Olecranon Bursitis: Symptoms, Types, Causes and Treatment

Olecranon bursitis is a frequently encountered elbow condition that can significantly impact daily activities, especially for those whose work or hobbies demand frequent elbow use. Whether you’re a patient seeking clarity or a health professional looking for a comprehensive resource, this article will guide you through the symptoms, types, causes, and evidence-based treatments of olecranon bursitis. Drawing from the latest research, we aim to deliver a clear, actionable, and human-centered overview.

Symptoms of Olecranon Bursitis

Olecranon bursitis often announces itself with visible and palpable changes to the back of the elbow. Recognizing these symptoms early can make a crucial difference in diagnosis and management, especially when an infection may be present. Let's break down what to look for and how these symptoms can vary depending on the underlying cause.

Symptom	Description	Distinction (Septic/Aseptic)	Source(s)
Swelling	Noticeable bulge at elbow's tip	Both types; usually more pronounced	1 3 5 7 10
Pain	Aching/tenderness around the elbow	Common in both, often worse if septic	1 2 3 5 7
Redness	Erythema or redness of the skin	More common/severe in septic cases	1 2 7 10
Warmth	Increased local skin temperature	Present in both, more in septic	1 7 10
Fever	Body temperature >37.8°C	Suggests infection (septic)	1 2 7 10
Reduced Motion	Stiffness or limited elbow movement	More likely if swelling is significant	5 6

Table 1: Key Symptoms

Common Clinical Presentation

The hallmark symptom of olecranon bursitis is swelling at the elbow’s posterior aspect—often described as a “goose egg” appearance. This swelling is usually soft and fluctuant to the touch. Pain may range from mild discomfort to more severe, especially when bending the elbow or resting it on a hard surface. In some cases, movement is limited due to the swelling or pain 3 5 6.

Distinguishing Septic from Aseptic Symptoms

While both septic (infectious) and aseptic (non-infectious) bursitis can produce similar symptoms, certain features are more suggestive of infection:

• Redness (erythema), warmth, and tenderness are much more pronounced in septic cases. For instance, erythema occurs in about 83% of septic cases versus 27% of aseptic cases; tenderness in 88% versus 36%, and warmth in 84% versus 56% 1.
• Fever is a red flag for infection—present in up to 38% of septic olecranon bursitis cases and almost never in aseptic cases 1 2 7 10.
• Skin lesions or recent trauma can be a clue, especially if the area over the bursa is broken, increasing risk for infection 1 7.

Additional Features

• Fluctuation: The swelling is often fluctuant (moves when pressed), distinguishing it from solid masses.
• Chronic vs. Acute Symptoms: Chronic cases may show skin thickening or repeated swelling, while acute cases present suddenly 5.

Types of Olecranon Bursitis

Understanding the different types of olecranon bursitis can help guide both diagnosis and treatment. The main distinction lies in whether or not the bursa is infected, but additional subtypes exist based on cause and chronicity.

Type	Main Feature	Typical Cause	Source(s)
Aseptic	Non-infectious swelling	Trauma, overuse	3 5 7 10
Septic	Infectious inflammation	Bacterial invasion	1 2 4 7 10
Chronic	Prolonged/recurrent	Repeated microtrauma	5 13
Unusual	Rare pathogens	Fungi, Brucella	4 8 9

Table 2: Olecranon Bursitis Types

Aseptic (Non-Infectious) Olecranon Bursitis

Aseptic bursitis makes up about two-thirds of cases and typically results from repetitive minor trauma, pressure, or overuse. It is more common among men aged 30–60 and those whose jobs involve leaning on their elbows 3 10. This type is usually less painful and less likely to have systemic symptoms like fever.

Septic (Infectious) Olecranon Bursitis

Septic bursitis accounts for roughly one-third of cases. Infection often occurs when bacteria (most commonly Staphylococcus aureus) enter the bursa, especially after a break in the skin 1 2 7 10. Septic bursitis is generally more severe, with pronounced redness, warmth, and sometimes fever.

Chronic Olecranon Bursitis

When symptoms persist for weeks or months, or if the swelling recurs repeatedly, the condition is considered chronic. Chronic bursitis may be aseptic or septic and can lead to skin changes, persistent pain, or even complications like wound breakdown 5 13.

Unusual and Rare Types

While most infections are caused by common bacteria, rare pathogens—including nontuberculous mycobacteria, Brucella, Candida, and Aspergillus species—can also cause olecranon bursitis, particularly in immunosuppressed individuals or those with occupational exposures 2 4 8 9.

Causes of Olecranon Bursitis

The underlying causes of olecranon bursitis are diverse. While trauma and infection are the most recognized, sometimes systemic diseases or unusual organisms play a role.

