PREFERRED PRACTICE PATTERN
4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Localized Inflammation
A 54-year-old male bartender presents with posterior elbow pain that has been present for the past 2 weeks. The patient complains of dull pain with difficulty bending and straightening the elbow for dressing activities and weakness with pushing heavy items at work. He has marked pain when leaning his weight on his elbow when bent, especially on hard surfaces. The patient has focal swelling at the posterior elbow over the olecranon, which he notes varies in size when he leans on his elbow at work. The patient has had plain film x-rays which were negative for fracture.
Localized inflammation of the olecranon bursa, which is a subcutaneous bursa at the olecranon process of the elbow
Bursa fills with blood and serous fluid as a response to either acute or repeated microtrauma
Presents as pronounced, local swelling, isolated to the posterior elbow
Olecranon bursitis (OB) is a result of single episode of trauma or repeat trauma to the posterior elbow when the elbow is in a flexed position.
Commonly related to occupation or specific activity that causes rubbing or pressure on the posterior elbow from a hard surface.
Swelling is contained to olecranon bursa which results in the visualization of an “egg” appearance at the posterior elbow.
Patients often note focal pain to palpation of swollen bursa, decreased range of motion, or inability to don a long-sleeved shirt.
Laboratory evaluation of the bursal aspirate.1
Olecranon bursitis. (A) Noninfectious. (B) The significant swelling and erythema suggested an infectious etiology. (From Simon RR, Sherman SC: Emergency Orthopedics, 6th ed www.accessemergencymedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)
Isolated diagnosis related to acute or chronic activity (pressure to the posterior elbow by a hard surface) and focal swelling/pain to the olecranon bursa
Marked tenderness or swelling with acute onset may signal underlying fracture
Exquisite swelling, marked tenderness, and redness or heat may be indicative of infection
No reports identifying or limiting demographics. Incidence related to activity
Occurs primarily in adults, but can occur in children and athletes of any age
Chronic cases often associated with occupation (miner) or prolonged activity (student), which places posterior elbow ...
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