Olecranon Bursitis
Elbow Bursa
Jacksonville, FL
A soft, fluid-filled swelling over the tip of the elbow — sometimes the size of a golf ball — that appeared after repetitive pressure or minor trauma. That's olecranon bursitis. Dr. R. David Graham at JOI always tries conservative management first. When conservative measures fail, bursectomy is straightforward — but the wound complication risk over the posterior elbow skin is discussed with every patient before surgery.
- Bursa = fluid-filled sac over the olecranon tip — normally paper-thin
- Swells in response to repetitive pressure, trauma, or infection
- Non-infected: aspiration, compression wrap, NSAIDs, padding
- Infected (septic bursitis): aspiration, culture, antibiotics; surgery if needed
- Bursectomy when conservative management fails
- Wound complication risk discussed upfront — posterior elbow skin is tenuous
Non-infected olecranon bursitis is almost always managed conservatively first — aspiration and compression are frequently adequate. Bursectomy is reliable but the posterior elbow wound heals more slowly than most patients expect, and this is discussed before surgery.
What Is Olecranon Bursitis
The Golf Ball on
the Back of the Elbow
The olecranon bursa is a small fluid-filled sac that sits between the skin and the bony tip of the elbow. Normally flat and barely perceptible, it can accumulate fluid in response to repetitive friction (leaning on the elbow), a direct blow, inflammatory arthritis (gout is a common trigger), or infection. The result is the characteristic soft, compressible swelling over the olecranon tip — often dramatically larger than patients expect and alarming to see for the first time.
The most important clinical distinction is infected versus non-infected bursitis. Non-infected (aseptic) bursitis is managed conservatively — aspiration, compression dressing, NSAIDs, and protective padding. Infected (septic) bursitis produces warmth, erythema extending beyond the bursa margin, fever, and purulent aspirate — it requires aspiration with culture, antibiotics, and sometimes surgical drainage or bursectomy if the infection doesn't clear.
In Dr. Graham's approach, non-infected olecranon bursitis is always managed conservatively first. Aspiration alone frequently produces lasting resolution, particularly when followed by a compressive wrap for several weeks. When bursitis recurs repeatedly despite conservative management, bursectomy provides definitive treatment. The important pre-operative conversation is the wound healing risk: the posterior elbow skin is thin, under-vascularized, and under constant flexion stress. Wound dehiscence and delayed healing are more common at this location than at most elbow incisions, and patients are counseled on this before surgery.
- ✓ Non-infected: soft, fluctuant, non-tender to light touch, skin normal color
- ✓ Infected (septic): warm, tender, erythema beyond bursa, may have fever
- ✓ Aspiration with culture distinguishes the two definitively
- ✓ Gout can produce olecranon bursitis — crystal exam on aspirate
- ✓ Septic bursitis: Staph aureus most common — antibiotics +/- surgery
- ✓ Non-infected: aspiration + compression — frequently resolves
Treatment
Conservative First — Bursectomy When Needed
Aspiration
Fluid is aspirated from the bursa and sent for cell count, culture, crystal analysis (to rule out gout), and Gram stain. Aspiration alone provides immediate relief of tension and frequently resolves non-infected bursitis when the bursa is allowed to heal against a compression dressing.
Compression & Padding
Compressive wrap applied after aspiration and maintained for 2–4 weeks. Elbow padding (neoprene sleeve or doughnut pad) eliminates the repetitive friction that perpetuates the bursitis. NSAIDs reduce inflammation. Activity modification to avoid sustained elbow pressure.
Bursectomy — When Conservative Fails
Surgical excision of the bursa when recurrent bursitis does not respond to repeated aspiration and compression. Outpatient procedure through a posterior elbow incision. The wound healing risk is specifically discussed before surgery: the posterior elbow skin is tenuous, and wound healing takes longer than most locations. Patients are counseled on keeping the elbow extended and avoiding pressure on the wound for 2–3 weeks post-operatively.
FAQs
Frequently Asked Questions
Related Conditions
Next Steps
Swelling over the elbow tip —
evaluated and aspirated same day.
Olecranon bursitis is seen and managed at the first visit — aspiration, culture, and initiation of conservative management. Walk-ins welcome via JOI Now, Monday–Friday.
Jacksonville Beach, FL 32250
Walk-ins welcome via JOI Now.