What is this?

A bursa is a thin, slippery sac that acts as a cushion between bones and soft tissues. The olecranon bursa lies between the loose skin and the bony tip at the back of the elbow called the olecranon. Normally the olecranon bursa is flat but if it becomes irritated or inflamed (bursitis), more fluid will accumulate in the bursa and bursitis will develop. Often there is no clear cause although it may be related to an injury or repetitive irritation such as leaning on the elbow. The presence of a bone spur in this area may be a contributing factor. Systemic diseases such as gout and rheumatoid arthritis can be associated with olecranon bursitis as well.

What are the symptoms?

Olecranon bursitis results in a variable sized swelling which can develop quickly or over time. Most of the time the swelling is not painful unless it gets knocked. It can become infected with bacteria leading to increased pain, tenderness, redness and warmth in the area and symptoms of fever. In this situation you may need see your General Practitioner urgently or attend the hospital

Will I need any further investigations?

Olecranon bursitis is usually diagnosed on history and examination findings. An x-ray is required to look for associated bone spurs. More specialist tests such as ultrasound or MRI scans are occasionally needed if the diagnosis is not clear.

What are the non-surgical treatment options?

Most patients with olecranon bursitis will get better without surgery. A compressive dressing may help to decrease fluid accumulation and an elbow pad may also be used if the area is getting irritated from leaning on the elbow.

What does surgery involve?

Surgery is sometimes necessary to remove a thickened bursa that has not improved with any other treatment. Surgical removal is usually done because the swollen bursa is restricting your activity or is painful. An incision is made over the swelling, which is then carefully removed as well as any underlying bone spur. The wound is closed with sutures and a compression bandage is applied.

What is the success of surgery?

Generally, this is a safe and reliable operation to remove the swelling although occasionally the swelling can return.
What are the potential risks of surgery?
Any surgical procedure carries risks, however every effort is made to minimise these to ensure the best possible outcome from your surgery. The commonest risks of surgery include infection, bleeding, and wound healing problems. There is also a risk that the swelling can return in the future.

What is the recovery after surgery?

If the swelling that was removed was very large, then it is important to rest the soft tissues as the wound heals. After this you can begin gently moving the elbow with light activity. The range of motion in the elbow will gradually return and physiotherapy is not usually required. You will be seen in clinic two weeks after surgery to remove sutures and assess your recovery.

When can I return to normal activities?

Return to work depends on the nature of the job. You can return to desk and computer work when you feel comfortable to do so but avoid any manual work, heavy lifting or sporting activities for 4-6 weeks. You may return to driving when you feel safe to control the vehicle, which is usually between one and two weeks after surgery.