Olecranon Bursitis
Upper LimbOverview
Olecranon bursitis is inflammation of the bursa located between the olecranon process and overlying skin at the posterior elbow. This common condition can result from trauma, repetitive pressure, or infection, presenting with swelling, pain, and reduced elbow function. Early intervention typically resolves symptoms, though chronic cases may require more aggressive management.
Pathophysiology
The olecranon bursa is a fluid-filled sac that reduces friction between the olecranon process and skin. Inflammation occurs through either traumatic rupture with hemorrhage, chronic repetitive pressure (leaning on elbows), or infectious seeding (typically Staphylococcus aureus). Non-infectious cases involve synovial inflammation with fluid accumulation, while septic bursitis involves bacterial proliferation within the bursa, potentially leading to abscess formation and systemic infection.
Patient Education
Avoiding direct pressure on the affected elbow and modifying activities that stress the posterior elbow are crucial for recovery; most cases resolve within weeks with conservative management, though persistent swelling may require aspiration or injection.
Typical Presentation
Site
Posterior elbow over the olecranon process; swelling may extend into the forearm
Quality
Dull, aching pain; localized tenderness; sometimes sharp pain with direct pressure or certain movements
Intensity
Mild to moderate pain; often 3-5/10 at rest, increasing with elbow flexion/extension or direct trauma
Aggravating
Direct pressure on posterior elbow, leaning on elbows, repetitive elbow flexion-extension, contact sports, pushing activities
Relieving
Rest, ice application, elbow padding, anti-inflammatory medications, elevation, avoiding direct pressure
Associated
Visible posterior elbow swelling (may be fluctuant), limited elbow range of motion, erythema, warmth (if infected), regional lymphadenopathy (if septic), possible systemic signs in infectious cases (fever, malaise)
Orthopaedic Tests
Test descriptions are written with AI assistance from standard clinical texts. Where a test lists Sources, its description has been checked against them; those sources are independent and do not endorse OsteoKit. Accuracy figures and grades (A–D) appear only when checked against the published study; tests without one are marked “No accuracy study”.
Further reading: full test procedures are described in standard clinical examination texts, e.g. Magee & Manske, Orthopedic Physical Assessment (7th ed.), and Cook & Hegedus, Orthopedic Physical Examination Tests: An Evidence-Based Approach (2nd ed.).
Ultrasound
Procedure
Arranged through the GP or sports doctor when the diagnosis is unclear or to guide aspiration.
Positive Finding
A fluid-filled bursa, with or without thickening or increased blood flow.
Interpretation
Confirms the bursa is the cause of the swelling and can guide aspiration. It cannot reliably tell septic from non-septic bursitis; fluid testing is needed for that.
Aspiration and Fluid Analysis
Procedure
Performed by a doctor under sterile conditions when infection or crystal disease is suspected.
Positive Finding
Cloudy or purulent fluid, organisms on Gram stain or culture, or crystals.
Interpretation
The way to confirm septic bursitis (infection) or gout. Suspected septic bursitis is a same-day medical referral, especially in people with diabetes, immune suppression or a skin wound over the elbow.
Olecranon Bursa Palpation
Procedure
With the elbow bent, look at and gently palpate the swelling over the point of the elbow. Note size, softness, warmth, redness and tenderness, and check the skin for cuts or abrasions.
Positive Finding
A soft, fluid-filled swelling over the olecranon.
Interpretation
Confirms bursitis. A painless, cool swelling after pressure or leaning usually settles with protection. Heat, redness spreading around the elbow, marked tenderness, a skin wound or fever suggest septic bursitis and need same-day medical assessment. Gout and rheumatoid arthritis can also cause olecranon bursitis.
Elbow Range of Motion
Procedure
Ask the patient to bend and straighten the elbow fully, then move it passively, comparing with the other side.
Positive Finding
Pain or tightness over the bursa at end of bending; joint movement otherwise full.
Interpretation
In bursitis the elbow joint itself usually moves fully, with discomfort only when the swollen bursa is stretched in full bending. Painful restriction of all movement suggests a problem in the joint (effusion, fracture or septic arthritis) rather than the bursa.
Bursa Tenderness Assessment
Procedure
Press gently on the bursa and ask about tenderness.
Positive Finding
Marked tenderness over the bursa.
Interpretation
Mild tenderness is common in simple bursitis. Marked tenderness, especially with warmth and redness, raises concern for infection. Firm nodules in the bursa may be rheumatoid nodules or gouty tophi.
Leaning Test (Pressure on the Elbow)
Procedure
Ask about pain when leaning on the elbow (for example on a desk or car door), and ask the patient to lean gently on the elbow on the plinth.
Positive Finding
Pain over the bursa with leaning.
Interpretation
Pain with leaning is typical of olecranon bursitis and guides advice (elbow padding, avoiding leaning). Not a diagnostic test.
