Elbow Bursitis
Elbow bursitis occurs in the olecranon bursa, a thin, fluid-filled sac that is located at the boney tip of the elbow. The bursae located throughout the body act as cushions between bones and soft tissues, such as skin. They contain a small amount of lubricating fluid that allows the soft tissues to move freely over the underlying bone. If the olecranon bursa becomes irritated or inflamed, more fluid will accumulate in the bursa and bursitis will develop.

People in certain occupations are especially vulnerable to bursitis, particularly plumbers or HVAC technicians who have to crawl on their knees in tight spaces and lean on their elbows. Certain athletic activities may also prompt the development of olecranon bursitis, such as long holds of the plank position.

A traumatic blow to the tip of the elbow can cause the bursa to produce excess fluid and swell. Or, if an injury at the tip of the elbow breaks the skin, such as an insect bite, scrape, or puncture wound, bacteria may get inside the bursa sac and cause an infection.

Certain conditions, such as rheumatoid arthritis and gout, are associated with elbow bursitis.

The first symptom of elbow bursitis is often swelling. The skin on the back of the elbow is loose, which means that a small amount of swelling may not be noticed right away.

As the swelling continues, the bursa begins to stretch, which causes pain. The pain often worsens with direct pressure on the elbow or with bending the elbow. The swelling may grow large enough to restrict elbow motion. If the bursa is infected, the skin becomes red and warm. If the infection is not treated right away, it may spread to other parts of the arm or move into the bloodstream. This can cause serious illness.

Activity modification: Resting and stopping any activity that aggravates the condition, such as activities that cause direct pressure to the swollen elbow should be the first course of action.

Medications: Anti-inflammatories such as ibuprofen (Motrin or Advil) and naproxen (Aleve) are used to reduce pain and inflammation. The max dose for ibuprofen is 800 mg three times per day. The max dose for naproxen is 500 mg twice daily. Prolonged usage should be avoided and these should be taken with food since they can affect the stomach lining. If one experiences an upset stomach these should be stopped.

Surgery:  Surgery might be necessary if any of the dislocated bones have also been broken, if torn ligaments need to be reattached or if damaged nerves or blood vessels need repair.

Injections: If swelling and pain do not respond to these measures after three to six weeks, removing fluid from the bursa and injecting a corticosteroid medication into the bursa may be necessary. The steroid medication is an anti-inflammatory drug that is stronger than the medication that can be taken by mouth. In some patients, corticosteroid injections work well to relieve pain and swelling.  However, some patients do not have any relief of symptoms with corticosteroid injections.

Aspiration:  If the bursitis is due to an infection, aspirating (removing the fluid from) the bursa with a needle may be necessary. This is commonly performed as an office procedure. Fluid removal helps relieve symptoms and gives a sample that can be looked at in a laboratory to identify if there is an infection.

Surgery:  If the bursa is infected and it does not improve with antibiotics or by removing fluid from the elbow, surgery to remove the entire bursa may be needed. The bursa usually grows back as a non-inflamed, normally functioning bursa over a period of several months.

If elbow bursitis is not a result of infection, surgery may still be recommended if nonsurgical treatments do not work. In this case, surgery to remove the bursa is usually performed as an outpatient procedure. The surgery does not disturb any muscle, ligament, or joint structures.