Q: Doctor my child is having swelling behind elbow, please guide.

A: The condition needs to be properly assessed by a medical professional for a definite diagnosis. Olecranon bursitis is a condition in which there is an inflammation of the bursa overlying the olecranon process at the proximal aspect of the ulna.

The superficial location of the bursa, namely between the ulna and the skin is susceptible to inflammation from a variety of mechanisms, primarily either acute or repetitive trauma. It is also possible that the inflammation is due to infection, called septic bursitis. Two-thirds of the cases are bursitis without an infection or nonseptic bursitis. However the olecranon bursa normally provides a mechanism with which the skin can glide freely over the olecranon process, consequently the bursa prevents tissue tears.

A bursa is a part of your body that allows two other parts to move smoothly together (outside of a joint). It’s a sac made of thin, slippery tissue. Bursae occur in the body wherever skin, muscles, or tendons need to slide over bone and are lubricated with a small amount of fluid inside that helps reduce friction from the sliding parts.

The olecranon bursa is located between the tip, or point, of the elbow (called the olecranon) and the overlying skin. This bursa allows the elbow to bend and straighten freely underneath the skin, but when the bursa gets irritated, the sac fills up with fluid which leads to swelling of the elbow tip.

Olecranon bursitis is a condition which is relatively common. It is possible that the pain at the posterior elbow may cause morbidity, with limitation of some functional activities (e.g. writing). Two-thirds of cases are nonseptic (ie, without infection) and usually occur when trauma or repeated small injuries lead to bleeding into the bursa or release of inflammatory mediators.

This condition can be caused by acute injuries (trauma) during sports activities because they can include any action that involves direct trauma to the posterior elbow. For example falling onto a hard floor.

Other common causes of olecranon bursitis, which are not related to sports activities, include repetitive microtrauma, like rubbing constantly the elbow against a table during writing. Such a trauma or those repeated small injuries lead to bleeding into the bursa or the release of inflammatory mediators. People in certain occupations are especially vulnerable, particularly plumbers or heating and air conditioning technicians who have to crawl on their knees in tight spaces and lean on their elbows. Finally inflammation may be due to a systematic inflammatory process, like rheumatoid arthritis, or a crystal deposition disease, like gout and pseudogout.

Patients usually remark a focal swelling at the posterior elbow, the swelling is sometimes painless. Pressure, like leaning on the elbow or rubbing against a table while writing with the ipsilateral hand, are factors which can often exacerbate the pain. Chronic recurrent swelling is usually not tender. A typical symptom of olecranon bursitis is the frequent bumping of the swollen elbow, because it protrudes further than it usually would. Bursal inflammation’s most classic finding is a swelling, at the posterior elbow. This swelling is clearly marked off by its appearance as a goose egg over the olecranon process. There may be a tenderness for palpation at the affected site. Cases in which infection is present may show a warm and red affected area. If the trauma has recently occurred, the inspection of the skin may reveal abrasion or contusion. Generally a patient with advanced infection, can have fever.

The Range of motion (ROM) of the affected elbow is usually normal but now and then it is possible that the end-range of elbow flexion is slightly limited due to pain. Patients suffering from systematic inflammatory processes (like rheumatoid arthritis) or crystal – deposition disease (like gout or pseudogout) may reveal evidence of focal inflammation at other sites. When you exam a patient who has rheumatoid arthritis, it is possible that you can see rheumatoid nodules during inspection of the elbow. If the patient reports elbow pain during active or passive ROM and if a history of trauma exists, this may increase the clinical suspicion of an olecranon process fracture.

Most of the time physical and occupational therapy are not necessary, but are often indicated to reduce recovery time. Patients who have often olecranon bursitis are recommend to apply the RICE method of treatment. Rice stands for Rest, Ice, Compression and Elevation. There are also other physical therapy modalities that could be helpful for reducing pain and inflammation. For example phonophoresis, electrical stimulation. However, most patients with olecranon bursitis don’t necessary need those modalities. The physical therapist can also take care of the patient education and present compensatory strategies for resting the involved upper extremity while healing takes place. When the patient shows no response to conservative treatment and his condition deteriorates, then surgery may be indicated. When a patient undergoes a bursal excision (bursectomy), there might be a recommendation for physical therapy after the operation for regaining or maintaining the ROM and strength of the elbow.

Ther treatments that have been suggested in the past for nonseptic olecranon bursitis include the following: Bursal aspiration alone, with or without compressive dressings, Nonsteroidal anti-inflammatory drugs for 10 to 14 days, Corticosteroid injections alone, after aspiration, A “blood patch” injection, The temporary 3-day use of a percutaneous-intrabursal drainage catheter, Holding a needle in place with a hemostat, if aspirating and injecting, Intrabursal injections of tetracycline and talcum powder.

However the treatment and the suitable option is selected depending upon the patient condition by a specialist.