Elbow or Olecranon Bursitis

Elbow bursitis, also called olecranon bursitis, causes fluid to collect in a sac that lies behind the elbow, called the olecranon bursa. Elbow bursitis is the most common type of bursitis. A bursa is a slippery, sac-like tissue that normally allows smooth movement around bony prominences, such as the point behind the elbow. When a bursa becomes inflamed, the sac fills with fluid. This can cause pain and a noticeable swelling behind the elbow.

The bursa of the elbow forms when you are a young child, although it is not present when you are born. The reason for the delayed formation is thought to be the result of the developing skeleton. As the bone of the olecranon becomes more rigidly formed and developed, the body reacts by creating a bursa to protect the area and to allow for smooth bending of the elbow joint. The olecranon bursa measures up to 6 cm in length, and can swell to a size larger than a golf ball.

Elbow bursitis may follow a traumatic accident, such as a falling on the back of the elbow, or it may seemingly pop up out of nowhere. People who rest their elbows on hard surfaces may aggravate the condition and make the swelling more prominent. An infected elbow bursitis, also called septic bursitis, may occur after an injury where the skin behind the elbow is cut or abraded. If bacteria can enter in the bursa, the infection may cause an infected bursitis.

Signs of Elbow Bursitis

The common symptoms of elbow bursitis include:​​

• Pain around the back of the elbow
• Swelling directly over the bony prominence of the tip of the elbow
• Limited range of motion of the elbow

There are other conditions that can cause elbow pain and swelling, and these should also be considered as a possible diagnosis.

Your doctor can usually diagnose elbow bursitis on examination, but an x-ray may be done to ensure the elbow joint appears normal. An MRI is not necessary to diagnose elbow bursitis, and will only be done if there is uncertainty about the diagnosis.

In some systemic conditions, elbow bursitis can manifest as a sign of that condition. In order to alleviate the symptoms of bursitis, that underlying condition may also require treatment, so it's important for your doctor to assess for these conditions. Some of the systemic problems that can lead to an olecranon bursitis include arthritis, gout, pseudogout, and chondrocalcinosis. If you have one of these conditions, you should let your doctor know, as it may alter the treatment recommendations for your bursitis.

Infected Elbow Bursitis

About 20% of individuals diagnosed with elbow bursitis have the infection within the bursa, this is called infected elbow bursitis or septic bursitis. Patients with systemic inflammatory conditions, such as gout and rheumatoid arthritis, have a higher chance of developing infected elbow bursitis.

The following are signs of infection within the bursa. If you experience these symptoms, you should alert your doctor so he or she can evaluate for a possible infected elbow bursitis:

• Fevers
• Chills or sweats
• Redness around the back of the elbow
• Breaks in the skin (scrapes/cuts) around the swollen area

If there is uncertainty if infection is present in a swollen bursa, a sample of fluid may be obtained from the swollen bursa and analyzed in the lab. Your doctor may be able to culture the fluid to actually see the bacteria. In addition, elevated white blood cells and glucose levels in the bursa fluid can be an indication of infection. 

Treatment of Elbow Bursitis

Most often, treating elbow bursitis is accomplished with some simple steps. It is important that foremost people understand that this injury occurred because of inflammation to the bursa.

Therefore, resting the elbow and preventing pressure on the back of the elbow is critical to successful treatment. If people continue the same activities that led to developing bursitis, the problem is unlikely to go away. Draining the fluid from an elbow bursitis is controversial, especially if there is no infection of the bursa. In this situation, placing a needle into the bursa could introduce bacteria, and lead to the development of infected bursitis, which is much more challenging to treat.

_Sources

_{Aaron DL, et al. "Four Common Types of Bursitis: Diagnosis and Management" J Am Acad Orthop Surg June 2011 ; 19:359-367.}