ELBOW BURSITIS

(SWOLLEN ELBOW)


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related talks: tennis elbow; golfers elbowchildren's broken elbowradial head fracture (type of broken elbow); elbow dislocationelbow stiffnessbroken forearmbroken arm; broken elbow
 

What is Elbow Bursitis?

Elbow bursitis is an inflammatory condition.

Inflammation is caused by excessive pressure or rubbing over the elbow causing the bursa to become inflamed.  A bursa is a fluid filled sac that sits over the pointy areas of our bones and protects the skin that rubs over the area.   Bursa are found all over the body (such as your shoulder, knee, hip, etc) and can get inflamed if they experience too much friction.  The most common cause of excess friction is repetitive rubbing over an area.  

Sometimes elbow bursitis is called "Student's Elbow" because after hours of studying, with elbows perched on the desk, your elbow's bursa gets inflamed.

The most common area to develop bursitis is over the knee cap, however developing it over the elbow is fairly common.  

How is Elbow bursitis diagnosed?

The condition is diagnosed based on examination of the painful elbow.  The skin over the elbow is usually very swollen and is sometimes red.  However,  if the injury is isolated to the bursa, there shouldn’t be any pain with flexion and extension of the elbow joint. 

There are three types of burisits:

1) the acute form which is a single occurrence, 

2) a chronic form which occurs repeatedly, due to continued pressure on the elbow,

3) an infected type of bursitis after a scrape leads to bacterial overgrowth within the bursa.  

Xrays can be useful to eliminate other possible causes of pain in the elbow like a fracture, or a dislocation.  However you cannot see a bursa on x-ray, so you cannot use it to make a specific diagnosis. 

How is Elbow bursitis treated?

The best treatment is to use compression and ice, and to avoid irritating the elbow.  In a few weeks the inflammation will resolve and the swelling will go away.

If the bursa remains very painful and swollen, the fluid can be drained under sterile conditions by a health care professional.  Drainage must be performed under these settings because if don’t incorrectly there is a high risk of creating an infection or of creating a wound that continues to drain for days.  70% of bursa effusion resolve in 1 month after aspiration and compressive dressing. 

In patients with recurrent (comes and goes) bursitis, they may  develop a rubbery, hard bursa, which is less likely to respond to treatment, and may require surgery to completely remove the bursa.  The success rate is very high, with about 95% of patients reporting satisfactory results. 

On occasion traumatic bursitis becomes infected and requires drainage and irrigation with sterile water, as well as antibiotics until the bursitis has resolved.  Many times you can just aspirate the septic bursa, if there are no systemic symptoms like fevers chills, feeling sick, but if these symptoms are felt or there is obvious pus coming from the bursa, surgery is warrent drainage. 

What is the long term outcome?  

The patients do well.  There is typically a low rate of recurrence.  If there are multiple recurrences, doctors can inject a medication (tetracycline) to create scarring within the bursa so that there is no space to fill with fluid.  The biggest risk of injection is possibly introducing bacteria into the bursa, creating an infection.  Thats why its so important for a doctor to perform this.

Reference

1. Aaron DL et al. Four common types of bursitis: diagnosis and management. JAAOS 2011; 19: 359-67. full article. review

2. Ho G Jr, Tice AD. Comparison of nonseptic and septic bursitis: Further observations on the treatment of septic bursitis. Arch Intern Med1979;139:1269-1273. full article. 30 cases septic bursitics: req. 12 days abx average, but related to length of time before treatment. 

3.Quayle JBRobinson MPA useful procedure in the treatment of chronic olecranon bursitis. Injury 1978;9:299-302. full article. 11 cases, remove olecranon spur, leave bursa, adequate rx.

4. Chen J et al. Development of the olecranon bursa: An anatomic cadaver study. Acta Ortho Scand 1987;58:408-409. full article. not found in kids < 7 yo.  forms late childhood.

5. Pien FD et al. Septic bursitis: Experience in a community practice. Orthopedics 1991;14:981-984. full article. 47 pts, 50% hx of trauma, 70% staph, all treated with outpt abx. 

6. Canoso JJ. Idiopathic or traumatic olecranon bursitis: Clinical features and bursal fluid analysis. Arthritis Rheum 1977:1213-1216. full article. eval 30 cases, looked at fluid analysis.  majority had some traumatic component.

7. Ike RW. Chemical ablation as an alternative to surgery for treatment of persistent prepatellar bursitis. J Rheumatol 2009;36: 1560. full article. case report. injects sodium morruhate.