Bursae are thin, slippery sacs located throughout the body that act as cushions between bones and soft tissues. They contain a small amount of lubricating fluid that allows the skin to move freely over the underlying bone. The olecranon bursa lies between the loose skin and the pointy bone at the back of the elbow called the olecranon. Normally, the olecranon bursa is flat. If it becomes injured, irritated or inflamed, fluid (serous, purulent, or hemorrhagic) will accumulate in the bursa causing it to swell.
The differential for olecranon bursitis includes trauma, prolonged pressure (such as leaning on tip of the elbow against hard surfaces), infection, uremia especially in patients with chronic kidney disease, and inflammatory conditions such as rheumatoid arthritis and gout.
If an injury at the tip of the elbow breaks the skin, such as an insect bite, scrape, or puncture wound, bacteria may get inside the bursa sac and cause an infection. The infected bursa produces fluid, redness, and swelling. As the swelling develops, the bursa begins to stretch, which causes pain. The pain often worsens with direct pressure on the elbow or with bending the elbow.
Aspiration of the bursa fluid for diagnosis is often also therapeutic. Incision and drainage should generally be avoided because of poor healing.
Treatment with NSAIDs, possibly corticosteroid injection, avoiding activities that cause direct pressure on the bursa, and wearing an elbow pad to prevent direct impact often provide adequate pain relief for the patient.
Making an elbow pad can be a challenge because you want to avoid applying pressure to the bursa. You need a donut structure which can bursa can fit into. I have had good success making these for the patient using foam. I have prepared a little tutorial for the process.
Prepare the Foam
I like to use this 1/4″ thick foam made by 3M. It comes in 4 in wide strips. It has a nice density and light weight. There is adhesive on one side of the foam. Cut 4-5 strips about 8 inches long.
Stack the Foam
Remove the adhesive covering from the foam strips and stick the pads together to make a stack. For the last top layer, the adhesive should be down so that there is no exposed adhesive sides.
Trim the Foam
Now cut a hole in the center of the foam stack to accommodate the bursa. I also give the edges a slight taper.
Put on Patient
The long axis of the foam should align with the arm. The bursa should fit in the hole comfortably, but without too much extra room. An ACE wrap can keep the foam in place while the patient heals.