain and inflammation associated with this ailment (Del Buono et al 2012). There is a modest risk of post-injection problems such as infection and local skin discoloration due to the bursa’s shallow position. Due to the greater accuracy of needle placement, this is considerably reduced when employing ultrasound guidance [cornerstone article].

All ultrasound injections at Joint Injections can be done the same day. Our team of highly specialised physiotherapists are fully qualified musculoskeletal sonographers and can prescribe the best medication for you before administering an ultrasound-guided injection all in the same consultation. Prior to using our same-day service, you do not need to be referred or have a prescription from your doctor.

Septic olecranon bursitis

Antibiotics and aspiration of the infected fluid within the bursa are commonly used to treat septic olecranon bursitis. According to studies, 82 percent of all infected bursae necessitate aspiration (Sayegh et al., 2014). Septic olecranon bursitis requires medical treatment from your GP or an orthopaedic consultant, with antibiotics and aspiration resolving the great majority of septic cases. In the unlikely event that treatment does not relieve symptoms, surgical intervention may be required.