Shoulder and Elbow

Elbow (Olecranon) Bursitis

Anatomy

A bursa is a small, jelly-like sac filled with lubricating fluid that allows the skin to move freely over the underlying bone. By providing a cushion between bones and soft tissues such as tendons and muscles, bursae help reduce friction around joints and enable free movement. Bursae can be found throughout the body, near most major joints, including the shoulder, elbow, knee, heel and hip. The olecranon bursa lies between the loose skin and the pointy bone at the back of the elbow (olecranon).

Description

Normally, the olecranon bursa is flat. However, if it becomes irritated or inflamed, more fluid accumulates in the bursa causing elbow bursitis to develop.

Symptoms

Typically, the first sign of elbow bursitis is swelling but because the skin on the back of the elbow is loose, a small amount of swelling may not be immediately noticeable. As swelling continues and the bursa begins to stretch, it causes pain in the elbow which often worsens with bending and direct pressure on the joint. Swelling may grow large enough to restrict elbow motion. If the skin becomes red and warm, it may be a sign of infection. This requires immediate treatment to prevent the infection from spreading to other parts of the arm, or into the bloodstream, where it can produce serious illness. Occasionally, an infected bursa opens spontaneously and drains pus.

Causes

Elbow bursitis can occur for a number of reasons.

• Trauma—A hard blow to the tip of the elbow can cause the bursa to produce excess fluid and swell.
• Prolonged pressure—Leaning on the tip of the elbow for long periods of time on hard surfaces, such as a tabletop, may cause the bursa to swell. Typically, this type of bursitis develops over several months. People in certain occupations are especially vulnerable, particularly plumbers or heating and air conditioning technicians who have to crawl on their knees in tight spaces and lean on their elbows.
• Infection—If an insect bite, scrape, puncture wound, or other injury at the tip of the elbow breaks the skin, bacteria may enter the bursa sac and cause an infection. An infected bursa produces fluid, redness, swelling and pain, and without treatment, the fluid may turn to pus. Occasionally, the bursa sac may become infected without any obvious injury to the skin.
• Medical conditions—Certain conditions, such as rheumatoid arthritis and gout, are associated with elbow bursitis.

Diagnosis

After discussing your symptoms and medical history, your doctor will examine your arm and elbow. An X-ray may be recommended to check for a foreign body or bone spur on the tip of the elbow bone, which is common in patients who experience repeated instances of elbow bursitis. Your doctor may recommend an X-ray to look for a foreign body or a bone spur. Bone spurs are often found on the tip of the elbow bone in patients who have had repeated instances of elbow bursitis.

Nonsurgical Treatment

If the bursitis is due to an infection, your physician may recommend aspirating (removing the fluid from) the bursa with a needle. This is commonly performed as an office procedure. In addition to symptom relief, fluid removal provides a sample that can be tested for bacteria growth which helps your physician identify the appropriate antibiotic to prescribe, if needed. However, some doctors try to avoid aspiration because it does carry the risk of introducing bacteria into a noninfected bursa and can also lead to persistent drainage. While the exact type of infection is being identified, it may be necessary to prescribe an antibiotic that is effective in treating a number of possible infections in order to prevent the infection from progressing.

If the bursitis is not the result of an infection, it may be treated with a number of options.

• Compression—This is the most effective treatment for olecranon bursitis. Applying an ACE™-type elastic bandage, wrap or compression sleeve from the wrist to the upper arm, 24 hours a day for 2-4 weeks, typically resolves the bursitis and allows the elbow to return to its normal size. Do not apply wrapping around the elbow only, because this causes swelling in the hand.
• Elbow pads—Cushioning the elbow helps relieve excess pressure placed on the joint when leaning on it.
• Activity changes—Avoid activities that cause direct pressure to the swollen elbow.
• Nonsteroidal anti-inflammatory medication (NSAIDs)—Drugs such as ibuprofen or naproxen may help relieve pain, inflammation and swelling. Most people are familiar with nonprescription NSAIDs such as aspirin and ibuprofen, however, whether using over-the-counter or prescription strength, they must be taken carefully. Using these medications for more than one month should be reviewed with your primary care physician. If you develop acid reflux or stomach pains while taking an anti-inflammatory, be sure to talk to your doctor.
• Corticosteroid injections—If swelling and pain have not responded to other nonsurgical treatments after 3-4 weeks, your doctor may recommend removing fluid from the bursa and injecting a corticosteroid medication into the bursa. Steroid injections are anti-inflammatory drugs that are stronger than oral (taken by mouth) medications. Although corticosteroid injections usually work well to relieve pain and swelling, the symptoms can return. Some doctors recommend avoiding injections into an olecranon bursa because they carry the risk of introducing bacteria into a noninfected bursa and can also lead to persistent drainage.

Surgery

• Surgery for infected bursa—If an infected bursa does not improve with antibiotics or by fluid removal, surgery to the entire bursa may be needed. This is often an inpatient procedure that requires an overnight stay in the hospital. Surgery may be combined with oral or intravenous antibiotics. Following surgery, a normally functioning, non-inflamed bursa usually grows back over a period of several months.
• Surgery for noninfected bursa—If elbow bursitis is not a result of infection, but nonsurgical treatments are not effective, surgery may be needed to remove the bursa. This is typically performed as an outpatient procedure and does not disturb any muscle, ligament, or joint structures.
• Recovery—After the procedure, your orthopaedic surgeon will apply a splint to the arm to protect your skin. A cast or prolonged immobilization is typically not necessary. Although formal physical therapy after surgery is not usually needed, specific exercises may be recommended to improve your range of motion. These are typically permitted within a few days of the surgery. The skin should heal within 10 to 14 days after the surgery, and after 3 to 4 weeks, your orthopaedic surgeon may allow you to fully use your elbow, however, it may need to be padded or protected for several more months to prevent reinjury.
• Risks and complications—With any surgery, there are some risks, and these vary from person to person. Complications are typically minor, treatable and unlikely to affect your final outcome. Your orthopaedic surgeon will speak to you prior to surgery to explain any potential risks and complications that may be associated with your procedure.