Elbow Bursitis is a condition in which the bursa around the elbow joint gets inflamed or irritated. Bursae are fluid filled sacs between the bone and tissues like tendon. When these bursae get irritated, they can result in inflammation called bursitis. Elbow Bursitis is one of the commonest types of bursitis and is also called as olecranon bursitis as it occurs in the olecranon bursa at the tip of the elbow (olecranon).
What is Elbow Bursitis?
Elbow Bursitis, an inflammation of the olecranon bursa present in between the tip or point at the back of elbow which is known as olecranon and the tendon of the elbow. Olecranon bursa or bursa of the elbow contains some fluid in it, which act as cushion. The bursa helps to reduce friction, provides lubrication and protects elbow joint from injuries. The bursa has a thin outer membrane called synovium and synovial fluid is present inside, which provides cushioning.
Normally, only a small amount of fluid is present in the sac of the olecranon bursa and appears flat. When the synovium gets irritated or inflamed, causing Elbow Bursitis, large amount of synovial fluid may get accumulated in the bursa causing pain and discomfort.
Elbow Bursitis or olecranon bursitis is also called as Popeye elbow due to the bump developed at the back of the elbow appears like Popeye, the cartoon character's elbow.
What Causes Elbow Bursitis?
Elbow Bursitis occurs when the lining of the bursa gets irritated due to certain factors. Some of the causes of Elbow Bursitis include:
- Inflammation – Elbow Bursitis commonly occurs due to inflammation of the bursa from constant pressure on the elbow, poor sitting postures, leaning by giving pressure on the elbow or certain occupations or activities requiring leaning or crawling on the elbows. Elbow Bursitis caused due to inflammation commonly occurs due to repeated micro injuries to the bursa when students rest their elbows on hard surfaces while studying, hence, it is also called as student's elbow.
- Joint Condition – Underlying joint conditions like rheumatoid arthritis, osteoarthritis, gout or other forms of arthritis can cause irritation and inflammation of the elbow bursa causing Elbow Bursitis. Persons with inflammatory conditions, autoimmune disorders and joint related problems are at an increased risk of developing Elbow Bursitis.
- Injury – Injury to the elbow joint, hurting the bursa can cause Elbow Bursitis. Injury can occur due to sudden fall, direct blow to the elbow, sports injuries or due to accidents. Previous injuries to the elbow joint can also make the bursa more vulnerable to further injuries or irritation and increase the risk of Elbow Bursitis. Chronic injuries can result from repeated use of the elbow joint during sports or work related activities, which can trigger Elbow Bursitis.
- Infection – Certain infections may be a contributing factor for triggering symptoms of Elbow Bursitis. Infective or septic arthritis is a form of inflammation, which is caused by infection in the olecranon bursa, leading to Elbow Bursitis. Infection can spread through the skin in case of cuts, wounds, animal bites and reach the olecranon bursa to cause Elbow Bursitis. Sometimes, infection elsewhere in the body can trigger. Elbow Bursitis in some people, while in some cases, the cause and origin of infection maybe unknown.
- Other Medical Conditions – Presence of certain medical conditions can increase a person's risk of having Elbow Bursitis. Conditions like chronic obstructive pulmonary disease (COPD), disorders of the immune system like HIV, lupus, autoimmune disorders and diabetes can increase the risk of Elbow Bursitis in some people. Those who are taking immune suppressant medications, long term steroid treatment and those with a weakened immune system are at risk of suffering from Elbow Bursitis.
What are the Symptoms of Elbow Bursitis?
Elbow Bursitis is an inflammation of the soft tissue in the elbow joint, hence the signs and symptoms often include pain, swelling and discomfort. Some of the commonly noticed symptoms of Elbow Bursitis include:
Elbow Pain – Elbow pain may be less in mild cases when swelling in less, but with larger swelling, elbow pain often occurs. Symptoms of pain in elbow joint, is particularly present at the tip at the back of the elbow. Elbow pain due to Elbow Bursitis can worsen when moving the elbow, applying pressure on the elbow or resting the elbow on a hard surface. Elbow Bursitis is often caused due to increased tension over the elbow bursa and can sometimes cause difficulty in movement of the elbow joint causing limited range of motion. Symptoms of pain in Elbow Bursitis often worsens when the elbow touches or bangs on other surfaces and there is difficulty in moving or bending the elbow joint.
