Definition
Bursitis olecrani is the inflammation of the bursa at the elbow. Colloquially, this inflammation is often referred to as “student elbow”. A distinction is made between acute and chronic bursitis olecrani, which have different causes but a similar course.
Causes
An inflammation of the bursa of the elbow can have an acute or a chronic origin. Often it is caused by a long-lasting overload of the elbow. This can be caused, for example, by always leaning on the elbow when working regularly at the desk.
As a result, the elbow or the bursa lying just under the skin are permanently irritated. As this is particularly often the case with pupils or students who have to learn, this is also referred to as a “student’s elbow” or “student elbow”. Acutely, bursitis olecrani is mainly caused by injuries: Both open injuries, for example lacerations, and closed injuries, for example contusions, can cause inflammation of the bursa.
This form of bursitis often affects athletes who are at high risk of suffering trauma to the elbow as a result of their sport, such as ice hockey players, volleyball players or wrestlers. Another cause of bursitis olecrani can be metabolic diseases (e.g. gout). Furthermore, systemic diseases, which are associated with a misregulation of the immune system, can also cause inflammation of bursae. These include in particular rheumatic diseases such as rheumatoid arthritis. In rare cases, bursitis can also be caused directly by pathogens that either enter the tissue through an injury or affect the bursa as part of an infectious disease.
Symptoms
The main symptom of bursitis olecrani is the severe swelling of the elbow, which can even grow to the size of a chicken egg. The other cardinal symptoms of inflammation (redness, overheating, pain and limited function) are also present in a typical bursitis of the elbow. Because the bursa is usually filled with an effusion as a result of inflammation, it feels firm and elastic.
In addition, so-called “grains of rice” can occasionally be discovered under the skin during palpation. If the inflammation was caused by bacteria, it can sometimes also lead to an accumulation of pus. While the symptoms of acute bursitis olecrani are very sudden and severe, a chronic form can be conspicuous either by swelling without accompanying pain or by recurrent attacks.
Therapy
The therapy of bursitis olecrani is usually started conservatively, i.e. without a surgical intervention: If the conservative measures do not result in any or only an insufficient improvement of the symptoms, surgery should be performed. However, this is rarely the case. A further indication for a surgical intervention are patients in whom the bursitis is purulent.
During the operation, the entire bursa is removed (bursectomy) and, if necessary, the pus is drained. In the purulent form, chains of antibiotics must also be inserted into the wound and left there for a few days. Immediately after the operation, the elbow should be immobilised by an upper arm splint.
Later on, further treatment with elastic bandages should be continued for some time. However, if incorrect strain or injuries continue to exist, the disease may recur (relapse). – The most important thing is to immobilize the elbow joint, possibly with the help of a splint.
It should be noted that in particular the activity that may have caused the chronic overloading of the elbow should be completely stopped for a time if possible. – In addition, cooling the affected region has a pain-relieving effect. If there is a large effusion, the bursa is often punctured to relieve the pressure and thus reduce pain.
- On this occasion, there is the option of injecting anti-inflammatory drugs, such as glucocorticoids, into the bursa at the same time. – Drugs that can be administered orally and that help well against the pain in bursitis olecrani are non-steroidal anti-inflammatory drugs such as ibuprofen or diclofenac. – If the inflammation is caused by a bacterium, antibiotics may also be useful.
If it is septic, i.e. bacterially infected bursitis olecrani, antibiotics are used as therapy. Usually the pathogen is a bacterium called Staphylococcus aureus and can be fought with certain antibiotics for 7-10 days. Even if the symptoms improve before the end of the therapy, the antibiotic must continue to be taken over time, for as long as the doctor prescribes it.
If the patient stops taking the antibiotic early, the bacterium may develop resistance to the antibiotic or the inflammation may worsen after a few days. Some cases of bursitis olecrani can last for several weeks with pain and then months of swelling. For example septic inflammation, i.e. inflammation of the bursa infected by bacteria that does not respond to antibiotic therapy.
In such cases, it is medically necessary to consult an orthopaedic surgeon in order to carry out a surgical treatment of bursitis. Antibiotics are usually given to support the operation, also to prevent infections caused by the operation. Often a puncture is first made before an operation, with which either fluid or pus can be drained.
In case of septic bursitis olecrani, the entire bursa is removed in one operation. Even in the case of non-septic but complicated courses of olecranian bursitis, the entire bursa is removed; this can be done on an outpatient basis under certain circumstances. The skin wound usually heals within 2 weeks.
After the operation, the elbow is immobilised with a splint until it can be re-inserted after 3-4 weeks. The bursa does not grow back after the operation, but new tissue is formed which can partially replace the function. The muscles around the elbow should then be stabilised under physiotherapeutic care in order to counteract inflammation in the joint in the long term. More about this under:
- Operation of a bursitis
