Derm Dx: Persistent swelling on the elbow - Clinical Advisor

Derm Dx: Persistent swelling on the elbow

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A 65-year-old patient presented with complaints of persistent swelling of his elbow. The swelling is associated with minimal pain. He is otherwise healthy.

Physical exam revealed swelling at the olecranon fossa. The area is palpated and inspected for fluctuance, tenderness and erythema, as well as to evaluate for signs of trauma.

Diagnosis & TreatmentOlecranon bursitis involves either acute or chronic inflammation of the olecranon bursa. The olecranon bursa is a subcutaneous synovial-lined sac that acts to cushion the olecranon aspect of the elbow unit.  The bursitis occurs due to either acute...

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Diagnosis & Treatment

Olecranon bursitis involves either acute or chronic inflammation of the olecranon bursa. The olecranon bursa is a subcutaneous synovial-lined sac that acts to cushion the olecranon aspect of the elbow unit. 

The bursitis occurs due to either acute or repetitive trauma; rarely, the buritis is caused by infection within the bursa.

Acute trauma may occur during activities such as sporting events where the athlete falls directly onto the olecranon process. Chronic trauma may occur when an elbow constantly rubs against a table while writing. 

Inflammation can also because by infection from a laceration to the area, from a systemic inflammatory disease such as rheumatoid arthritis, or from crystal deposition disease. 

Patients usually complain of either painful or painless swelling at the posterior elbow. If the patient experienced acute trauma then the swelling may have been sudden; however, if the cause of the bursitis is chronic irritation than the swelling may be gradual. 

Olecranon bursitis is not typically treated by a dermatologist, but these may be the first healthcare providers to see patients with this condition as they often perceive the issue as a “skin problem.” Referral to either the patient’s primary care health provider or an orthopedic surgeon for further evaluation and management is appropriate. 

If the lesion is very painful, erythematous, associated with cellulitis, fever or any other signs of infection, then urgent follow-up is necessary. 

Adam Rees, MD, is a graduate of the University of California Los Angeles School of Medicine and a resident in the Department of Dermatology at Baylor College of Medicine also in Houston.

References

  1. Wieting, M. Olecranon Bursitis. 1 April 2013. Medscape. Retrieved 4/30/14 from http://emedicine.medscape.com/article/327951-overview
  2. Cecil R, Goldman L, Schafer A. 2012. “Chapter 271: Bursitis, Tendinitis, and Other Periarticular Disorders and Sports Medicine.” Goldman’s Cecil Medicine. Philadelphia: Saunders Elsevier. Print.
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