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Elbow Bursitis

Elbow bursitis, also known as olecranon bursitis, is a term used to describe the inflammation of a bursa that is found between the skin of the elbow and the olecranon, which is the bony tip of the elbow. A normal bursa is a flat, fluid-filled sac that lies between various tissues and structures such as tendons and bones to cushion them and allow them to glide smoothly over each other. There are many bursae in the body, the major ones found at the large joints. If a bursa is injured or inflamed it swells with extra fluid, creating pressure that can lead to irritation and pain.

Swelling of the bursa may be caused by a trauma to the elbow, or it may develop gradually as a result of habitually leaning on the elbows. People whose occupations require them to spend extended periods leaning on their elbows, for example plumbers, heating engineers or even students, are at increased risk of developing bursitis.

Some medical conditions, such as gout or rheumatoid arthritis, tend to produce elbow bursitis.

An infection of the bursa, whether from an injury to the elbow or not, can cause swelling. Because the bursa lies just under the skin of the elbow and is not protected by fat, muscle or other tissue, the risk of puncture wounds is greater than for bursae elsewhere in the body. A puncture wound to the elbow bursa can provide an entry for infectious microbes.

  • Pain and tenderness at the elbow, made worse with pressure or bending the elbow
  • A swollen lump at the tip of the elbow that may restrict elbow range of motion
  • Possible heat and redness of the skin around the elbow, if infected
Your doctor will ask you for your medical history, particularly any previous injuries to your elbow. Your lifestyle, occupation, and recreational activities will be discussed. Your elbow and arm will then be physically examined, with the location and amount of swelling noted, along with areas of tenderness. You will be asked to bend your elbow so the doctor can check if the swelling is preventing the full range of motion of the joint.

If an infection is suspected, your doctor may aspirate some fluid from the bursa. This is done in the office and is a simple procedure that removes, via a needle, some of the fluid. This fluid can then be sent to a laboratory for analysis.

An X-ray may be ordered to look for any other reason for the bursa swelling, such as a bone spur or foreign object. Bone spurs tend to be found in patients with a history of repeated elbow bursitis. Occasionally, if the diagnosis is unclear, a bone scan or MRI (magnetic resonance imaging) scan can be a useful test.

Treatment for elbow bursitis is initially conservative (non-surgical). Most cases resolve within a couple of weeks with such measures and surgery is only necessary if conservative treatment fails to provide relief.

Non-surgical treatment for uninfected bursitis may include:
Ice: Applying ice, crushed in a bag and wrapped in a towel, to the elbow for as long as is comfortable, several times a day, will help reduce swelling.
NSAIDs: Non-steroidal anti-inflammatory medication such as ibuprofen (Advil), naproxen (Aleve) or aspirin, taken according to directions, can reduce swelling and alleviate pain.
Rest: Avoiding the sorts of activities or movements that press directly on the olecranon will allow the swelling to subside.
Compression: Wearing a compression bandage will make you feel more comfortable. It should feel snug, but be sure not to wrap it so tightly that you feel tingling in your fingers or notice that your fingers are turning blue.
Elevation: Raising your elbow above the level of your heart will help any swelling to go down. Do not hold your elbow over your head, but instead rest it on a couple of pillows.
Needle aspiration: As well as providing fluid for analysis, by removing fluid from the swollen bursa this procedure will relieve pressure and pain.
Injection: Your doctor may administer a corticosteroid injection directly into the bursa, often at the same time as aspirating the site. The corticosteroid is an anti-inflammatory and can provide immediate relief, although such relief may be only temporary. There is a limit to the number of times a corticosteroid can be given.
Protection: A pad worn over the elbow will provide protection from further pressure.
Physical therapy: Although physical therapy is not often needed for elbow bursitis, your doctor may suggest that you practice some stretching and strengthening exercises, after the bursitis has eased. Sometimes applying ultrasound to the elbow can promote healing.

Fluid from an infected bursa will need analysis to identify the cause of infection, followed by a course of antibiotics. Occasionally the medicine may need to be administered intravenously (into a vein), and the aspiration repeated.

A bursa may need to be surgically removed if conservative treatment, or antibiotics in the case of an infected bursa, has not improved your symptoms. After surgery, the bursa would gradually, over several months, grow back into a symptomless, fully functioning structure. If infection caused your elbow bursitis, you would probably continue with a course of antibiotics for a time.

A splint would be worn temporarily to protect the surgical site, and after a period of a few days, you would be able to begin some exercises to restore the full range of motion to your elbow. Continuing to protect the elbow with a pad for several months would be advisable.

The most effective way to prevent elbow bursitis from returning is to avoid excessive leaning on your elbows. For those people whose occupations require such leaning, protect the elbows with pads and use the methods outlined above (rest, ice, compression, elevation, NSAIDs) if you begin to feel any pain.

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