Olecranon Bursitis

What is olecranon bursitis?

Olecranon bursitis is a condition characterized by tissue damage and inflammation of the olecranon bursa (a small fluid filled sac located at the back of the elbow) causing pain in the back of the elbow.

The elbow is formed primarily from the union of the humerus (upper arm bone) and the ulna (forearm bone). The ulna has a bony process situated at the back of the elbow known as the olecranon (figure 1). This bony prominence is a point of attachment of several muscles including the triceps (figure 2) and forms the outer most point of the back of the elbow. Between the olecranon and overlying skin lies a bursa known as the olecranon bursa (figure 1). A bursa is a small sac filled with lubricating fluid and is designed to reduce friction between adjacent soft tissue layers.

The triceps muscle is primarily responsible for straightening the elbow and is particularly active during pushing activities. During contraction of the triceps, friction is placed on the olecranon bursa. Pressure may also be placed on the olecranon bursa following a direct impact or leaning on the elbow. When these forces are excessive due to too much repetition or high force, irritation and inflammation of the bursa may occur. This condition is known as olecranon bursitis.

Causes of olecranon bursitis

Olecranon bursitis most commonly occurs due to repetitive or prolonged activities placing strain on the olecranon bursa. This typically occurs due to prolonged pressure on the bursa (such as repetitive falls on the elbow or prolonged resting of the elbow on hard surfaces) or due to repetitive pushing activities or straightening the elbow against resistance (placing strain on the bursa via the triceps tendon). Occasionally, the condition may occur suddenly due a direct blow to the elbow (such as a fall onto a hard surface).

Signs and symptoms of olecranon bursitis

Patients with olecranon bursitis typically experience pain and swelling in the back of the elbow. Pain typically increases when leaning on the affected elbow or when bending and straightening the elbow. In less severe cases, patients may only experience an ache or stiffness in the elbow that increases with rest following activities placing strain on the bursa. These activities typically include resting or falling on the elbow (particularly on hard surfaces), pushing activities, repetitive use of a hammer or straightening the elbow against resistance. The pain associated with this condition may also warm up with activity in the initial stages of injury.

As the condition progresses, patients may experience symptoms that increase during sport or activity. Patients may notice marked swelling and an appearance of a large bulge over the point of the elbow. Most patients with olecranon bursitis experience pain on firmly touching the olecranon bursa. Occasionally small lumps may be felt over the point of the elbow. Patients may also experience weakness in the elbow particularly when attempting to straighten the elbow against resistance.

Diagnosis of olecranon bursitis

A thorough subjective and objective examination from a physiotherapist may be sufficient to diagnose olecranon bursitis. Further investigations such as an Ultrasound, X-ray, CT or MRI scan are often required to assist with diagnosis and assess the severity of the condition.

Prognosis of olecranon bursitis

Most patients with this condition heal well with appropriate physiotherapy and return to normal function in a number of weeks. Occasionally, rehabilitation can take significantly longer and may take many months in those who have had their condition for a long period of time. Early physiotherapy treatment is vital to hasten recovery in all patients with olecranon bursitis.

Contributing factors to the development of olecranon bursitis

There are several factors which can predispose patients to developing this condition. These need to be assessed and corrected with direction from a physiotherapist. Some of these factors include:

•  joint stiffness (particularly the elbow)

•  muscle tightness (particularly the triceps)

•  inappropriate or excessive training or activity

•  inadequate recovery from training or activity

•  inadequate warm up

•  muscle weakness

•  muscle imbalances

•  inadequate rehabilitation following a previous elbow injury

Physiotherapy for olecranon bursitis

Physiotherapy treatment is vital to hasten the healing process, ensure an optimal outcome and reduce the likelihood of recurrence in all patients with this condition. Treatment may comprise:

•  soft tissue massage

•  dry needling

•  electrotherapy (e.g. ultrasound, TENS etc)

•  stretches

•  joint mobilization

•  ice or heat treatment

•  the use of an appropriate compression bandage

•  progressive exercises to improve strength, flexibility, posture and scapula stability

•  education

•  anti-inflammatory advice

•  activity modification advice

•  a gradual return to activity program

Other intervention for olecranon bursitis

Despite appropriate physiotherapy management, some patients with this condition do not improve adequately. When this occurs the treating physiotherapist or doctor will advise on the best course of management. This may include further investigations such as X-rays, ultrasound, MRI or CT scan, pharmaceutical intervention, corticosteroid injection, drainage of the bursa or referral to appropriate medical authorities who will advise on any interventions that may be appropriate to improve the condition. In rare and recurrent cases of this condition surgical removal of the bursa may be indicated.

Exercises for olecranon bursitis

The following exercises are commonly prescribed to patients with this condition. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally, they should be performed 2 - 3 times daily and only provided they do not cause or increase symptoms.

Your physiotherapist can advise when it is appropriate to begin the initial exercises and eventually progress to the intermediate, advanced and other exercises. As a general rule, addition of exercises or progression to more advanced exercises should take place provided there is no increase in symptoms.