Assistant Professor Indiana University Health Indianapolis, Indiana, United States
Case Diagnosis: Olecranon bursitis, ulnar nerve subluxation
Case Description: 14- year-old volleyball player presented for evaluation of acute right elbow pain and swelling with intermittent numbness of her ulnar three digits which started after a fall on the elbow while diving for a ball during practice. She was found to have findings consistent with traumatic olecranon bursitis resulting in compressive ulnar neuropathy with ulnar nerve subluxation observed on ultrasound. She was initially treated with conservative measures- rest, ice, over the counter anti-inflammatories, physical therapy, and a compressive and padded brace. X-ray was negative for fracture. MRI was consistent with impingement and chronic irritation of the ulnar nerve at the elbow. EMG showed no abnormal electrodiagnostic findings. The patient had acute worsening of pain and numbness with return to play despite conservative measures. She was referred to hand surgery for consideration of ulnar nerve transposition versus other options.
Discussions: Olecranon bursitis can be caused by trauma, excessive pressure, infection, or underlying medical conditions. Rarely, olecranon bursitis can lead to ulnar nerve irritation or subluxation from swelling and changes in the anatomical structures around the elbow joint. These changes can put pressure on the ulnar nerve potentially leading to its displacement from its usual position. In turn, the ulnar nerve might not glide smoothly within its groove causing discomfort, pain, numbness, and tingling occurring in the forearm and hand. Treatment usually involves addressing the bursitis to relieve the pressure on the nerve, in addition to conservative measures like anti-inflammatories.
Conclusions: The presented case underlies the importance of considering both conditions concurrently, as their coexistence can exacerbate symptoms and complicate treatment strategies. As our understanding of these conditions continues to evolve, further research is needed to refine diagnostic techniques and optimize therapeutic interventions.
