Patient resources
NHS Lothian MSK Self Help Resources Webpage
Definition
- Inflammation of the olecranon bursa
- Non-septic (most common): sterile inflammation resulting from various causes including trauma or overuse
- Septic: infection resulting from seeding of the bursal sac with micro-organisms, usually bacteria
Typical signs and symptoms
- Fluctuant (moveable and compressible) swelling over the olecranon
- Pain (although may be painless), redness, warm to touch
- Elbow joint movement should be painless except at full flexion when the swollen bursa is compressed
- Septic bursitis: painful, red, hot swelling, progressively worsening; localised cellulitis, abrasion at the elbow, systemic symptoms
Prevalence and risk factors
- Male > female, typically aged 30-60 years
- Non-septic bursitis: athletes who play sports which involve repetitive overhead throwing or elbow flexion/extension; jobs which involve risk of regular elbow trauma or pressure on the bursa e.g. gardeners and mechanics; systemic conditions, most notably gout and rheumatoid arthritis (RA)
- Septic bursitis: history of trauma/ open wound, immunocompromised
Prognosis/ risk factors for poor outcome
- 50% of non-septic cases settle within 2 weeks, 75% settle within 8 weeks
- 10% of people may still have swelling at 6 months
- Non-septic cases are more likely to recur or become chronic
- Risk factors include: occupations requiring repetitive activity increase the risk of recurrence and chronicity – activity modification should be advised
Differential diagnoses
Gout & RA are associated with olecranon bursitis
Relevant Standards & Guidelines
NICE Clinical Knowledge Summary: Olecranon Bursitis
P.A & M.A- 15-7-26
Who can refer:
- All primary care clinicians with relevant appropriate scope of practice i.e. GPs, Primary care MSK advanced practice physiotherapists, advanced nurse practitioners
- Patient self referral (resident of East Lothian HSCP, Edinburgh HSCP and West Lothian HSCP Where To Find Us – Musculoskeletal Physiotherapy)
- Secondary care consultants and associated teams
- MSK physiotherapists who identify patients with suspected serious conditions of the shoulder or elbow shoulder follow agreed pathways and processes NHS Lothian Integrated Shoulder & Elbow Service
Who and How to refer:
** If there has been a breakage to the skin, signs of infection, or any suspicion of a septic joint, this is a red flag and should be managed as an emergency **
| Condition | Referral Type | Referral destination and process |
|---|---|---|
| Suspected septic arthritis/ septic bursitis | Same day | Orthopaedic registrar via Flow navigation centre on 03000 134000/ on call Orthopaedic registrar via switchboard 0131 242 1000 |
| Suspected facture or dislocation | Same day | Orthopaedic registrar via Flow navigation centre on 03000 134000/ on call Orthopaedic registrar via switchboard 0131 242 1000 |
| Suspected acute distal biceps rupture | Same day | Orthopaedic registrar via Flow navigation centre on 03000 134000/ on call Orthopaedic registrar via switchboard 0131 242 1000 |
| Suspected acute traumatic rotator cuff tear in the younger patient | Urgent | Orthopaedics via SCI gateway > Lauriston Buildings > Orthopaedics- Elbow & Shoulder |
| Suspected malignancy/ tumour specific to shoulder* | Urgent | Orthopaedics via SCI gateway > Lauriston Buildings > Orthopaedics- Elbow & Shoulder |
| Suspected inflammatory condition | Consider referral to Rheumatology – see RefHelp Rheumatology. | |
| Suspected neurological condition | Consider referral to Neurology – see RefHelp Neurology. |
* Please also see Sarcoma – RefHelp. If clinical assessment leads to a very strong suspicion of suspected underlying malignancy, with no specific localising signs or symptoms to suggest a specific underlying primary, consider recommendations and referral options detailed on GP Access to CT for Suspected Cancer (No Clinically Obvious Primary) – RefHelp
Who not to refer:
- Patients who have the presence of significant red flags/ suspicion of serious shoulder and elbow conditions or have suspected inflammatory condition – see serious shoulder & elbow conditions
- Age <16
For further information see associated sections
- Link to NHS Lothian patient internet site including patient information resources – https://services.nhslothian.scot/ISES/Pages/default.aspx
- Link to NHS Inform page shoulder problems https://www.nhsinform.scot/illnesses-and-conditions/muscle-bone-and-joints/self-management-advice/shoulder-problems
- Link to NHS Inform shoulder problems- Patient self help guide https://www.nhsinform.scot/self-help-guides/self-help-guide-shoulder-pain
- Link to NHS Inform page elbow problems https://www.nhsinform.scot/illnesses-and-conditions/muscle-bone-and-joints/self-management-advice/elbow-problems
- Link to intranet site NHS Lothian Integrated Shoulder and Elbow Service http://intranet.lothian.scot.nhs.uk/Directory/physiotherapy/NHSLIntegratedShoulderandElbowService/Pages/default.aspx
