Classic history and presentation: The most pathognomonic symptom is swelling in the posterior olecranon / elbow. It can be painless. It may or may not have associated erythema or warmth. Pain, erythema, and warmth are much more common in septic compared with aseptic bursitis but can be present in either condition. Fever is associated with septic bursitis. Approximately 80% of cases are aseptic (not infected).
This can rapidly go from aseptic bursitis to septic bursitis, so reevaluation is recommended after initial diagnosis, especially if risk factors are present such as uncontrolled diabetes mellitus type 2 or skin disruption.
Variant presentation: While less likely, a patient could have minimal swelling in the bursa even with septic bursitis.
Prevalence: There is little information on the incidence of this pathology, as it is often self-limiting. One study calculated it as 0.03% in the general population.
- Age – This is unusual to see in the pediatric population; it is mainly an adult condition.
- Sex / gender – The condition is more common in men, particularly those engaged in manual labor where impact is placed repetitively on the olecranon process.
Predisposing history includes a past medical history of gout, as monosodium urate crystals often deposit in superficial bursa. Bilateral olecranon bursitis is unusual and should raise suspicion for a gout diagnosis. Uncontrolled diabetes increases the risk for septic bursitis. Disruption of skin integrity from abrasions, dry skin, or trauma can also increase risk of bursal infection. Chronic hemodialysis also increases risk for the development of septic pathology.
Pathophysiology: The most common etiologies are –
- Macrotrauma leading to a hemorrhagic bursitis
- Repetitive microtrauma leading to an aseptic serous bursitis
- Inflammatory (aseptic) bursitis from rheumatoid or gouty arthropathy
- Septic bursitis
M70.20 – Olecranon bursitis, unspecified elbow
425940002 – Inflammation of bursa of olecranon
- Elbow effusion
- Elbow fracture
- Olecranon fracture
- Supracondylar fracture
- Radial head fracture
- Elbow contusion
- Triceps tendonitis (including calcific tendonitis)
- Distal biceps tendon tear
- Elbow ligament injury
- If a patient is immunocompromised, consider bacterial or fungal septic bursitis even without typical symptomatology. Immunocompromised status can be caused by immunomodulating agents such as those in use to treat rheumatoid arthritis or other autoinflammatory conditions. Be aware of chronic steroid use and HIV status. Alcohol use disorder and smoking may alter immune status, increasing incidence in those populations.
- Rapid expansion, skin changes, and weight loss should be suspicious for a sarcoma. Consider an oncologic consult.