Olecranon bursitis is a common problem where a sac of fluid appears on the back of the elbow. It usually occurs after the elbow is hit against a hard object, but may occasionally occur for no reason at all. The olecranon bursa becomes inflamed and swells with fluid, like a blister beneath the skin. Olecranon bursa are benign and require no formal treatment if they are not causing problems.
If an olecranon bursitis is tender or annoying, initial treatment is aspiration. The fluid is “sucked out” with a needle. Steroids should not be injected, as these increase the chance for infection.
Following aspiration, pressure needs to be maintained over the back of the elbow full-time, 24/7, for 2 weeks or the olecranon bursitis will probably recur. Pressure can be placed over the olecranon bursa either through either 1) an ace wrap or, 2) by bending the elbow. The ace wrap should provide snug pressure, but not to the point of discomfort. The ace wrap is worn full-time for 2 weeks, including while asleep. During showering, pressure is maintained over the olecranon bursa by elbow flexion: Bend the elbow, remove the ace wrap, keep the elbow fully bent during the shower, dry off, then reapply the ace wrap. While wearing the ace wrap activities are not limited, i.e. normal activities can be performed.
Endoscopic Olecranon Bursectomy
For problematic olecranon bursitis that fails aspiration, endoscopic bursectomy (bursal excision) can be considered. Endoscopic olecranon bursectomy is a minimally-invasive, effective outpatient procedure. Instead of an open incision, which can predispose to wound problems, two small “stab wounds” are made and the bursal sac is removed using arthroscopic equipment. Following endoscopic olecranon bursectomy, an ace wrap is worn for 2 weeks, as above. Recurrence is rare.
Most cases of olecranon bursitis require either no treatment or simple aspiration, followed by two weeks in an ace wrap. For the occasional problematic bursa that persists following aspiration, endoscopic olecranon bursectomy is a minimally-invasive, effective treatment.