Cause	Description	Common/Rare	Source(s)
Trauma	Direct blow or repetitive pressure	Common	3 5 7 10 13
Infection	Bacterial invasion (mostly S. aureus)	Common	1 2 7 10
Systemic Disease	Gout, rheumatoid arthritis	Less common	5 7
Unusual Pathogens	Fungi, Brucella, mycobacteria	Rare	2 4 8 9
Occupational Risk	Jobs involving leaning on elbows	Common	3 5 10

Table 3: Major Causes of Olecranon Bursitis

Trauma and Microtrauma

• Acute trauma: A direct blow to the elbow can cause the bursa to fill with fluid, leading to swelling and pain 3 5 7 13.
• Chronic microtrauma: Repetitive pressure or friction (like resting elbows on hard surfaces) is a frequent cause, particularly in certain occupations (plumbers, students, athletes) 3 5 10.

Infection

• Bacterial infection: Most frequently caused by Staphylococcus aureus, but also streptococci. Entry is often through a skin lesion, abrasion, or after a penetrating injury 1 2 7 10.
• Unusual infections: Fungi (such as Candida or Aspergillus), nontuberculous mycobacteria, and Brucella species can infect the bursa, especially in immunocompromised patients or those with specific exposures (e.g., animal workers for Brucella) 2 4 8 9.

Systemic Diseases

Certain medical conditions can predispose the bursa to inflammation:

• Gout and pseudogout: Crystal deposition can inflame the bursa.
• Rheumatoid arthritis: Chronic inflammation may involve the bursa 5 7.

Occupational and Activity-Related Risks

Jobs or activities requiring frequent elbow leaning or pressure increase risk, such as:

• Manual laborers
• Office workers resting elbows on desks
• Athletes (e.g., wrestlers, football players) 3 5 10

Treatment of Olecranon Bursitis

Treatment for olecranon bursitis varies by type and severity. Most cases resolve with conservative measures, but some situations demand more aggressive intervention.

Approach	Methods/Examples	Indications	Source(s)
Conservative	Rest, ice, compression, NSAIDs	Most aseptic cases	3 5 6 10 12
Aspiration	Removal of bursal fluid	Diagnostic, symptomatic relief	7 10 12
Antibiotics	Oral/IV antibiotics	Septic cases	1 2 7 10 12
Steroid Injection	Intrabursal corticosteroids	Selected aseptic cases	11 12 13
Surgery	Bursectomy, drainage	Refractory or complex cases	7 10 12

Table 4: Treatment Strategies

Conservative Management

• Rest and Activity Modification: Avoid activities that provoke symptoms.
• Ice and Compression: Reduce swelling and discomfort.
• NSAIDs: Nonsteroidal anti-inflammatory drugs (like naproxen) help relieve pain and inflammation 3 5 6 10 12.

This is the first-line approach for most patients with non-infectious bursitis.

Aspiration

• Diagnostic Role: Aspiration of bursal fluid helps distinguish between septic and aseptic bursitis by allowing analysis for bacteria, crystals, and cell counts 7 10 12.
• Therapeutic Role: Aspiration can relieve pressure and discomfort, but repeated aspirations may be needed in some cases 7 13.

Antibiotic Therapy

• Indicated in septic bursitis.
• Choice and duration: Most often targets S. aureus, but unusual pathogens require tailored therapy. The optimal duration is debated and may range from 1–4 weeks, depending on severity and response 1 2 7 10 12.
• Route: Oral antibiotics are usually sufficient, but severe cases may need intravenous therapy or hospital admission 1 7.

Corticosteroid Injection

• Aseptic cases only: Intrabursal corticosteroid injections can hasten recovery, especially for patients with high occupational or athletic demands 11 12.
• Risks: Increased complications have been reported, including infection, skin atrophy, and chronic pain. Therefore, they are not routinely recommended unless conservative measures fail 12 13.

Surgical Management

• Reserved for refractory or chronic cases: Indications include persistent infection despite antibiotics, chronic draining sinus, or failure of non-surgical management 7 10 12.
• Procedures: May involve incision and drainage or surgical removal (bursectomy) 5 7 12.
• Risks: Surgical management is associated with higher complication rates compared to conservative treatment 12.

Special Considerations

• Unusual Infections: Fungal and atypical bacterial infections require specific antimicrobial regimens and may need longer treatment 4 8 9.
• Red Flags: Rapidly progressive symptoms, systemic illness, or immunosuppression warrant urgent medical evaluation and more aggressive management 5 7 8.

Conclusion

Olecranon bursitis is a common and often manageable condition, but distinguishing septic from aseptic types is crucial for effective treatment. Understanding the spectrum of symptoms, underlying causes, and evidence-based treatment options empowers both patients and clinicians to make informed decisions.

Main points covered:

• Olecranon bursitis often presents as swelling, pain, and sometimes redness or warmth over the elbow tip, with more severe symptoms indicating possible infection.
• Types include aseptic, septic, chronic, and rare forms caused by unusual pathogens.
• Causes range from trauma and repetitive pressure to infections, systemic diseases, and occupational risks.
• Most cases respond well to conservative treatment (rest, ice, NSAIDs), while septic cases require antibiotics and, rarely, surgery.
• Corticosteroid injections may hasten recovery in select aseptic cases but carry notable risks.
• Correct diagnosis—especially distinguishing septic from aseptic bursitis—guides effective and safe management.

By staying attentive to symptoms and following a structured approach to diagnosis and treatment, most people with olecranon bursitis can expect a good outcome and return to their normal activities.