Joint Movement – While Elbow Bursitis may not always affect the elbow joint movement, it can cause elbow pain and discomfort in some cases. Bending or straightening the elbow may be painful and can cause discomfort due to the swelling in Elbow Bursitis.
Swelling – Elbow Bursitis, causing inflammation of the bursa results in swelling of the bursa and accumulation of excess synovial fluid. Symptom of swelling is often noticeable and can be felt over the tip of the elbow, which is very painful to touch. The symptoms of swelling in Elbow Bursitis can appear like an obvious bump at the back of the elbow.
Redness and Warmth – Inflammatory process can cause redness around the area of the inflamed bursa. The skin over the inflamed area may be warm to touch. This is noted more commonly in infected cases or septic arthritis type of Elbow Bursitis.
Tenderness – Symptoms of tenderness in the area of swelling is often noted in Elbow Bursitis. However, symptoms of tenderness may be more in acute injuries as compared to chronic repeated injuries causing inflammation. When Elbow Bursitis is caused due to infection or septic arthritis, more tenderness may be felt around the elbow joint.
Infection – When Elbow Bursitis is caused due septic arthritis or an infection, the fluid gets infected. There may be signs of infection present like fever, chills, rapid onset of symptoms, sudden appearance of elbow swelling, decreased appetite and general feeling of being unwell.
Sometimes, an infected bursa in Elbow Bursitis, can open and drain the infected fluid into the surrounding area. Hence, understanding the symptoms and seeking medical advice at the earliest is essential.
How is Elbow Bursitis Diagnosed?
Elbow Bursitis needs to be properly evaluated with medical history and clinical examination.
Medical history includes gaining information about personal history, including medical illnesses, ongoing medications and other treatments, history of infections, injuries, joint disorders, autoimmune conditions, etc. Past history includes information about previous episodes of elbow pain or swelling, injuries, trauma to the elbow joint, past illnesses, surgeries and treatments taken in the past. Family history to understand familial predisposition, presence of elbow joint problems or rheumatoid problems in close family members and other medical details are noted.
Characteristic features like sudden onset of arthritis, which shows redness, swelling, warmth and severe pain in the joint, which may have developed just in a day, involvement of a single joint or varying joints, without any symmetry, more attacks of acute arthritis, need to be evaluated and any suspicion of septic arthritis causing Elbow Bursitis must be properly investigated. Hence detailed investigations are needed to rule out other forms of arthritis and infective conditions.
Investigations help to diagnose Elbow Bursitis and include some of the following tests.
Blood tests are done to detect presence of infection causing Elbow Bursitis and to rule out possibility of septic or infective arthritis. They are also done to rule out other forms of arthritis. Blood tests like CBC, ESR, CRP, may also be done to detect inflammation and understand its severity; or other forms of arthritis; detecting blood uric acids levels to rule out gout in elbow, RF, rheumatoid factor to rule out rheumatoid arthritis and other tests to rule out autoimmune disorders.
Imaging studies like X-rays, CT scans and MRI can help to detect changes in the bone, joint deformities and damage occurring to other tissues. Damage to the cartilage and bony erosions can be detected through these imaging studies. Performing these tests may be also useful in monitoring the progress of the disease and efficacy of the treatment plan, wherein damage to the joints and tissues needs to be studied.
X-ray of the elbow joint can help to detect any damage to the elbow joint, bone structures, fracture or other injuries to the bone and arthritis or degenerative changes. MRI can help to detect any damage to the soft tissues around the elbow joint or arthritis. It can be helpful in detecting joint effusion, soft tissue swelling and aid in diagnosing Elbow Bursitis.
Joint Fluid Analysis for Elbow Bursitis
Elbow Bursitis can cause sufficient amount of swelling around the elbow joint. The elbow becomes tender to touch, severely painful and sometimes also becomes stiff. Joint fluid aspiration is performed as a diagnostic procedure in Elbow Bursitis to aspirate the excess fluid accumulated in the elbow joint.
