The Olecranon is the part of the Ulna bone that is near the elbow joint, and is the superficial bone that you lean on when you rest your elbow on an armrest. Between the bone and the skin, there is a thin layer of tissue called the Bursa that is responsible for lubricating the elbow area in order to minimize the friction between the skin and bone when bending the elbow.
Sometimes when the elbow has been traumatized with a fall or with repetitive leaning on the elbow, the bursa can become irritated and inflamed, causing it to produce excessive fluid. This fluid can at times also get infected, possibly due to cracks in the skin due to dry skin and the fact that the skin here becomes stretched so often with movement.
The swelling on the tip of the elbow can be surprisingly large, even as large as the size of a tennis ball! At times when palpating the area, a small, tender piece of hard tissue resembling a piece of uncooked rice can be felt, appropriately called a "rice body." When it is not infected, it may not be very painful, but can be cosmetically disfiguring for some patients. If infected, the elbow can look red and have increasing pain. Progression of the infected bursa can cause advancing areas of redness called cellulitis, and may eventually cause fevers, chills and systemic symptoms.
X-rays are often ordered to determine whether there is a fracture and or other associated injuries. Also, an MRI may be ordered to help work up soft tissue and other pathology.
Minor swelling of the area can be treated with soft compression with a compression wrap such as Coban or an Ace bandage, usually for up to 2-3 weeks. It is important to try NOT to rest on or bump the elbow. In those that are large enough to be cosmetically bothersome to patients, or if there is a question whether or not there is an infection, a needle aspiration can be performed to remove the fluid. It is not uncommon for the swelling to come back requiring repeat needle aspirations. If there is a mild infection, antibiotics, as well as a heating pad may also be prescribed.
Surgery is recommended if the swelling recurs despite multiple needle aspiration, and/or if the patient objects to the cosmetic appearance, a decision the patient gets to make because of personal preference.
If the bursitus is also associated with an infection, Dr. Lee may recommend surgery in those patients where the infection appears to be significant or has not been adequately treated with oral antibiotics.
The surgery takes on average about 15 minutes to perform, and is usually performed as an outpatient.
Elbow surgery is an area requiring special expertise in order to master because some elbow surgery is typically performed by hand surgeons, and others by sports surgeons, yet neither of them typically do a large quantity of elbow surgery. Dr. Steven Lee is uniquely fellowship trained in both hand/upper extremity surgery as well as sports medicine, and has is one of the most experienced orthopaedic surgeons for elbow surgery in NYC. Learn more about scheduling surgery.
All surgical patients are immediately immobilized in a non-removable splint from above the level of the elbow to the wrist for 7-10 days following surgery. During this time, patients are encouraged to elevate their hand above their heart, keep their dressings clean and dry, and to move their fingers. Patients are allowed to use their fingers to text and type, but not to lift anything heavier than a cup of coffee or that which causes them more than a 2/10 pain level.
Depending on how the elbow looks, the patient may be started on some physical therapy at this time, or maybe immobilized further for another week or so. During the postoperative period, it will be important for the patient not to rest on or bump the elbow. Patients are often using their arms relatively normally by about 4-6 weeks after the surgery.
*It is important to note that all of the information above is not specific to anyone and is subject to change based on many different factors including but not limited to individual patient, diagnosis, and treatment specific variables. It is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopedic advice or assistance should consult Dr. Steven Lee or an orthopedic specialist of your choice.
*Dr. Steven Lee is a board certified orthopedic surgeon and is double fellowship trained in the areas of Hand and Upper Extremity Surgery, and Sports Medicine. He has offices in New York City, Scarsdale, and Westbury Long Island.