Clinical features

A swelling (fluid filled sac) can be palpated over the olecranon process (1)

• onset of symptoms can be from several hours to several days (2)
• the swelling is usually movable (3) and there can be localised tenderness (4)
• movement of the elbow joint does not cause pain except at extreme flexion where compression of the swollen bursal compartment may induce pain (3)

Septic and non-septic bursitis cannot always be differentiated from the clinical features (4)

• a painless, non tender, simple swollen bursa that has been present for days to weeks is almost always due to non septic causes (2,5)
• the following features may suggest a septic olecranon bursitis:
  • hot, tender, painful, and red swelling of the bursa
  • systemic symptoms like fever and rigors
  • immunocompromised state (4)
  • abrasion or laceration over the bursa (3)
  • seeking medical help early in the disease (2)
• erythema (in 63-100% of septic cases vs 25% of non-septic cases) and peribursal cellulites (more than 60% of septic cases and 25% of noninfective cases) is seen in both types (2,4)

Clinical differentiation of acute gouty olecranon bursitis from septic olecranon bursitis is complicated since both present with red, hot, swollen and tender bursae with associated fever and raised white cell count (5).

Reference:

• 1. Cardone DA, Tallia AF. Diagnostic and therapeutic injection of the elbow region. Am Fam Physician. 2002;66(11):2097-100
• 2. Stell IM. Septic and non-septic olecranon bursitis in the accident and emergency department--an approach to management. J Accid Emerg Med. 1996;13(5):351-3
• 3. McAfee JH, Smith DL. Olecranon and prepatellar bursitis. Diagnosis and treatment. West J Med. 1988;149(5):607-10
• 4. Wiler JL. Symptoms: Swollen, Painful Elbow. Emergency Medicine News 2008;30(8):4-12
• 5. Roberts JR. Olecranon Bursitis: Etiology and Clinical Characteristics: Part I in a Series. Emergency Medicine News 2002;24:11-22