Joint fluid aspiration is a procedure performed taking aseptic precautions, in which a sterile needle is inserted into the elbow joint space around the swollen area. The excess synovial fluid accumulated in the swollen area, is aspirated through the needle. The aspirated fluid is sent for laboratory testing, where fluid analysis is done for detailed study regarding the presence of different types of cells, blood, crystals or infective organisms, based on which a diagnosis can be made. Inflammatory process in the elbow joint due to Elbow Bursitis can show presence of other cells like white blood cells, etc. which can aid in the diagnosis.
Fluid analysis helps to detect the presence of pus cells, white blood cells, bacteria, which can help to rule out other forms of arthritis including septic arthritis and tuberculosis. Presence of bacteria or pus cells can point towards an infection. It can also help to detect the presence of calcium pyrophosphate crystals, which can confirm the diagnosis of pseudogout in elbow or any presence of uric acid crystals can direct towards the diagnosis of gout in elbow.
What is the Treatment for Elbow Bursitis?
Treatment of Elbow Bursitis is aimed at relieving pain, reducing swelling and associated symptoms during acute attacks, treat underlying conditions and factors triggering Elbow Bursitis, prevent further episodes of Elbow Bursitis, protect the elbow joint in the longer run and minimize the risk of permanent damage to the elbow joint.
Some of the treatment modalities for Elbow Bursitis include:
Medical Management of Elbow Bursitis
Acute attacks of pain, swelling and inflammation of the elbow joint in Elbow Bursitis are treated with non-steroidal anti-inflammatory medicines (NSAIDs) that can provide relief in the elbow joint symptoms of inflammation. These medicines can cause irritation of the gastric mucosa and should be taken with appropriate medical advice.
Antibiotics for Elbow Bursitis may be given if an infection is suspected or confirmed with fluid analysis results. Specific antibiotics may be given to treat specific infections depending on the microorganisms found in the culture test in fluid analysis.
Steroids are another class of medicines that can help to fight inflammation and bring quick relief. There are oral and injectable steroids, which can also be taken directly into the inflamed elbow joint for immediate relief of symptoms. These may be considered in those who are unable to tolerate oral steroids or when oral steroids are contraindicated due to some reasons.
Pain Management in Elbow Bursitis
- Rest - Rest is necessary for recovery of Elbow Bursitis. As repeated injuries, stress and strain on the inflamed bursa can cause more elbow pain and damage, resting the elbow joint is essential. Sportspersons, need to take a break from their sports and so should others involved in occupations that can hurt the elbow more in an already inflamed state. Activities causing pain and those giving direct pressure on the elbow must be avoided or modified.
- Ice Packs - Applying cold compresses, ice packs rolled in a cloth and gently rubbing over the inflamed area can help. Elevation of the joint and keeping the elbow joint raised above the heart level can help to reduce the swelling and pain in Elbow Bursitis. Using ice packs for 10-15 mins can help reduce inflammation. Ice packs can also be used after exercising or after performing activities that cause elbow pain to avoid repeated injury and swelling, once routine is resumed.
- Braces - Sometimes, light compression of the swollen elbow joint in Elbow Bursitis can help in reducing the swelling and also allows the joint to rest, but care should be taken and not kept for too long, not too tight or not while sleeping. Using a brace that supports the inflamed tendon can help in relieving symptoms of tendonitis elbow. The type of brace depends on the location and type of tendon inflammation, hence following medical advice is essential. Elbow pads may be used to protect the elbows from further injuries and direct blows.
Joint Aspiration for Elbow Bursitis
Joint aspiration for Elbow Bursitis is commonly performed when there is a huge swelling in the elbow joint that has affected the movement of the elbow. Stiffness and pain in the elbow joint is often unbearable and removing some excess accumulated fluid can help in relieving the pressure of the swollen elbow. Aspiration of fluid from the elbow joint helps to relieve pain, pressure and reduces the swelling in the elbow joint, thus giving relief in symptoms. It also helps to improve the elbow joint movements and its functioning.
Surgery for Elbow Bursitis
Some cases of Elbow Bursitis may fail to heal completely with conservative treatment, which has been followed for months or when elbow pain has not responded or temporarily responded to steroid injections. Surgery for Elbow Bursitis, may also be considered if elbow pain from Elbow Bursitis is causing sufficient interference in daily activities, the elbow pain is considered unbearable or there are other associated conditions, which affect the healing process, like medical problems, smoking, etc.
