Bursitis olecrani, colloquial: students elbow Bursitis olecrani is a painful inflammation of the bursa located just under the skin in the area of the elbow, which can be septic (with bacterial colonization) or aseptic. The diagnosis is usually made on the basis of the clinical symptoms, the chances of recovery are very good with adequate therapy.
Cause
In more frequent cases, bursitis olecrani, i.e. an inflammation of the bursa protecting the olecranon, occurs due to mechanical irritation from the outside. This form of bursitis is therefore atraumatic, i.e. without open injury from the outside. The colloquial term “students elbow” suggests a common cause of irritation: Repeated prolonged resting on the elbow during desk work can trigger an inflammation of the bursa.
But an open injury can also be the cause. Bursitis caused by a stab, cut or other open injury is usually septic (purulent), as the injury creates an entry point for bacteria. In patients with reduced resistance, for example those whose immune system is weakened (suppressed) by chemotherapy or certain diseases, septic bursitis can also occur without an open injury or through a very small injury.
Bursitis after a fall
After falling on the elbow, the bursa there may be irritated by being squeezed but remaining closed. This stimulus causes a serous, i.e. serum-like, effusion in the bursa, which can be felt or even seen on the elbow, depending on its size. The effusion presses on the bursa wall, causing pain and sensitivity to touch.
As a consequence of the irritation of the bursa, aseptic bursitis can occur in the further course of the fall. Therapeutically, the elbow should be immobilized and pain-relieving or anti-inflammatory medication should be given to alleviate the symptoms. After a fall, the effusion is normally absorbed by the surface cells in the bursa.
As the effusion diminishes, the symptoms and the bursitis are also reduced. If the fall is a one-time event that irritates the bursa and if it is not otherwise stressed, for example by the elbow resting on the bursa, no chronification of the symptoms and permanent changes in the bursa tissue can be expected. In both septic and aseptic forms, the main symptom is a painful, burning swelling over the olecranon, which is usually very sensitive to touch.
The swelling is caused by an effusion, i.e. an accumulation of fluid, in the bursa as part of the inflammatory reaction; it can reach hen’s egg size. The septic form is usually accompanied by redness and overheating, and is often even more sensitive to touch. With this form of inflammation, the inflammation values in the blood are also conspicuous (increase in the number of white blood cells = leukocytosis and increase of an inflammation parameter, the C-reactive protein = CRP).
Furthermore, wounds in the area of the elbow indicate bacterial genesis. The bursa at the elbow is a closed unit which is filled with a so-called synovial fluid which the bursa itself produces and breaks down again. Normally this fluid is clear and free of germs.
However, if germs penetrate the bursa from the outside, for example in the case of an open injury, they can then cause bacterial bursitis. This is accompanied by a bulging, pain-sensitive and reddened elbow. As a result, the body makes white blood cells available for defence against this inflammation.
One form of white blood cells, the “neutrophil granulocytes”, can then form pus, which consists of sunk cells. If the bursa is punctured, the pus emerges as a cloudy, yellowish liquid of varying consistency. In case of bursitis with pus, it should always be removed in order to release the pressure and to prevent further spreading of the infection.The therapy is therefore either to puncture the bursa first and remove it completely during surgery if necessary.
This should be done as quickly as possible to prevent the germs from spreading into the bloodstream and the risk of blood poisoning. A targeted antibiotic therapy can be used to accompany the puncture if the surrounding tissue is bacterially contaminated. The diagnosis is made clinically, i.e. based on the symptoms described above.
An X-ray is usually taken to exclude bony affections, otherwise the use of further imaging procedures is not the rule. In the aseptic form, treatment is usually conservative, i.e. non-surgical. Cooling, local or systemic administration of anti-inflammatory drugs (antiphlogistics) and, if necessary, temporary immobilization are the means of choice here.
If there is no significant improvement, the bursa is surgically removed (bursectomy). In case of septic bursitis, surgical removal is always performed. In addition, antibiotics are usually given or inserted into the area of inflammation and removed a few days after surgery.
- More about bursitis elbow treatment
If recurrent bursitis of the elbow occurs frequently, or if there is a serious bacterial inflammation, surgery may be considered to treat the symptoms. Causes of recurrent bursitis can be, for example, increased strain on the elbow due to movement or may be caused by immunological processes in the body. The bursa is located exactly between the elbow bone and the skin.
It has a cushioning and friction-reducing function, which is useful but not vital. Therefore, if it does more harm than good to the person affected by inflammation and pain, it can be removed. If there is an acute inflammation of the bursa with a bacterial component, it is recommended to first puncture the bursa in a small operation to drain the infectious fluid and reduce the pressure with the associated pain of the bursa.
This slightly smaller procedure is usually followed by open surgery, in which the bursa is completely removed. Further information can be found under our topic: Operation of a bursa at the elbowEven if the bursa has been opened by an accident, an operation with removal of the corresponding tissue should be performed, just as in the case of chronic bursitis at the elbow. In order to avoid infections caused by the operation, a local antibiotic therapy can be applied as a precaution during the operation in the form of a so-called antibiotic chain.
Furthermore, sterile work during the surgery for bursitis is, as always, of great importance in order to avoid postoperative problems. The approach to the operation is a straight incision directly above the elbow, which is about 6 cm long, if necessary, and is made in a bent arm position. Then the bursa is freely prepared, detached from the surrounding tissue and removed.
It is then examined again by the surgeon for any abnormalities. The wound is then closed and a plaster splint is applied to immobilize and protect the joint and promote problem-free healing. After the operation, the patient should continue to protect the arm.
This surgery for bursitis can be performed on an outpatient basis. Since the procedure is relatively small and without complications, it can be performed under plexus anesthesia. This means that the pain sensation of the arm is specifically switched off for the operation and the patient remains awake.
Nevertheless, the procedure of the surgery is specially adapted to the needs of the patient and the severity of the bursitis. Pain therapy in the form of medication can be administered afterwards as required. In addition to the risk of infection, there is also the possibility of injuring the ulnar nerve (nervus ulnaris), which is anatomically located near the bursa.
For the treatment of a simple, i.e. non-bacterial, bursitis of the elbow, taping of the corresponding joint can help. Since the special adhesive tape lifts the underlying tissue, a special stimulus and sometimes also a massaging effect is triggered. This activates the tissue around the bursa and the bursa itself, and promotes the body’s own self-healing at the site.This is caused, among other things, by an increased blood and lymph flow and thus an increased metabolism, which in total should reduce the inflammation.
The tape is applied directly to the elbow with the arm bent and then fixed in a stretched position with a certain amount of tension. It is important that the joint is not restricted in its freedom of movement, because movement is part of the therapy concept. The advantage of taping is that it can be easily applied and corrected if the tape does not fit correctly. In addition, its flat design makes it very comfortable to wear, it can also be worn without slipping when swimming and showering, and at the same time it effectively stimulates the bursa sac. After taping, the tape can be left in place for about seven days, after which it should be renewed to maintain its effect until no more symptoms appear.
