Olecranon Bursitis Rehabilitation Protocol

Pathophysiology

Olecranon bursitis is an inflammation of the olecranon bursa, a small fluid-filled sac located between the olecranon process (the bony tip of the elbow) and the skin. This bursa normally allows for smooth gliding of the skin over the bone during elbow flexion and extension. Bursitis occurs when the bursa becomes irritated and inflamed, leading to swelling, pain, and limited range of motion.

Common causes of olecranon bursitis include:

• Direct trauma (e.g., a blow to the elbow)
• Repetitive microtrauma (e.g., prolonged leaning on the elbow)
• Infection (septic bursitis)
• Underlying medical conditions such as rheumatoid arthritis or gout

This protocol is designed for non-septic olecranon bursitis. Septic bursitis requires immediate medical attention and antibiotic treatment.

Rehabilitation Phases

Phase I: Protection (Acute Phase - Days 0-7)

Goals: Reduce pain and inflammation, protect the injured tissue, and prevent further aggravation.

• Activity Modification:
  • Avoid activities that aggravate the condition, such as leaning on the elbow or repetitive elbow movements.
  • Modify work environment to avoid prolonged pressure on the elbow. Consider using an elbow pad.
• Pain and Swelling Management:
  • RICE Protocol:
    • Rest: Avoid activities that cause pain.
    • Ice: Apply ice packs to the elbow for 15-20 minutes every 2-3 hours. Use a protective barrier between the ice pack and skin.
    • Compression: Apply a compression bandage to the elbow to help control swelling. Ensure the bandage is not too tight.
    • Elevation: Elevate the elbow above heart level whenever possible.
  • Medications: Physician may prescribe NSAIDs or other pain relievers.
• Range of Motion (ROM):
  • Gentle Active ROM: Pain-free range of motion exercises (flexion/extension, pronation/supination) performed several times a day to prevent stiffness. Focus on quality movement, not quantity.
  • Assisted ROM: If active ROM is limited due to pain, gentle assisted ROM can be performed.
• Isometric Exercises:
  • Isometric Elbow Flexion/Extension: Perform contractions without movement, holding for 5-10 seconds, repeated several times a day.
• Bracing/Padding:
  • Use an elbow pad to protect the bursa from direct pressure.
  • A soft elbow sleeve can provide mild compression and support.

Phase II: Loading (Subacute Phase - Weeks 1-4)

Goals: Gradually increase ROM, strength, and endurance while continuing to control pain and inflammation. Prepare the elbow for functional activities.

• Pain and Swelling Management:
  • Continue ice application as needed.
  • Consider contrast baths (alternating hot and cold water) to reduce swelling.
• Range of Motion:
  • Active ROM: Progress active ROM exercises, aiming for full pain-free ROM.
  • Stretching: Gentle stretching exercises to improve flexibility, including elbow flexion/extension, pronation/supination. Hold each stretch for 30 seconds, repeated 2-3 times.
  • Joint Mobilization: If ROM is limited, manual therapy techniques (joint mobilizations) may be performed by a physical therapist to improve joint mechanics.
• Strengthening:
  • Isotonic Exercises: Begin with light resistance using dumbbells or resistance bands.
    • Elbow Flexion/Extension: Bicep curls, triceps extensions.
    • Wrist Flexion/Extension: Wrist curls, wrist extensions.
    • Pronation/Supination: Perform pronation/supination exercises with a light dumbbell.
  • Progressive Overload: Gradually increase the resistance as tolerated. Focus on proper form and controlled movements.
• Endurance Exercises:
  • Low-intensity, high-repetition exercises to improve muscular endurance.
  • Example: sustained grip exercises.
• Proprioception Exercises:
  • Closed-chain exercises (e.g., weight-bearing on the hand in a stable position) to improve joint stability and proprioception.

Phase III: Return to Function (Weeks 4+)

Goals: Restore full function, strength, and endurance to allow a return to desired activities without pain or limitations. Focus on activity-specific training.

• Strengthening:
  • Advanced Strengthening Exercises: Progress to more challenging exercises, such as push-ups (modified initially), weightlifting, and plyometric exercises.
  • Eccentric Exercises: Incorporate eccentric exercises to improve strength and control during deceleration movements.
• Endurance:
  • Progress endurance training to meet the demands of specific activities.
  • Examples: prolonged gripping, repetitive elbow movements.
• Functional Training:
  • Simulate activities that the individual will be performing in their daily life or sport.
  • Gradually increase the intensity and duration of these activities.
• Sport-Specific Training (if applicable):
  • Introduce sport-specific drills to prepare the individual for a return to sport.
  • Focus on proper technique and biomechanics.
• Return to Activity:
  • A gradual return to activity is recommended, starting with low-impact activities and gradually increasing the intensity and duration.
  • Monitor for any signs of recurrence, such as pain or swelling.
• Preventative Measures:
  • Continue to use proper technique and biomechanics during activities.
  • Use an elbow pad to protect the bursa from direct pressure, especially during activities that involve leaning on the elbow.
  • Maintain good flexibility and strength of the elbow joint.

Common Special Tests

These tests help differentiate olecranon bursitis from other elbow pathologies. Clinical findings are crucial for accurate diagnosis.

• Palpation: Palpation of the olecranon bursa will reveal tenderness, swelling, and warmth. Fluid fluctuation may be palpable.
• Range of Motion Assessment: Active and passive range of motion may be limited, particularly elbow flexion. Pain may be elicited at end ranges of flexion.
• Resisted Muscle Testing: Resisted elbow flexion/extension, pronation/supination, and wrist flexion/extension are typically normal and pain-free unless there is concurrent involvement of muscles or tendons. This helps to rule out tendinopathies.

Disclaimer: This rehabilitation protocol is a general guideline and should be adapted to the individual's specific needs and tolerance levels. It is essential to consult with a qualified healthcare professional (e.g., physical therapist, physician) for a proper diagnosis and individualized treatment plan.