Olecranon Bursitis: A Case Review
Caitlin Gardiner
Case Presentation:
A 25-year old male boil maker presents with
a painful, visible lump on the proximal end of
his right elbow. The patient states the lump
has been present for around 3 weeks, in
which time it has increased in size, redness
and pain. He recalls no trauma to the elbow
but noted he performs labour-intensive
work. The referral requests an elbow
ultrasound querying a haematoma or joint
effusion.
Ultrasound Examination
Informed consent is obtained by explain the
ultrasound procedure and the interpretation
of the results by a radiologist. The
examination is undertaken on a GE Logiq E8,
using a broad-band 5-13MHz linear probe
and selection a MSK general pre-set.
A full assessment of the elbow tendons is
performed. The patient is seated opposite
the sonographer with his arms extended on
the examination table. His palms are placed
together allowing a lateral coronal position
to assess the lateral elbow. The common
extensor origin shows good hyperreflectivity and normal homogenous
fibrillary pattern. No hyperaemia or
intrasubstance tears are noted and the
patient indicates no tenderness over this
point. Refer to Figure One.
Fig One: The right common extensor origin of a
25-year old male.
To assess the medial elbow, the patient is
asked to rotate his forearm laterally to
expose his medial elbow. Though this
position can be difficult for some, this
patient demonstrated little discomfort. The
common flexor origin shows similar
echotexture to the lateral elbow and also
shows no hypervascularity. The patient is
non-tender whilst scanning. Please see
Figure Two.
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Figure Two: The common flexor origin of a 25year old male elbow.
The patient is asked to place his forearm on
the bed, slightly bent at the elbow, with his
palm facing upwards. The bicep tendon is
obtained by locating the bicep muscle from a
medial approach and following the tendon
distally to the insertion, before rotating 90
degrees to gain a long axis. Given the
insertion is particularly deep due to muscle
bulk, beam steering is used to aid fibrillary
assessment. Refer to Figure Three.
Figure Three: The distal bicep insertion onto the
right radial tuberosity of a 25-year old male.
flexes. This readily allows assessment of the
tricep insetion which shows a normal fibrillar
pattern and bony insertion (see Figure Five).
Fig Five: The right triceps insertion of a 25 year old
male with a palpable lump over the olecranon.
Maintaining this same position, the palpable
lump is assessed. The ultrasound reveals a
subcutaneous, 38*40*14mm complex cystic
structure, superficial to the olecranon
process with significant hyperaemia of the
solid components (see Figure Series Six). The
lesion is compressible and painful under
probe-pressure.
The arm is straightened slightly, and with the
probe in a longitudinal position, the anterior
joint is assessed in it’s entirely for any
effusion or pathology (see Figure Four).
Fig Four: The right anterior joint of a 25-year old
male with a palpable lump overlying the
olecranon.
In order to assess the posterior elbow, the
patient is asked to place his hanf flat on the
table, then rotate it inwards and his elbow
Figure Series Six: Longitudinal and transverse
images over the palpable lump on the distal
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olecranon in a 25 year old male. A 38*40*13mm
complex cystic lesion is noted with significant
hyperaemia throughout the solid components.
Findings:
The on-site radiologist confirms the findings
as olecranon bursitis. The elbow joint
appears, otherwise, unremarkable.
Discussion:
Olecranon bursitis, otherwise known as
‘student’s elbow’ or ‘miner’s elbow’ typically
presents as a painless, superficial lump
overlying the olecranon process (1). It is
commonly caused by repetitive local trauma
and typically occurs in men between ages
30-60 (2).
Although 66% of cases are due to
microtrauma, either due to excessive
repetitive movement or secondary to calcific
enthesopathy of the distal triceps, various
septic pathologies are often the causes (1,
4). Olecranon bursitis is often observed in
patients with rheumatoid arthritis, gout,
hydroxyapatite and calcium pyrophosphate
or those infected with staphylococcus or
tuberculosis (1) As a result, basic blood tests
are often performed when a patient
presents with olecranon bursitis (4).
Haemorrhagic and septic bursitis may
demonstrate subtle oedema or cellulitis, but
typically require analysis post needle
aspiration for diagnosis (4).
Treatment for olecranon bursitis usually
included ice, rest, anti-inflammatories,
analgesics and bursal fluid aspiration.
Surgical removal of the bursal tissue, is
reserved for unresponsive patients (3).
References:
Ultrasound of olecranon bursitis shows a
localised fluid collection within the
subcutaneous tissue immediately posterior
to the olecranon. With sensitive colour or
power Doppler, hyperaemia can be noted as
rim-like peri-bursal pattern (1). Though
typically a result of micro-trauma,
ultrasound is useful to exclude a penetrating
foreign body from blunt trauma, whilst plain
radiography can exclude fracture in sudden
onset cases (3).
Though typically painless, signs of
inflammation may be present in cases of an
infected bursitis.
1. Bianchi S and Martinoli C, 2007.
Ultrasound of the Musculoskeletal
System. Springer.
2. Blackwell JR, Hay BA, Bolt AM and Hay
SM, 2014. Olecranon Bursitis: A
systematic Overview. Shoulder and
Elbow;
3. Sconfienza LM, Sarafini G and Silvestri E,
2012. Ultrasound-guided
Musculoskeletal Procedures. Springer,
Italy.
4. Del Buono A, Franceschi F, Palumbo A et
al, 2012. Diagnosis and Management of
Olecranon Bursitis. The Surgeon; 10(5):
297-300.
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