What is the condition?

The olecranon bursa is a small, thin fluid-filled sac that sits between the skin and the tip of the ulna (the point of the elbow). Its job is to let the skin glide smoothly over the bone when you lean on the elbow or bend and straighten it.

 

Olecranon bursitis is swelling of this bursa. It can occur from repeated pressure (for example leaning on a desk), a direct knock, inflammatory conditions such as gout or rheumatoid arthritis, or infection. The bursa can fill with fluid and become visibly swollen.

 

What are the symptoms?

The typical feature is a soft swelling at the back of the elbow. It may be painless, mildly tender, or quite painful depending on the cause.

 

Redness, warmth, increasing pain, fever, or a feeling of being unwell suggests an infected bursa. Infection requires prompt medical review because it usually needs antibiotics and sometimes drainage.

 

How is it diagnosed?

Diagnosis is usually clinical. Your assessment focuses on the size of the swelling, skin condition, tenderness, and whether there are signs of infection.

 

X-rays may be used if there was trauma or if a bone spur is suspected. If infection is a concern, aspiration of the bursa fluid may be considered to look for bacteria or crystals, but this is done selectively because aspiration itself can introduce infection or create a persistent draining sinus.

 

Non-surgical treatment

Most non-infected cases settle with conservative care. The main steps are avoiding pressure on the elbow, using a padded sleeve, and managing inflammation. A short course of anti-inflammatory medication may be appropriate for some patients.

 

Compression bandaging can reduce swelling, but it must not be so tight that it affects hand circulation. Ice can help in the early irritable phase.

 

If gout is suspected, treatment of the underlying gout is important. If rheumatoid arthritis is present, coordination with your rheumatologist is helpful.

 

When is surgery considered?

Surgery (bursectomy) is uncommon but may be recommended if swelling is recurrent, persistent, painful, or if there are repeated infections. Surgery carries a recognised risk of wound-healing problems because the skin over the elbow is thin and under tension.

 

Recovery and rehabilitation

Recovery depends on severity and whether infection was present. With conservative treatment, swelling can take weeks to settle fully. After surgery, wound care is crucial and leaning on the elbow is avoided until healing is secure.

 

Expected outcomes

Most people recover well with non-surgical management. Recurrent bursitis can occur if repeated pressure continues or if there is an underlying inflammatory condition.

 

Risks and complications

The main complication is infection, either as a primary cause or after aspiration. A persistent draining sinus can occur if the bursa is repeatedly irritated or infected.

 

Surgical risks include infection, wound breakdown, recurrence, and scar sensitivity.

 

When should I seek urgent review?

Seek urgent review if the elbow becomes increasingly red, hot, very tender, rapidly enlarges, or if you develop fever or feel unwell. These features raise concern for an infected bursa.

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What does the rehabilitation/recovery involve?

To find out more about rehabilitation and recovery after elbow surgery please see our Rehabilitation Protocols here.