In this condition a swelling appears on the back of the elbow below the skin over the bony tip you can normally feel there. This bony tip is called the Olecranon. The swelling forms inside a gliding structure between the skin and the bone called a bursa. Normally this is very thin with only a trace of fluid in it to allow the skin to move over the bone. If this bursa becomes irritated for any reason extra fluid can be made and a swelling appears. This swelling can become very uncomfortable or even hot, red and infected. It is important to make sure the infection is not coming from inside the joint itself as this is more serious and needs aggressive treatment.
This condition can occur in anyone but there is an increased risk if you spend a lot of time resting on the tip of your elbow, whilst at work for instance. Sometimes the swelling occurs after the skin on the tip of the elbow has been grazed or cut.
When the bursa first swells up the pain can be intense and the elbow can become painful to bend fully. If there is an infection as well you may feel unwell in yourself with a temperature and even hot sweats. The back of the elbow can become red and hot and the red area can spread up and down the arm.
Later on, when the heat has gone out of the elbow, the bursa can remain thickened and more easily felt behind the elbow than before which can be a little uncomfortable.
Usually the diagnosis is made by listening to your history and looking at your elbow. An xray is often taken to look at the joint and the bones. Sometimes this shows a small prominence on the end of the olecranon, this is probably incidental and does not cause the irritation in the bursa.
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In mild cases the inflammation settles with rest, ice packs, pain killers and time.
If there are signs of infection antibiotics might be added. Occasionally these need to be strong antibiotics into a vein which will mean you will have to be admitted to hospital.
If a great deal of fluid accumulates in the bursa some can be drained off using local anaesthetic and a needle. This fluid can be sent off to check for infection and relieves some of the pressure on the skin.
Very occasionally the swelling is so intense that an operation is recommended to drain out the bursa in theatre. It can be difficult to get the skin to heal after this sort of surgery however so this is usually only performed as a last resort.
If there is any question of the infection involving the joint a sample of fluid from inside the elbow joint might need to be taken.
After an episode of inflammation it is useful to try and avoid any activity that may have set off the swelling as repeated episodes of inflammation do occur in some people.
If you are left with a thickened and uncomfortable bursa in the longer term it is possible to have the bursa removed in theatre but again there are frequent difficulties with wound healing after this sort of surgery so this is not an operation to rush into.
In the long-term it is important to avoid activities that might have set off your olecranon bursitis to avoid the problem recurring.
If you have had a severe episode of inflammation it is important to try and get the elbow moving again as quickly as possible. Exercises will be demonstrated to you and physiotherapy arranged if necessary.
If you have had to have an open operation on your bursa when it is very inflamed you are likely to have had the wound left at least partially open to allow any further pus to drain out naturally. This open section of wound will take at least 2 weeks to heal and will require regular dressings. You will still need to get the elbow moving however, to avoid stiffness.
If you have had your bursa removed for persistent, long-term swelling you will have dressings and a bandage applied in theatre. The bandage is usually left in place for at least 5 days to let the wound settle down. A lighter dressing will then be applied but the wound needs to be kept clean and dry until the stitches are removed 10-14 days after the surgery. Some fluid accumulation in the space where the bursa was is common and sometimes needs to be drained in clinic with a needle. Early movement of the elbow, wrist and hand is encouraged to avoid stiffness.