Olecranon bursitis !
Olecranon bursitis is a swollen, fluid-filled sac at the point of the elbow, caused by pressure, injury, gout or infection.
Updated 2026-10-29
Structures involved
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Why it happens
- Patterns of acute inflammation: serous, fibrinous, purulent, abscess, ulcer
- Synovial joints: capsule, synovial membrane and articular cartilage
What it is
Inflammation of the superficial bursa over the tip of the elbow, which fills with fluid and forms a soft swelling. It can be aseptic (pressure, injury, gout or rheumatoid arthritis) or septic (bacterial infection), and telling them apart guides treatment.
Who gets it
Common in adults, more often men, and in jobs or habits that lean on the elbow (manual workers, miners, students, drivers). Septic cases are a substantial share of those seen in emergency care.
Causes
- Repetitive pressure or friction on the elbow (leaning on desks, kneeling-type work done on the elbows)
- A single blow or fall on the point of the elbow
- Crystal disease (gout, calcium pyrophosphate deposition) or rheumatoid arthritis
- Infection, most often by Staphylococcus aureus and then streptococci, through a skin break or nearby cellulitis
Risk factors
- Occupations or sports with pressure on the elbow
- Gout, rheumatoid arthritis or chronic kidney disease on dialysis
- Diabetes, alcohol use disorder, immunosuppression or corticosteroid therapy (for septic bursitis)
- Skin abrasions, wounds or eczema over the elbow
Pathophysiology
The olecranon bursa lies just under thin skin, so pressure or trauma readily irritates its lining, which then produces excess fluid. In septic bursitis bacteria enter through the skin and cause a purulent collection with surrounding cellulitis. Because the bursa does not communicate with the elbow joint, joint motion is usually preserved.
Classification
- Aseptic (traumatic, idiopathic, crystal-related or rheumatoid)
- Septic (bacterial)
- Acute or chronic
Symptoms and signs
- Soft, fluctuant swelling over the point of the elbow, sometimes large
- Little pain in aseptic cases; marked pain, warmth and redness in septic cases
- Elbow motion largely preserved, with discomfort mainly at full flexion
- Fever, spreading redness or a skin wound suggesting infection
Diagnosis
- Clinical
- Swelling confined to the bursa with preserved elbow motion. Warmth, redness, tenderness, fever and a skin breach favour infection, but clinical signs alone do not reliably separate septic from aseptic bursitis.
- Tests
- Aspiration of the bursa when infection is suspected: cell count, Gram stain, culture and crystal analysis. Blood count and inflammatory markers support the assessment.
- Imaging
- X-rays look for an olecranon spur, fracture or foreign body; ultrasound shows the fluid collection and guides aspiration.
Differential diagnosis
- Septic arthritis of the elbow
- Cellulitis without bursal involvement
- Gouty tophus or rheumatoid nodule
- Olecranon fracture
- Triceps tendon injury
Goal of treatment
Relieve swelling and pain, eradicate infection when present, and prevent recurrence and chronic bursitis.
Treatment
- Conservative
- Aseptic bursitis: relative rest, padding and avoiding pressure on the elbow, a compression bandage and cold; many resolve over weeks.
- Medical
- Aseptic bursitis: nonsteroidal anti-inflammatory drugs for pain; treatment of underlying gout or rheumatoid arthritis. Corticosteroid injection is debated because of infection and skin-atrophy risk.
- Medical
- Septic bursitis: antibiotics active against staphylococci and streptococci, oral for mild cases and intravenous for severe or immunosuppressed patients, adjusted to culture and local resistance patterns.
- Procedure
- Aspiration of the bursa for diagnosis and relief, repeated in septic cases if fluid reaccumulates.
- Surgical
- Incision and drainage or bursectomy for septic bursitis that does not respond, or for chronic, recurrent, disabling bursitis.
Complications
- Chronic or recurrent bursitis
- Spread of infection: cellulitis, septic arthritis or osteomyelitis of the olecranon
- Draining sinus after aspiration or drainage
- Wound-healing problems after bursectomy
Prognosis
Aseptic bursitis usually settles with protection from pressure, though it can recur. Septic bursitis generally responds to antibiotics and drainage when treated early; delayed treatment or immunosuppression increases the risk of surgery and complications.
Prevention
- Elbow pads and avoiding leaning on the elbows
- Prompt care of skin wounds over the elbow
- Control of gout and rheumatoid arthritis
Test yourself
Think of the answer, then tap the question to see it.
Which organism most often causes septic olecranon bursitis?
Staphylococcus aureus, followed by streptococci.
How is septic olecranon bursitis distinguished from aseptic bursitis?
Aspiration of bursal fluid for Gram stain, culture, cell count and crystals; warmth, redness and fever raise suspicion but are not reliable alone.
Why is elbow motion usually preserved in olecranon bursitis?
The olecranon bursa is superficial and does not communicate with the elbow joint, so the joint itself is not inflamed.
What finding suggests septic arthritis of the elbow rather than olecranon bursitis?
Painful, markedly restricted active and passive elbow motion with a joint effusion.
Which systemic diseases are linked to aseptic olecranon bursitis?
Gout, calcium pyrophosphate deposition disease and rheumatoid arthritis.
Related conditions
Educational information, not medical advice. For any symptom, see a health professional.
Sources: Olecranon Bursitis (StatPearls (NCBI Bookshelf), 2025).
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