Olecranon Bursa

Tophi (urate deposits) are uncommon in gouty subjects and are a late complication of hyperuricemia. The most common sites of tophaceous deposits in patients with recurrent acute gouty arthritis are the base of the great toe, helix of the ear, olecranon bursae, Achilles tendon, knees, wrists, and hands. 

Male 70 Finger, toes olecranon bursa Recurrent pulmonary emboli Frusemide 550 60... 

The elbow should be examined first by observation. The carrying angle of the elbow should be noted, as should any swelling, which may be diffuse or localized to the olecranon bursa posteriorly. Signs of old or new trauma should be noted, such as scars, abrasions, bruises, and the like. 

The soft tissues and bony structures are then palpated to evaluate the integrity of the bones and the presence of any tenderness, masses, asymmetries, or crepitus. Any temperature changes should be noted, especially over the bursa and around the joints. Bony landmarks should be identified and compared between elbows. Swelling, especially over the olecranon bursa, should be noted. The olecranon bursa should not be palpable unless it is filled with fluid or thickened. 

Several synovial bursae around the elbow joint lessen friction between bones and the overlying skin and soft-tissue structures. The most important are the olecranon bursa and the bidpitoradial bursa. The olecranon bursa is a large subcutaneous bursa which intervenes between the skin and the olecranon process over the posterior aspect of the elbow. The bidpitoradial bursa (cubital bursa) lies deep in the anterior compartment of the elbow, between the distal biceps tendon and the radial tuberosity, to reduce friction between, especially during pronation of the forearm (Skaf et al. 1999). In fact, the radial tuberosity rotates posteriorly during pronation and wraps the tendon around the radial cortex. During this movement, the bursa is tracked between the tendon and the bone (Fig. 8.8). When distended by fluid, the bicipitoradial bursa may surround the biceps tendon completely and may cause a mass effect on the adjacent branches of the radial nerve. 

Distal triceps tendon tear is an uncommon condition that mostly occurs at or close to the olecranon process of the ulna, often associated with a fleck of bone attached to the retracted tendon as a result of avulsion fracture (Fig. 8.47). The mechanism involves either forced flexion of the elbow against a contracting triceps, as occurs during a fall on an outstretched arm, or relates to a direct blow onto the olecranon process. Local steroid injection into the olecranon bursa, anabolic steroid abuse and pre-existing tendinosis may also have a role in the tendon rupture. As a rule, complete tears occur more... 

Fig. 8.50a-c. Chronic traumatic olecranon bursitis in a manual laborer who had recently injured several times his posterior right elbow, a Midsagittal and b transverse 12-5 MHz US images over the olecranon process (O) show a markedly distended olecranon bursa (arrowheads) containing thick septa (curved arrows) and anechoic effusion (asterisks). Straight arrows, distal triceps tendon, c Photograph showing the bursal lump (arrows) on the posterior elbow... 

Fig. 8.51a-c. Hydroxyapatite olecranon bursitis, a Transverse and b,c longitudinal 12-5 MHz US images of a painful soft-tissue mass over the olecranon (0) show the olecranon bursa filled with homogeneous highly echogenic fluid (asterisks) that could be seen fluctuating during probe compression. The bursa exhibits thickened walls (arrowheads) and septa (arrows). In this case, needle aspiration of the bursal fluid revealed calcium milk solution... 

Fig. 8.53a,b. Calcific olecranon bursitis in a patient with renal osteodystrophy, a Posterior midsagittal 12-5 MHz US image with b lateral radiographic correlation demonstrates a large calcification (asterisks) that lies superficial to the insertion of the distal triceps tendon (arrowheads) reflecting an extensively calcified bursa. Note the relation of the mass with the posterior olecranon... 

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