Olecranon Bursa Excision

Summary

This operation is performed for a condition called olecranon bursitis.  The aim of the operation is to remove the chronically infected and inflamed olecranon bursa.  It should not be performed after a single episode of infection as the majority of these will settle.

Factors to Consider

Symptoms from olecranon bursitis vary significantly between patients.  Many patients will have a single episode of olecranon bursitis and then have no further problems.  However, some patients will have recurrent infections and can develop thickened tissue over the point of their elbow.  This can be uncomfortable when pressure is applied and be unsightly.  

If antibiotics and anti inflammatories have not settled your symptoms then the next logical step would be to consider surgery.  Surgery will remove the fluid filled sac (olecranon bursa) that is driving the problem.  However, it is hard to remove this fully and so fluid can continue to be produced which can cause recurrence of symptoms or wound healing problems.  

Description of Surgery

The operation can usually be performed as a daycase procedure but you will need to ensure that there is someone to drop you off and pick you up from the hospital.  You will also need to have a responsible adult at home with you on the night of the operation.

The operation is performed through a 6cm incision on the back of your elbow.  The surgeon will then identify the olecranon bursa and inflamed tissue and remove this.  The wound is then closed with stitches.  If the elbow is quite inflamed at the time the surgeon may decide to place you in a plaster cast to splint the elbow until the wound has healed.  They may also give you antibiotics during this time.  The operation itself takes about 30 minutes.

Anaesthetic

The operation is usually performed under a general anaesthetic and so you will be given instructions as to when you need to stop eating and drinking (normally the night before) before you come into hospital.  

Your pain can be well controlled with local anaesthetic given during the operation.

What are the risks?

All operations involve an element of risk.  The risks for this particular operation are small but it is important that you are aware of them.

The main risk for this operation is wound problems in the first 3 weeks after surgery.  The job of the olecranon bursa is to produce fluid and if this continues to occur after surgery then the wound may not heal fully.  This can occur in about 5% of patients.  

The risk of infection is small and is thought to be about 2%.  Most infections will settle simply with antibiotics.

Damage to nerves and blood vessels around the elbow can occur but this is rare.

 

After Surgery

Pain

Local anaesthetic will be used during the operation and so you will feel comfortable when you first wake up.  This can last up to 12 hours but the elbow may be sore after it wears off.  You will be given a combination of pain killers to go home with.  It is important that you take regular pain relief so that you can start moving your arm early.  

Dressings

You will wake up with your arm in a bulky bandage.  This can be removed 7 days following the surgery and is used to help with swelling.    There will be dressings applied to the wound under these bandages.  These can occasionally come off and will need to be replaced during the first 2 weeks after surgery to protect the wound.  

The dressings are splash proof but not waterproof and so you should avoid getting them wet.

The wound is closed using non-dissolvable stitches.  The stitches will need to be removed 14 days following surgery.  The nurses will arrange for this to be done at your local GP practice before you are discharged.

You may be given a sling but this is only for comfort.  You can get rid of the sling as soon as you feel comfortable.

Driving

You can drive when you feel you are safe to drive.  This means that you feel confident that you have full control of your car and are able to swerve out of the way of something in the road.  This will vary between patients but normally takes about a week.  

Return to work

This depends on what your job is.  You should be able to return to a “desk job” within a few weeks of your surgery.  If you have a more manual job it can take up to 6 weeks before you feel ready to return to work.  Please discuss this further with your surgeon or physiotherapist if you feel unsure.  A sick note can be given to you at the time of your surgery if required.  Please ask the nurses on the ward if you need one.

What to expect

Recovery following surgery can be quite variable.  Your symptoms should be improved/improving by 6 weeks with the majority fully recovered by 3 months.