Elbow bursitis, medically known as bursitis olecrani or simply bursitis, is a painful condition affecting the elbow. Because the bursa in the elbow acts as a cushion directly beneath the skin, it is particularly susceptible to irritation. Elbow bursitis often develops gradually due to mechanical stress or frequent leaning on the elbow, which is why it used to be commonly referred to as “student’s elbow.” However, a bacterial infection of the bursa can also cause severe pain and significant swelling. If bursitis is treated, it usually heals well; if left untreated, it can lead to chronic bursitis. Whether the elbow requires treatment or whether surgery is considered depends on the severity of the inflammation.
What is a bursa?
A bursa (medically known as a synovial sac) is the sac-like structure that surrounds every joint and is filled with synovial fluid. The bursa consists of synovial membrane, which continuously produces synovial fluid (= secretion) and simultaneously reabsorbs (absorbs) it.
In joints with a wide range of motion, such as the hip or shoulder, the lining of the bursa is very loose, forming a true sac. This ensures that the joint’s wide range of motion is maintained. During prolonged inactivity—for example, following a shoulder injury—the bursa shrinks very quickly, which can subsequently cause significant problems with mobility. The bursa performs the following functions:
- Protection of the joint surface (cartilage)
- Production and renewal of synovial fluid, thereby
- ensuring mobility
- Protection against pathogens
How does bursitis develop?
One of the causes of pain associated with bursitis in the elbow is the increased production of synovial fluid. The body combats joint overload or inflammation by increasing blood flow to the area. The affected area becomes warm and red. If bacteria are the cause of the inflammation, pus may also form.
Bursitis usually develops as the body’s response to prolonged overuse, an injury, or a bacterial infection. In rarer cases, underlying medical conditions can also trigger the inflammation.
What are the typical causes of bursitis?
- Excessive pressure on the bursa: This is often caused by constantly resting the elbow on a surface. This position can irritate the joint to the point of inflammation. This results in what is known as atraumatic inflammation, which—unlike traumatic inflammation—is caused not by impacts or injuries but by prolonged, regular strain.
- Physical trauma to the bursa: When the bursa is subjected to force in the form of impacts, bruises, or sports injuries, this can trigger the condition. A single strong blow can be enough to cause bursitis.
- Infiltration of pathogens: When pathogens (bacteria, viruses) penetrate the bursa, they can cause inflammation. In most cases, pus also forms. Typically, however, such infections occur only when there are open wounds or when the bursa or the underlying joint has been punctured. This can also be a serious complication when painkillers are injected into a joint.
- Inflammation without pathogens: So-called abacterial—that is, pathogen-free—inflammation of a joint can also cause bursitis in the elbow. Such joint inflammations occur without pathogens and are often associated with an underlying condition such as rheumatism or gout.
What are the symptoms of bursitis in the elbow?
The bursa swells significantly and feels thick and firm yet elastic. This leads to noticeable discomfort, with the area being highly sensitive to touch and feeling tight. The area around the bursa is extremely tender to pressure. The pain is sudden and intense. The affected area is often warm to the touch and reddened, and movement of the joint is restricted. In rare cases, the inflammation spreads beyond the elbow and can lead to swelling of the lymph nodes in the armpit or redness of the hands. General symptoms of inflammation, such as fever and chills, may also occur.
How is bursitis of the elbow diagnosed?
Elbow bursitis is usually diagnosed visually. This means that the diagnosis can be made based solely on the externally visible combination of redness, swelling, limited range of motion, and pain in the area of the affected bursa.
However, a thorough diagnosis also includes taking a medical history—that is, asking the patient about their movement habits, previous medical conditions, and the exact nature of their symptoms. The medical history is also used to identify or rule out other conditions in order to determine the appropriate treatment approach.
During the physical examination, the painful area on the elbow is palpated, and the joint’s mobility and range of motion are assessed. In most cases, the diagnosis of bursitis can be confirmed based on the presence of the classic symptoms and the typical findings on palpation.
In some cases, additional tests are necessary, such as an ultrasound or an X-ray. On an ultrasound, the bursa appears as a fluid-filled sac. If the bursa has thickened edges, this may be a sign of long-standing bursitis.
If there are signs of a purulent inflammation, a puncture is usually performed to confirm or rule out a suspected bacterial infection. Since germs can be introduced into the bursa from the outside during any puncture, the decision to perform one should be made with the utmost caution.
How is bursitis of the elbow treated?
Treatment depends on the cause of the condition. It involves the use of pain relievers and anti-inflammatory medications, cooling compresses, and, if necessary, antibiotics. Short-term immobilization of the joint using a splint or tape is often recommended. Rest and cooling are important.
In some cases, surgical removal of the bursa may also be necessary. However, this is extremely rare. Indications for bursa removal would include, for example, open wounds or exposed bursa contents.
Acute bursitis can also progress to a chronic form, but it is generally treatable. In most cases, the sooner treatment begins, the faster the symptoms subside. A visit to the doctor is advisable, especially if symptoms are severe.
What medications are helpful?
