What is an Olecranon bursa?
The Olecranon bursa is a sac of fluid that is located over the tip of the elbow (on the back of it). It is always present and lubricates tissues gliding under the skin but fluid can develop in it insidiously (out of the blue) when it then becomes prominent. Often this happens after trauma or after leaning on the elbow for a period of time. It can also be associated with gout and can be caused by the inflammation that occurs with gout, when fluid is produced.
Occasionally it can present after an infection and then it is known as an infected bursa. This is very different from an uninfected olecranon bursa which is just a large sac of fluid which is annoying in appearance and from the weight of the lump. When it is infected the whole arm can get quite red and be painful. In this scenario this requires antibiotics, rest, elevation and may even be so severe that it requires admission to hospital or surgery.
In an uninfected scenario, however, it is pain free and feels annoying because of the ache and the weight of the lump, and is more bothersome because of the appearance.
What causes it?
In patients free from infection and gout, it is caused by generalised irritation to the skin and the underlying sac between the skin and the bone called the bursal sac. The sac becomes irritated after a traumatic episode, such as a fall landing on the elbow, or from leaning on it, such as working on your hands and knees. In this scenario, unless the causative factor is removed then the condition will not settle. Even with surgery, it is important to stop any irritative factors. It is vitally important that any irritation to this area is removed prior to surgery as this may not only settle the condition or avoid surgical intervention, but is required after surgery anyway.
In cases caused by or associated with gout however, the control of the gout needs to be improved. This may involve adjusting medications; even if the patient is already on gout medication such as Allopurinol, the dose may need to be reviewed. As such the initial treatment of an olecranon bursa involves treating the underlying cause. Once the condition settles, minor episodes no longer aggrevate the underlying problem as the arm becomes more resistant to it.
What about an injection?
If the bursa does not settle on its own, in uninfected cases a steroid (cortisone) injection may be warranted. In this case, either by the Doctor or under ultrasound guidance, an injection may be inserted into the bursa to drain the fluid. Then a steroid injection may be administered in an attempt to settle the condition. This may aid the other measures in settling the inflammation and may resolve the condition. It is still very important to follow the advice above, otherwise the injection will be a waste of time.
Despite all of these measures, on occasion the patient may warrant surgery. This is more likely with a gouty bursa.
In these cases, surgery involves an overnight stay in hospital and an excision of the bursal sac and any underlying bone which may be irritating the skin. After surgery it is important to rest and elevate the arm, avoiding flexion of the arm which may put the bursa and skin under stress.
Are there any risks of the surgery?
Yes. The surgery does involve a scar on the back of the elbow, and while this often heals very well it will still be visible. Although it is extremely rare, the ulnar nerve on the inside of the elbow could potentially be bruised or damaged, and this could lead to some numbness and weakness in the hand. There is also the risk of wound breakdown and which may require regular dressings and antibiotic treatment, should it get infected.
Whilst there are risks of surgery, in general those patients who have failed to improve on their own can do very well with surgery, and can have resolution of the problem.
As always, at Glenelg Orthopaedics we believe it is important to consider all options, offering surgery as a last option. In those cases that do require surgery, we can offer a holistic approach to give you the best outcome.
We take the time to make sure that you get the best advice and options for your situation, and the treatments offered have the best chance of achieving the desired outcome. For great advice and quality care, give us a call on 08 8376 9988.
Glenelg Orthopaedics, Providing Quality Orthopaedic Care.