⚠ Red Flags
- •Signs of septic bursitis: fever, systemic malaise, rapidly progressive swelling, purulent drainage, severe pain disproportionate to examination
- •Cellulitis or spreading erythema suggesting deep space infection
- •Severe trauma with neurovascular compromise or open wound
- •Immunocompromised patients with any signs of infection
- •Inability to achieve full elbow extension suggesting mechanical obstruction
- •Trauma with fracture of olecranon process on imaging
⚡ Yellow Flags
- •Repetitive occupational exposure (plumbers, miners) suggesting chronic irritation and potential for recurrence
- •Patient belief that swelling indicates serious pathology increasing anxiety
- •Secondary gain from disability (work absence, compensation claims)
- •Psychosocial stress potentially affecting pain perception and recovery
- •History of recurrent bursitis suggesting maladaptive movement patterns or biomechanical dysfunction
Osteopathic Techniques
Aseptic olecranon bursitis is managed conservatively: rest, ice, compression, soft padding and avoiding direct pressure on the elbow, and most cases resolve. Steroid injection carries a higher complication rate and is used cautiously, if at all. No trials of osteopathic techniques were found.
- Reference bookPangia et al. · StatPearls 2025
Safety: Redness, warmth, marked tenderness or fever point to septic bursitis, which needs prompt medical review and antibiotics. Avoid direct pressure on the bursa.
- Reference bookPangia et al. · StatPearls 2025
Region
Humeroulnar and radioulnar joints
Technique
Rationale
Gentle glides of the humeroulnar, humeroradial and radioulnar joints to restore elbow and forearm movement.
How it's done, cautions & evidence
How it's done
Passive, rhythmic, low-velocity glides of the humeroulnar, humeroradial (radiocapitellar) and proximal radioulnar joints, within or up to the end of the available range. In lateral elbow pain, trials tested mobilisation with movement (Mulligan) and regional mobilisation.
Cautions
After a fall or a direct blow, rule out a fracture first: a suspected olecranon fracture needs orthopaedic review. A complete ulnar collateral ligament tear is an indication for surgical referral.
Evidence in Olecranon Bursitis
Searched 26 Oct 2026: no trials of elbow mobilisation in olecranon bursitis.
Sources
- Journal articleCoulter et al. · Spine J 2018
- Journal articleLucado et al. · J Hand Ther 2019
- Reference bookSullivan et al. · StatPearls 2023
- Journal articleCarr et al. · Arthroscopy 2020
Region
Forearm flexors and extensors, and triceps
Technique
Rationale
Muscle energy technique to ease tight forearm muscles around the elbow (wrist extensors or flexors, pronators or supinators).
How it's done, cautions & evidence
How it's done
The wrist or forearm is taken to the barrier of the tight muscle group (wrist extensors or flexors, pronators or supinators). The patient pushes gently back, at about 10–20% effort, against resistance for 5–10 seconds, relaxes for 3–5 seconds, and the new barrier is taken up.
Cautions
Not used with an acute fracture, a joint infection or a bone malignancy; take care with severe osteoporosis or after surgery that limits muscle contraction. Use the least force needed: too much can tear a muscle or pull off a tendon, especially in older patients.
Evidence in Olecranon Bursitis
Searched 26 Oct 2026: no trials of forearm muscle energy technique in olecranon bursitis.
Sources
- Reference bookWaxenbaum & Sina · StatPearls 2026
Region
Shoulder girdle and rotator cuff
Technique
Rationale
Soft tissue to the shoulder girdle and rotator cuff muscles.
How it's done & evidence
How it's done
Hands-on kneading, stroking and sustained pressure to the muscles around the shoulder: the rotator cuff, deltoid and the muscles around the shoulder blade. In trials it was given alongside shoulder exercise.
Evidence in Olecranon Bursitis
Searched 26 Oct 2026: no trials of shoulder soft tissue in olecranon bursitis.
Sources
- Journal articleFurlan et al. · Cochrane 2015
- Journal articlevan et al. · Phys Ther 2015
Rehabilitation Exercises
Gentle Elbow Flexion-Extension Pendulum
Triceps Stretch with Elbow Overhead
Forearm Extensor Stretch (Reverse Prayer Position)
Shoulder Cross-Body Stretch
Scapular Retraction (Braced Position)
Isometric Elbow Extension Against Table Edge
Forearm Pronation-Supination with Neutral Hold
Scapular Stabilization (Prone Y-T-W Holds)
Eccentric Elbow Extension with Light Resistance Band
Proprioceptive Upper Limb Weight Shifting in Quadruped
Upper Limb Ergonomic Positioning Awareness (Workstation Setup)
Walking with Proper Upper Limb Mechanics
Referral Criteria
- •Signs of septic bursitis (fever, systemic symptoms, rapid progression) requiring urgent medical evaluation and possible aspiration/culture
- •Purulent drainage, open wound, or cellulitis spreading beyond localized area—refer to emergency medicine or general practitioner
- •Failure to improve after 4-6 weeks of conservative management suggesting need for ultrasound-guided aspiration or corticosteroid injection
- •Recurrent bursitis (>2 episodes) requiring imaging to exclude underlying structural pathology or occult infection
- •Inability to achieve full elbow extension or significant mechanical limitation suggesting intra-articular involvement—refer for imaging
- •Trauma with suspected olecranon fracture—urgent orthopedic referral
- •Severe pain out of proportion to clinical findings or progressive neurological symptoms—refer to neurologist or surgeon
- •Immunocompromised patient with any sign of infection—refer to infectious disease specialist