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Figure. Lateral radiograph of the left elbow.
A 78-year-old man presents with a 3-year history of swelling of the posterior aspect of his left elbow. The swelling has waxed and waned, with the patient managing the swelling with ice and compression wraps. Physical examination of his left elbow reveals a boggy-feeling olecranon bursa without erythema or warmth and minimal bursal fluid. Lateral radiograph of his left elbow is obtained (Figure). The patient is requesting surgical excision of the elbow spur.
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The olecranon bursa is a fluid filled sac located on the olecranon process that provides a cushion between the bone and the surrounding soft tissues.1 Non-infectious olecranon bursitis may be caused by trauma to the elbow, prolonged pressure on the tip of the elbow, or irritation from an underlying olecranon traction spur.1,2
The patient in this case has an olecranon traction spur, otherwise known as an olecranon osteophyte, as determined by the patient’s radiograph results. The traction spur grows at the insertion site of the triceps tendon and can cause insertion triceps tendinitis in addition to olecranon bursitis. The spur is usually found in the superficial portion of the triceps tendon and away from the deep tendon attachments to the bone.1,2
Surgical excision provides excellent pain relief for olecranon traction spurs and does not adversely affect triceps strength and function.1 Surgical management of olecranon traction spurs may be considered when conservative treatment for chronic olecranon bursitis (including ice, activity modification, and nonsteroidal anti-inflammatory drugs) has not provided relief of symptoms.1,2
Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor in chief of the Journal of Orthopedics for Physician Assistants.
References
1. Alvi HM, Kalainov DM, Biswas D, Soneru AP, Cohen MS. Surgical management of symptomatic olecranon traction spurs. Orthop J Sports Med. 2014;2(7):2325967114542775.
2. Aaron DL, Patel A, Kayiaros S, Calfee R. Four common types of bursitis: diagnosis and management. J Am Acad Orthop Surg. 2011;19(6):359-367.
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