The Centers for Advanced Orthopaedics
Maryland Orthopedic Specialists
A Division of The Centers for Advanced Orthopaedics
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Elbow

Olecranon Bursitis

Olecranon bursitis — swelling of the bursa sac over the tip of the elbow — is a common and usually benign condition. However, distinguishing septic from aseptic bursitis is the most critical clinical decision, as septic bursitis requires antibiotic therapy and may need surgical drainage. At Maryland Orthopedic Specialists, we provide same-day evaluation, bursal aspiration with fluid analysis, and comprehensive management of all forms of olecranon bursitis.

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What is olecranon bursitis?

The olecranon bursa is a fluid-filled sac overlying the olecranon process at the posterior elbow tip. It reduces friction between the skin and the bony prominence. When irritated or infected, the bursa fills with fluid, producing the characteristic soft, fluctuant swelling.

The olecranon bursa is a fluid-filled sac overlying the olecranon process at the posterior elbow tip. It reduces friction between the skin and the bony prominence. When irritated or infected, the bursa fills with fluid, producing the characteristic soft, fluctuant swelling.

Causes:

  • Traumatic / repetitive pressure: The most common cause. Prolonged leaning on the elbow (students, plumbers, miners — hence "miner's elbow") or a direct blow causes bursal irritation and hemorrhagic effusion.
  • Inflammatory (crystal-related): Gout (urate crystal deposition) and pseudogout (calcium pyrophosphate) cause inflammatory bursitis. Rheumatoid arthritis (RA) also produces olecranon bursitis as part of systemic inflammatory joint disease.
  • Septic (infectious): The most serious form. Staphylococcus aureus accounts for ~80% of cases. Bacteria enter via skin breakdown over the posterior elbow, minor puncture wounds, or hematogenous spread. Diabetics and immunocompromised patients are at elevated risk.

Distinguishing septic from aseptic bursitis is paramount:

  • Skin erythema/warmth: Aseptic — Mild or absent; Septic — Usually prominent
  • Systemic signs (fever, leukocytosis): Aseptic — Absent; Septic — May be present
  • Bursal fluid WBC: Aseptic — < 2,000–5,000/µL; Septic — > 50,000/µL (may be lower)
  • Bursal fluid Gram stain/culture: Aseptic — Negative; Septic — Positive (~70%)
  • Crystal analysis: Aseptic — Positive in gout/pseudogout; Septic — Negative

Treatment options

Surgical Excision of the olecrenon bursa

Surgical excision of the olecranon bursa is reserved for cases that have failed 3 to 6 months of conservative management — including aspiration, compression, padding, and corticosteroid injection — and continue to cause significant pain or functional limitation. The procedure is performed as an outpatient surgery, removing the entire bursal sac through a posterior elbow incision with care taken to achieve meticulous wound closure, as the posterior elbow skin is under tension and wound healing complications are the most common adverse outcome. A compressive dressing and elbow splint are maintained for 2 to 3 weeks postoperatively to minimize dead space and reduce the risk of recurrence or wound dehiscence. Recurrence after complete surgical excision is uncommon — approximately 5 to 10 percent — and outcomes are generally excellent when the procedure is performed for appropriately refractory cases.

Frequently Asked Questions

How do I know if my elbow swelling is infected?
Key signs of septic bursitis include prominent skin redness extending beyond the bursa, warmth, fever, and systemic illness. Aspiration with fluid analysis is the definitive way to distinguish septic from aseptic bursitis.
Can I drain it myself?
No. Aspiration should be performed under sterile technique to avoid introducing infection into the bursa and to obtain fluid for proper analysis. Home drainage attempts carry a significant risk of converting aseptic to septic bursitis.
Will the bursa grow back after surgery?
Recurrence after surgical bursectomy is uncommon (< 5%), making it an effective permanent solution for chronic cases.
Should I avoid leaning on my elbow if I have olecranon bursitis?
Yes — avoiding repeated pressure on the point of the elbow is one of the most important steps in allowing the bursa to calm down and preventing the swelling from worsening. Using elbow padding or avoiding hard surfaces can significantly reduce irritation. In occupational or activity-related cases, identifying and modifying the repetitive pressure source is essential to preventing recurrence. Your MOS provider can recommend appropriate protective gear and activity adjustments as part of your overall treatment plan.
What is the treatment if my olecranon bursitis is not infected?
Non-infected (non-septic) olecranon bursitis is initially managed conservatively with activity modification, elbow padding, and anti-inflammatory medications. If the swelling is large and bothersome, aspiration by a physician can provide relief, though fluid often re-accumulates. A corticosteroid injection into the bursa can help reduce chronic inflammation in cases that do not resolve with rest alone. Surgery to remove the bursa is reserved for recurrent or persistent cases that have failed multiple rounds of conservative care, and your MOS surgeon will discuss the timing and approach that makes most sense for your situation.

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Related conditions

Elbow ArthritisElbow Fractures
Medically reviewed by Peter G. Fitzgibbons, MD, MD
Last reviewed May 1, 2026

References

  1. Blackwell JR, Hay BA, Bolt AM, Hay SM. Olecranon bursitis: a systematic overview. Shoulder & Elbow. 2014;6(3):182–190. https://doi.org/10.1177/1758573214532787
  2. Stell IM. Management of acute bursitis: outcome study of a structured approach. Journal of the Royal Society of Medicine. 1999;92(10):516–521. https://doi.org/10.1177/014107689909201008
  3. American Academy of Orthopaedic Surgeons. Olecranon (Elbow) Bursitis — OrthoInfo. https://orthoinfo.aaos.org/en/diseases--conditions/olecranon-elbow-bursitis (accessed May 2026).
  4. Ho G Jr, Tice AD, Kaplan SR. Septic bursitis in the prepatellar and olecranon bursae: an analysis of 25 cases. Annals of Internal Medicine. 1978;89(1):21–27. https://doi.org/10.7326/0003-4819-89-1-21