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Tales of the Swollen Elbow
A 48-year-old female presents to the emergency department due to worsening L elbow pain, swelling, and redness. Endorses subjective fevers. She was learning to surf around a week ago and thinks she may have cut her elbow on the board. She has been taking NSAIDs, icing the area, and using a compressive bandage but it has not improved.
Tales of the Swollen Elbow
Author: John Rolshoven, MD
Peer-Reviewer: Will Denq, MD, CAQ-SM
Final Editor: Alex Tomesch, MD, CAQ-SM
A 48-year-old female presents to the emergency department due to worsening L elbow pain, swelling, and redness. Endorses subjective fevers. She was learning to surf around a week ago and thinks she may have cut her elbow on the board. She has been taking NSAIDs, icing the area, and using a compressive bandage but it has not improved.
Image 1. Lateral and frontal plain radiographs of the L elbow in a patient with elbow pain and swelling. Radiopedia example: Case courtesy of A Abdrabou, Radiopaedia.org, rID:29196
Which diagnostic and imaging modalities can be used?
Olecranon bursitis is typically a clinical diagnosis and does not require imaging. However, plain films can be used to evaluate for olecranon fracture or avulsed osteophyte and will likely show soft tissue swelling superficial to the olecranon. Ultrasound can help differentiate olecranon bursitis from cellulitis and other soft tissue infections (Image 2) [6]. MRI may be used in atypical cases to differentiate bursitis from other diagnoses such as osteomyelitis, stress fracture or triceps tear [7].
Image 2. Short axis (left) and long axis (right) of elbow showing olecranon bursitis. Radiopaedia example: Case courtesy of A Abdrabou, Radiopaedia.org, rID: 29196
References
[1] Stell IM. Management of acute bursitis: outcome study of a structured approach. J R Soc Med. 1999;92:516-521.
[2] Deal JB Jr, Vaslow AS, Bickley RJ, Verwiebe EG, Ryan PM. Empirical treatment of uncomplicated septic olecranon bursitis without aspiration. J Hand Surg Am. 2020;45:20-25.
[3] Truong J, Mabrouk A, Ashurst JV. Septic Bursitis. StatPearls [Internet]. 2022. Available from: https://www.ncbi.nlm.nih.gov/
[4] Hubbard MJ, Hildebrand BA, Battafarano MM, Battafarano DF. Common Soft Tissue Musculoskeletal Pain Disorders. Prim Care. 2018 Jun;45(2):289-303.
[5] Pangia J, Rizvi TJ. Olecranon Bursitis. [Updated 2022 Jul 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/
[6] Blankstein A, Ganel A, Givon U, Mirovski Y, Chechick A. Ultrasonographic findings in patients with olecranon bursitis. Ultraschall Med. 2006 Dec. 27(6):568-71. [QxMD MEDLINE Link].
[7] Floemer F, Morrison WB, Bongartz G, Ledermann HP. MRI characteristics of olecranon bursitis. AJR Am J Roentgenol. 2004 Jul. 183(1):29-34. [QxMD MEDLINE Link]. [Full Text].
[8] Beyde A, Thomas A, Colbenson K. Efficacy of empiric antibiotic management of septic olecranon bursitis without bursal aspiration in emergency department patients. Academic Emergency Medicine. 2021; 29; 6-14. https://doi.org/10.1111/acem.
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