Olecranon Bursitis

Olecranon BursitisI woke up this morning and for some reason there seems to be a swelling the size of a golf-ball on the tip of my elbow. What on earth is it?

That sounds like an Olecranon Bursitis. The Olecranon is the medical name for the point of the elbow and a bursa is a little envelope of lubricating fluid that sits between skin and bone in various arts of the body which is prone to being rubbed. The classic one is Housemaids Knee.

This is not a little envelope.

No – not anymore. Something has irritated the bursa so instead of producing a dribble of fluid daily it has gone into overdrive and produced an eggs worth.

But why?

There are a number of causes. Usually it is from pressure through the elbow but it can be from a fall or bash onto the point and sometimes from a direct injury such as rose thorn or suchlike piercing it.

What do I do with it? My GP wants to drain it.

They nearly always disappear by themselves but that can take several months and I appreciate that they are pretty unsightly and can be uncomfortable when you lean on that elbow.

I am not a big fan of draining these because they nearly always fill back up again. If you do have it drained it is very important that your elbow is strapped up very tightly afterwards for 3 or 4 days and ideally rested in a sling.

Can you not remove it for me?

If you are fed up with it then, yes, I can do that. It means a day in hospital; a quick general anaesthetic; an incision over the lump which I then shell out. You will need to be in a very tight bandage and resting in a sling for about 4 days afterwards to minimise the chance of it filling up again.

How can it fill up again if you’ve cut it out?

Sorry – the bursa can’t fill up again you’re right. But there is now a big space under the skin where it was and that can fill up with blood. Hence the ‘pressure bandage’.

I left mine alone and it did go down but it feels like there are bits of bone under the skin now.

That’s not bone though I know they do feel very solid. You know if you blow up a balloon and then let it deflate there is more balloon material than when you started because it has stretched? That’s exactly what happens when the bursa deflates and what you are feeling are actually ridges or folds in the lining after it has collapsed.

I wasn’t too worried about my bursa but now it has become very red and swollen and painful.

Sounds like it may have become infected. That is always a risk with a swollen bursa.

So now will you take it out?

That sounds like it is the right thing to do but in fact its not. What we do is treat the infection and let the bursa settle down and then think about taking it out. So we will give you antibiotics and keep an eye on it until it settles.

An olecranon bursa can be a pain in the elbow but it isn’t anything serious and can be excised if you are fed up with it.

The other condition that presents with a lump on the elbow is Gout but I can usually tell which is which when I examine you and the treatment is to cut out the gouty lump.