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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