Elbow Swelling: Causes and Treatment

Where the swelling is matters

Common causes of elbow swelling

Olecranon bursitis

The bursa is a thin sac that lets skin glide over the bony tip of the elbow. Irritation makes it fill with fluid, producing a soft swelling that can reach the size of a golf ball or larger. It is also called student's elbow, miner's elbow or "Popeye elbow".

Causes include:

• Repeated pressure: leaning on desks, plumbers and miners working on elbows
• A direct knock
• Infection: bacteria enter through a scratch or graze, causing a red, hot, painful swelling
• Gout and rheumatoid arthritis

Non-infected bursitis is often only mildly painful. See elbow bursitis.

Injuries

• Fractures: a fall on an outstretched hand can break the radial head, the end of the humerus (common in children) or the olecranon. Swelling, bruising and inability to straighten the elbow are typical. See fracture of the arm.
• Dislocation: the elbow is visibly out of shape. A dislocated elbow needs emergency care.
• Sprains and ligament tears cause swelling on the inner or outer side.
• Pulled elbow in toddlers causes pain and refusing to use the arm, usually with little swelling.

Gout and pseudogout

Gout causes sudden, extremely painful, hot, red swelling, often overnight. It can affect the elbow joint or the olecranon bursa. Chalky deposits (tophi) may form over the elbow in long-standing gout.

Arthritis

Rheumatoid arthritis often affects both elbows, with swelling, warmth, morning stiffness and firm nodules on the forearm. Osteoarthritis of the elbow causes stiffness and loss of movement, with less swelling.

Infection

• Septic bursitis: infected bursa, usually from a skin break.
• Septic arthritis: infection inside the joint, causing severe pain on any movement, swelling and fever. This is an emergency that can destroy the joint.
• Cellulitis: skin infection spreading over the elbow.

Other causes

Lipomas, ganglion cysts, insect bites, allergic reactions and, rarely, tumors can cause swelling near the elbow. People with hemophilia can bleed into the elbow joint.

How elbow swelling is diagnosed

A clinician asks about injuries, pressure on the elbow, gout, arthritis and fever, then examines the swelling, skin, range of movement and nerves. Tests may include:

• X-ray after injury, or to look for bony spurs or arthritis
• Aspiration: drawing fluid with a needle from the bursa or joint. Fluid is checked for bacteria, crystals and blood. It also relieves pressure.
• Blood tests: infection markers, uric acid and arthritis antibodies
• Ultrasound to look at the bursa, joint fluid or a lump

Treatment

Non-infected bursitis

• Avoid leaning on the elbow; use a soft elbow pad.
• Apply ice wrapped in a cloth for 15 to 20 minutes several times a day.
• A compression bandage can reduce swelling.
• Take an anti-inflammatory such as ibuprofen at the label dose if safe for you; avoid NSAIDs with kidney disease, stomach ulcers or blood thinners unless your doctor agrees.
• Most settle in 2 to 6 weeks. A large or stubborn swelling may be drained, sometimes with a steroid injection, although this carries a small risk of infection.

Infected bursitis or joint

Antibiotics, usually tablets for bursitis and IV antibiotics for septic arthritis, plus drainage. Surgery to remove the bursa (bursectomy) is needed if infection or swelling keeps returning.

Injuries

Slings, splints or casts for minor fractures; surgery for displaced fractures; reduction of a dislocation. Early, guided movement prevents stiffness, which is a common problem after elbow injuries.

Gout and arthritis

Anti-inflammatory medicines, colchicine or steroids for gout flares, and long-term urate-lowering treatment if attacks recur. Rheumatoid arthritis is managed with disease-modifying medicines.

Prevention

• Use elbow pads for work or sports that involve pressure or falls.
• Avoid resting your elbows on hard surfaces for long periods.
• Clean and cover grazes on the elbow promptly.

Frequently asked questions

Why is my elbow swollen but not painful?

A soft, painless swelling at the tip of the elbow is usually olecranon bursitis from leaning on the elbow or a minor knock. It often settles with rest and padding over a few weeks. If it becomes red, hot or painful, see a doctor to rule out infection.

What does fluid on the elbow mean?

Fluid on the elbow most often means the bursa at the back of the elbow has filled with fluid (bursitis). Fluid inside the joint itself, called an effusion, suggests injury, gout or arthritis. Draining a sample helps find the cause.

Should a swollen elbow be drained?

Not always. Most non-infected bursitis settles without drainage. Doctors drain the elbow to test for infection or gout, to relieve a large swelling, or to treat confirmed infection. Draining it yourself is unsafe and can introduce infection.

When should I worry about a swollen elbow?

Worry if the elbow is hot, red and increasingly painful, if you have a fever, if a wound over it is oozing, or if you cannot move the elbow after an injury. These suggest infection or a fracture and need prompt medical care.

How long does elbow bursitis take to go away?

Non-infected bursitis usually improves over 2 to 6 weeks with rest, padding and avoiding pressure. Infected bursitis improves within days of starting antibiotics. Swelling that keeps returning may need the bursa removed.