Elbow Bursitis (Olecranon Bursitis)

What elbow bursitis is

A bursa is a thin, slippery sac that lets skin glide over bone. Inflammation of any bursa is called bursitis. The olecranon bursa sits just under the skin at the bony tip of the elbow (the olecranon). Because it is so close to the surface, it is easily irritated or injured. When inflamed, it fills with fluid, causing a visible bump.

Causes

Risk factors: jobs or hobbies involving leaning on elbows (plumbers, miners, students, gardeners), contact sports, diabetes, kidney disease on dialysis, alcohol misuse and immune suppression.

Symptoms

• swelling at the back of the elbow, from a small bump to a large balloon
• usually painless or mildly tender
• full elbow movement, because the joint itself is not involved
• with infection: redness, warmth, pain on pressure, a scab or wound, fever, and sometimes cellulitis spreading around it

Infected vs non-infected bursitis

It can be hard to tell from the outside. Infection is more likely with:

• warmth and redness over the bursa
• a skin break nearby
• marked tenderness
• fever
• a temperature difference compared with the other elbow

Pain when moving the elbow joint itself suggests infection inside the joint (septic arthritis), which is more serious. If in doubt, a doctor may draw fluid from the bursa with a needle (aspiration) to test for bacteria and crystals. Aspiration is often avoided in obvious non-infected cases because it can introduce infection or leave a draining tract.

Diagnosis

• examination of the elbow and comparison with the other side
• fluid aspiration if infection or gout is suspected: cell count, Gram stain, culture, crystals
• blood tests for infection or gout in some cases
• X-ray after injury to check for a fracture, bone spur or elbow arthritis
• ultrasound to confirm fluid and guide aspiration

Treatment

Non-infected bursitis

• avoid pressure: stop leaning on the elbow; use padded elbow protectors
• compression: an elastic sleeve or wrap can reduce swelling
• ice for 15 to 20 minutes a few times a day in the first days
• pain relief: ibuprofen or naproxen, following the label dose; avoid NSAIDs with kidney disease, stomach ulcers or heart failure
• time: most cases settle over 3 to 6 weeks

Draining the fluid may give quick relief for large bursae, but fluid often returns. Steroid injections are sometimes used but carry risks of infection, skin thinning and a chronic draining sinus, so they are used cautiously.

Septic bursitis

• antibiotics by mouth that cover Staphylococcus, usually for 1 to 2 weeks or longer
• repeated aspiration to drain infected fluid
• IV antibiotics in hospital for severe infection, spreading cellulitis or people at high risk
• surgical drainage or removal of the bursa if infection does not respond

Gout or inflammatory bursitis

Treat the underlying condition, for example with gout medicines.

Surgery

Removal of the bursa (bursectomy) is reserved for chronic, recurrent or resistant infected bursitis. Wound healing at the elbow can be slow.

Recovery and prevention

Non-infected bursitis usually resolves in a few weeks; infected bursitis may take several weeks with treatment. Recurrence is common if the elbow keeps being leaned on.

• use elbow pads for work and sports
• avoid resting elbows on hard surfaces
• clean and cover any skin breaks over the elbow promptly
• manage gout and rheumatoid arthritis

Frequently asked questions

What causes elbow bursitis?

The most common cause is repeated pressure from leaning on the elbow or a direct blow. Infection through a skin break, gout and rheumatoid arthritis are other causes. Occupations and sports that put pressure on the elbow raise the risk.

How do I know if my elbow bursitis is infected?

Infection is likely if the swelling is red, warm and tender, there is a cut or scrape nearby, or you have a fever or feel unwell. A doctor may test fluid from the bursa. Infected bursitis needs antibiotics promptly.

Should elbow bursitis be drained?

Not always. Non-infected bursitis often settles with protection and time, and draining can introduce infection or leave a draining tract. Doctors drain the bursa when infection or gout is suspected, or occasionally for a large, uncomfortable swelling.

How long does elbow bursitis last?

Non-infected bursitis usually improves within 3 to 6 weeks if you avoid pressure on the elbow. Infected bursitis typically takes several weeks of antibiotics and may need repeated drainage. Recurrence is common without protection.

Can I exercise with elbow bursitis?

Yes, as long as you avoid pressure on the elbow and the activity is not painful. Use padding for sports that involve falling or leaning on the elbow. If the bursa is infected, rest and follow your doctor's advice until it has cleared.