- Surgery for non-infected Elbow Bursitis may be done as an outpatient procedure, which is done to remove the inflamed bursa and generally does not involve any disturbance to the adjoining soft tissues.
- Surgery for infected Elbow Bursitis is planned when the condition does not improve with a course of anti-biotics or by joint fluid aspiration. Surgical removal of the entire bursa may be required, which is done with additional antibiotic coverage as further treatment.
During the recovery period after surgery, the elbow joint may be placed in a splint for protection. Post-surgical rehabilitation for Elbow Bursitis and therapeutic exercises may be advised by the treating physician. Once surgically removed, normal bursa develops over the next few months and functions normally.
Recovery Period in Elbow Bursitis
Recovery period in Elbow Bursitis depends on the cause of the inflammation and the type of treatment required. Minor injuries or inflammation resulting in elbow bursitis may resolve within 10 days, while those requiring long term treatment may take more than 2 weeks. In cases requiring surgical treatment and those with infected type of Elbow Bursitis, regular activities may be resumed within few weeks to months.
Recovery or healing time for elbow bursitis depends on the duration of symptoms, initiation of timely treatment, individual factors and existing medical conditions.
Exercises for Elbow Bursitis
Main exercises that help to manage and prevent Elbow Bursitis include stretching and strengthening exercises of the elbow. In acute conditions of Elbow Bursitis and acute elbow pain, exercises should be discontinued and should be performed under the guidance of an expert only after elbow pain subsides and Elbow Bursitis recovers.
Flexibility Exercises for Elbow Bursitis
- Gentle movements of the elbow joint, bend and straighten the elbow joint within its comfortable range of motion, while supporting the arm with the other hand.
- Gentle movements of the wrist joint, upwards, downwards and rotation of the wrists, while supporting the arm with the other hand.
- Raise one hand overhead and bend its elbow to reach the back. Gently push the elbow backwards with the other hand to feel the stretch.
Stretching Exercises for Elbow Bursitis
- Keep your arms stretched out, with elbow straight and bend the wrists to point the fingers towards the floor. Gently push the fingers towards the body with the other hand to feel a stretch at the wrist and the forearm.
- Keep your arms stretched out, with elbow straight and bend the wrists to point the fingers towards the roof. Gently push the fingers towards the body with the other hand to feel a stretch at the wrist and the forearm.
- Stretch out the arms in front of the body and make a fist. Bend at the elbow joint to bring the fist close to the body, hold and again straighten the elbow joint and stretch out the arm.
Strengthening Exercises for Elbow Bursitis
- Hold a light weight dumbbell in the hand with palm side down. Turn the wrist downwards and raise it upwards while supporting it with the other hand.
- Hold the light weight dumbbell in the hand with palm side down and twist the wrist to face the palm side upwards and rotate back to original position.
- Hold a light weight dumbbell in the hand with palm side up and elbow placed at right angle. Rotate the wrist, to twist and slowly face the palm side down.
- Hold a light weight dumbbell with palm side up keeping wrist straight and elbow placed at right angle. Gently bend the wrist inwards, towards the body, hold for few seconds and release.
- Hold a light weight dumbbell in the hand and place the hand over head, with elbow bent above the head and the dumbbell reaching the opposite shoulder. Gently raise the forearm to straighten the elbow, so that the hand is raised up and bring it back to the original position.
How to Prevent Elbow Bursitis?
Elbow Bursitis can be prevented by taking necessary precautions when involving in games, sports, adventures and activities that involve use of hands, bending or resting the elbows. Wearing appropriate sports gear, protective elbow pads and taking measures to protect the elbow from direct blows or hits are essential to prevent Elbow Bursitis.
In case of acute injuries, immediate treatment and resting the elbow joint is equally important. Performing proper warm up and regular muscle strengthening exercises of the hands can help to keep the muscles, ligaments and soft tissues of the elbow joint strong and flexible.
Knowing the warning signs, like high fever, intense pain, huge swelling, major injury or worsening of any existing joint problems or medical conditions is essential and must immediately receive medical attention.