Olecranon Bursitis (Student’s Elbow)

Background

  • Relatively common condition characterised by inflammation of the subcutaneous bursa overlying the olecranon process which normally cushions the olecranon, reducing friction between it and the skin.
  • Generally classified as
    • Non-septic (majority)
    • Septic (uncommon)
  • More common in young and middle aged men.  So-called student’s elbow because of the associated trauma that comes with leaning elbows on a desk

Causes

  • Non septic
    • Trauma/overuse
    • Systemic conditions e.g. gout, rheumatoid arthritis
  • Septic bursitis
    • Prone to infection due to its superficial location under the skin and risk of injury/trauma
    • Most cases are caused by Staph aureus and streptococci.

Presentation

  • Swelling over the olecranon process which typically occurs over hours/days.
    • Can be painful, tender or warm although pain tends to disappear quite quickly
    • Swelling can often be compressed (boggy) and is usually movable
    • It may or may not restrict full elbow flexion
  • Septic disease should be suspected if
    • there is a painful, hot, red swelling which is progressively and rapidly worsening
    • there is evidence of localised cellulitis
    • there is a history of abrasion/laceration to the bursa
    • there are signs of fever/chills or systemic upset
    • patient is immunocompromised
  • There may or may not be a history of overuse, trauma or irritation to the elbow
  • Note that generalised joint swelling is suggestive of another cause e.g. rheumatoid; and septic arthritis should always be considered in cases of suspected septic bursitis (especially if the patient has reduced ROM limited by pain).

Investigations

  • Non-septic bursitis is a clinical diagnosis.  If suspected septic bursitis, bursa aspiration is usually indicated.
  • Imaging e.g. x-rays, are rarely used- usually in rapidly developing disease, history of trauma or where another cause is suspected e.g. fracture, joint disease)

Management

  • Non-septic
    • Pain relief (paracetamol and NSAIDs), relief on ice, rest
    • Consider compression bandaging if swelling is severe
  • Septic
    • Usually flucloxacillin 500mg QDS for 3-5 days
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