Ultrasound-Guided Cortisone Injections and Hyaluronic Acid for Olecranon Bursitis

 

Introduction

Olecranon bursitis is a condition that affects the bursa located at the tip of the elbow. The olecranon bursa is a small, fluid-filled sac that acts as a cushion between the skin and the olecranon, which is the bony prominence of the ulna. This condition can develop due to trauma, repetitive pressure, infection, or inflammatory conditions, leading to swelling, discomfort, and restricted movement.

While mild cases may resolve with conservative treatment, persistent or severe olecranon bursitis may require interventional therapies such as ultrasound-guided cortisone and hyaluronic acid injections to reduce symptoms and improve elbow function.

This blog will explore the anatomy, pathology, symptoms, diagnosis, and treatment options for olecranon bursitis, with a focus on the role of cortisone and hyaluronic acid injections in managing the condition.



Anatomy of the Olecranon Bursa

The elbow joint consists of three bones:

  • Humerus – The upper arm bone.
  • Ulna – The larger of the two forearm bones, forming the olecranon process at the elbow.
  • Radius – The smaller forearm bone.

The olecranon bursa is a thin sac filled with synovial fluid that reduces friction and allows smooth movement between the olecranon process and the overlying skin.

Functions of the Olecranon Bursa

  • Acts as a cushion between the olecranon and skin.
  • Reduces friction during elbow movement.
  • Protects the bony prominence from external forces.

When the bursa becomes inflamed or irritated, it fills with excess fluid, leading to painful swelling and restricted mobility.

Pathology of Olecranon Bursitis

Olecranon bursitis can be classified based on its underlying cause:

1. Non-Infectious (Aseptic) Bursitis

  • Caused by repetitive trauma, prolonged pressure, or underlying inflammatory conditions (e.g., rheumatoid arthritis or gout).
  • Leads to fluid accumulation and thickening of the bursal lining.
  • Often associated with occupational or sports-related activities that involve prolonged leaning on the elbows.

2. Infectious (Septic) Bursitis

  • Occurs due to bacterial infection, usually caused by Staphylococcus aureus.
  • Results in pain, redness, warmth, and potential systemic symptoms like fever.
  • Requires urgent medical attention and often antibiotic therapy or drainage.

3. Traumatic Bursitis

  • Caused by a direct blow to the elbow, leading to haemorrhagic bursitis (bleeding into the bursa).
  • Common in athletes, manual labourers, and individuals with high-impact activities.

Symptoms of Olecranon Bursitis

Olecranon bursitis typically presents with:

  • Swelling – A soft, fluid-filled lump over the tip of the elbow.
  • Pain or tenderness, especially with movement or pressure.
  • Stiffness or limited range of motion in severe cases.
  • Redness and warmth (in cases of septic bursitis).
  • Skin breakdown or drainage if the swelling becomes infected.

Symptoms may gradually develop or appear suddenly, depending on the cause.

Diagnosis of Olecranon Bursitis

Diagnosis is based on clinical evaluation and imaging studies.

1. Clinical Examination

  • Inspection – Identifying swelling, skin changes, or redness.
  • Palpation – Assessing tenderness and fluid accumulation.
  • Range of Motion Test – Evaluating elbow mobility.

2. Ultrasound Imaging

  • Detects fluid accumulation and bursal thickening.
  • Differentiates between infectious and non-infectious bursitis.
  • Provides real-time guidance for injections.

Management of Olecranon Bursitis

Treatment depends on the severity and underlying cause.

1. Conservative Treatment

  • Activity modification – Avoiding prolonged pressure on the elbow.
  • Aspiration – Removal of excess fluid in persistent cases.

If symptoms persist despite conservative measures, ultrasound-guided injections may be considered.

Ultrasound-Guided Cortisone Injections for Olecranon Bursitis

Cortisone injections contain corticosteroids, which act as anti-inflammatory agents. When injected into the inflamed bursa, they help reduce swelling and discomfort.

Mechanism of Action of Cortisone Injections

  • Suppresses inflammatory mediators, including prostaglandins and cytokines.
  • Reduces vascular permeability, preventing further fluid accumulation.
  • Decreases immune cell activity, limiting inflammation.

Benefits of Cortisone Injections

  • Provides rapid pain relief.
  • Reduces swelling and fluid build-up.
  • Improves elbow function by decreasing inflammation.

Cortisone injections are effective in short-term symptom relief, but their long-term use should be monitored to avoid tissue weakening.

Ultrasound-Guided Hyaluronic Acid Injections for Olecranon Bursitis

Hyaluronic acid (HA) is a naturally occurring substance that provides lubrication and cushioning. HA injections are commonly used for joint conditions, but they can also help in bursitis by improving bursal fluid properties and reducing mechanical stress.

Mechanism of Action of Hyaluronic Acid Injections

  • Enhances bursal lubrication, reducing friction and irritation.
  • Improves tissue hydration, supporting healing.
  • Has mild anti-inflammatory properties, reducing pain and swelling.

Benefits of Hyaluronic Acid Injections

  • Provides longer-lasting relief compared to cortisone.
  • Supports bursal function and movement.
  • Helps in chronic cases where recurrent inflammation occurs.

Hyaluronic acid injections may be used alone or in combination with cortisone, depending on the individual patient’s condition.

Conclusion

Olecranon bursitis can cause discomfort and limit elbow movement, particularly in individuals with repetitive or high-impact activities. Ultrasound-guided cortisone and hyaluronic acid injections offer targeted relief by reducing inflammation and improving lubrication.

At Alton Pain Clinic, advanced ultrasound-guided injection techniques are used to ensure effective and safe treatment for persistent olecranon bursitis.

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