Pain relievers and anti-inflammatory medications are primarily prescribed to treat acute inflammation. Mild pain relievers such as ibuprofen or diclofenac (Voltaren®) are often sufficient. Depending on the severity of the pain, an injection of a local anesthetic into the joint may be indicated. Corticosteroid preparations can also be used to treat severe pain. If the cause is a bacterial infection, antibiotics are used, in part to prevent sepsis.
Are ointment dressings helpful?
A compress or bandage with a cooling and pain-relieving ointment or tincture almost always helps to relieve pain, reduce inflammation, and decrease swelling of the bursa. In addition, temporarily immobilizing the affected joint can help reduce swelling and alleviate pain. For this reason, the elbow joint is almost always temporarily immobilized using a splint or tape.
The arm should be kept off as much as possible. When taping, the special functional bandage allows the joint and muscles to remain partially mobile rather than being completely immobilized, while still preventing unwanted movements. Immobilization should therefore be maintained for as long as necessary, but for as short a time as possible.
It is important that the swelling and pain decrease significantly during immobilization. Afterward, a prompt resumption of movement and weight-bearing is recommended. Otherwise, both the bursa and the joint capsule may shrink, which can ultimately lead to reduced joint mobility.
When are further measures necessary?
If conservative measures—which include medication and bandages—prove ineffective, invasive procedures may be necessary. This term encompasses all procedures in which the body is “penetrated” using injections, catheters, or surgery.
Initially, a puncture may be indicated to relieve swelling. If this is insufficient or if there is an open wound, surgery to remove the bursa may be necessary. However, this is only indicated in rare cases.
If the condition does not resolve, chronic bursitis develops. This occurs when the inflammation of the bursa lasts longer than three to six weeks. In these cases, surgical removal of the bursa (excision) is often recommended; this is a minor surgical procedure. Afterward, the joint must be immobilized. Lymphatic drainage may be necessary.
How long does the healing process for bursitis take?
If acute bursitis in the elbow is treated promptly, it usually heals quickly. Symptoms usually last a few weeks, after which they generally disappear. However, if the affected area continues to be subjected to excessive strain, bursitis may develop again. Over time, elbow bursitis can then become chronic.
FAQ: The 8 Most Important Questions About Elbow Bursitis
How can you recognize elbow bursitis, and what are the symptoms?
The symptoms of elbow bursitis are usually unmistakable. A firm swelling, often the size of a chicken egg, forms at the tip of the elbow. Other signs of bursitis include redness, warmth, and tenderness. If the bursitis is caused by bacteria, it can be identified by additional symptoms such as fever and severe throbbing pain. Bursitis often develops rapidly, but in chronic cases, the pain may be less severe.
What are the most common causes of bursitis?
The causes of bursitis are varied, but mechanical irritation is the primary factor. Frequent leaning on the elbow or impacts irritate the tissue. Rheumatism or gout can also cause bursitis, as these conditions involve the deposition of crystals or inflammatory processes in the body. Additionally, an injury that introduces bacteria into the elbow can trigger purulent bursitis.
How is bursitis treated?
Treatment for bursitis is usually conservative. The doctor will advise you to rest your arm, apply ice, and take anti-inflammatory medication. Early treatment often prevents the inflammation from becoming chronic. Sometimes fluid is withdrawn from the bursa via a puncture, which also helps determine the cause (bacterial or non-bacterial). Whether bursitis always requires treatment with antibiotics depends on whether an infection is present.
When is surgical removal of the bursa necessary?
Surgical removal of the bursa (bursectomy) is necessary when conservative methods fail or in cases of severe, purulent olecranon bursitis. The bursa is also surgically removed in cases of persistent chronic olecranon bursitis that keeps recurring and causes symptoms. Removal of the bursa is a routine procedure in orthopedics and trauma surgery.
What is the difference between bursitis of the knee and the elbow?
In both the knees and elbows, the bursae are highly exposed and lie directly under the skin. In the international medical literature, prepatellar and olecranon bursitis (knee and elbow bursitis) are often considered together, as they have similar mechanisms of development (kneeling vs. leaning on the elbow). Whether the elbow or knee is affected makes little difference in terms of treatment: rest is crucial.
How is elbow bursitis diagnosed?
Elbow bursitis is usually diagnosed through a simple clinical examination. The doctor palpates the swelling and assesses range of motion. An ultrasound helps determine whether the bursa in the elbow has thickened walls or is filled with pus. A blood test clarifies whether the elbow bursitis is related to a systemic disease.
Can acute bursitis become chronic?
Yes, untreated acute inflammation can develop into chronic bursitis. With this chronic form of bursitis, the pain is often less acute, but the swelling persists or returns immediately upon exertion. Thickened bursa walls are often palpable here. Bursitis of the elbow tends to be recurrent if the mechanical cause is not addressed.
Why should you see a doctor right away if you have swelling in your elbow?
Early treatment is important to prevent the spread of a possible infection. If bacteria are involved, sepsis may be a risk. In addition, acute bursitis is easier to treat than hardened, chronic olecranon bursitis. If bursitis in the elbow is left untreated, surgery often ends up being a necessary consideration.
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