What is Elbow Bursitis?
Elbow bursitis, known as olecranon bursitis, is a fluid-filled sac in the elbow that is inflamed. Often this occurs from repeated pressure on the bursa sac or a traumatic injury such as a fall. The common nicknames used for this condition are:
- Baker’s elbow
- Miner’s elbow
- Plumber’s elbow
- Popeye elbow
- Student’s elbow
Often bakers or students rest their elbow on hard surfaces as they work. With this repeated and prolonged pressure, it may irritate the bursa sac. The name “Popeye elbow” is because the olecranon, or tip of the elbow, is swollen and looks like Popeye’s elbow.
So, what is a bursa sac? First, the elbow has three bones-humerus, ulna, and radius. The humerus is the upper arm bone and makes up the largest bone of the joint. The ulna resides in the forearm and is the second largest elbow bone. The radius also resided in the forearm and is the smallest of the three.
To hold the three bones together, we have muscles, tendons, and ligaments. The muscles help bones move, tendons help attach muscles to bones, and ligaments attach bone to bone. Combined the soft tissue of around our elbow assists with movements as well as stabilizes the joint.
We also have cushioning within our elbow. Surrounding each bone, we have cartilage which is rubbery tissue that allows our bones to glide and move freely without irritation or rubbing against one another. We also have a bursa sac, which is a fluid-filled sac that sits between the olecranon, tip of the elbow, and the skin. As we move our elbow, the bursa sac allows the skin to glide over the bone.
When we put repeated pressure, or prolonged pressure, on this bursa sac, it can become irritated and inflamed. Sometimes trauma or illness can also cause the bursa sac to inflamed. Those who suffer from gout, rheumatoid arthritis, or kidney disease and are getting treated by dialysis, are at a higher risk than the normal population for getting bursitis of the elbow.
What causes elbow bursitis?
There are a few common causes for elbow bursitis, and they are:
- Autoimmune disease such as arthritis
- Infections caused by skin lacerations or abrasions that become infected
- Prolonged and repeated pressure from leaning on the elbows
- Sports activities with repeated, and possible forceful movements (e.g. golf or tennis)
- Trauma from falling and landing on the elbow or hitting the tip of the elbow
- Unknown or other causes, sometimes this condition occurs with no triggering event
Symptoms of Elbow Bursitis
If you suffer from elbow bursitis, symptoms can range from mild to severe. Often, the olecranon is red and swollen. For some the swelling is minor, but for others the swelling is significant. You may also experience tenderness to the touch, and the elbow may feel warm.
These are signs the bursa sac are infected. If you suspect you have an infected bursa sac at the elbow, medical treatment is necessary. Your physician will remove the fluid, known as aspirate, and will test the fluid for bacteria. Understanding what bacteria is present will help your physician prescribe the proper antibiotic.
You can have bursitis without an infection. With repeated pressure, the sac over time becomes more and more swollen. Mild pain may be present, but not always. You will still have full function of the elbow; it will just look deformed due to the swelling. For some, the pain may be more severe, and it may include joint stiffness.
How is elbow bursitis diagnosed?
Often elbow bursitis is diagnosed with a review of your medical history, description of symptoms, and a physical examination of the elbow. If trauma to the elbow caused the swelling, your physician might order an X-Ray or MRI (magnetic resonance imaging) to take an internal look at the elbow.
An image will like an X-Ray will show fractures (broken bones) or bone spurs. An MRI will not only show the physician the integrity of your bones, but also he or she can look at soft tissue and cartilage. The goal is to rule out any further damage to the elbow.
If an infection is suspected, your physician will aspirate (extract some of the fluid) and complete lab work to determine if bacteria exists. Sometimes blood work will be drawn to assess if an autoimmune disease such as rheumatoid arthritis or gout is present.
If you see your physical therapist (PT) first, he or she can complete a full exam of the shoulder and determine not only if you have bursitis, but also if there are any other injuries the elbow. In most states, you can be seen by a PT first, without a physician’s order. To determine if your state has direct access, please visit the American Physical Therapy Association’s website Physical Therapy Direct Access By State.
Treatment of Elbow Bursitis
Depending on the severity of the swelling and your symptoms, bursitis may go away on its own if there is no infection. Apply RICE (rest, ice, compress, and elevate) may be all that is needed.
Reduce your activities that put pressure on the elbow. In some cases, putting a pad with cushioning around the elbow will help with this. Ice and gentle compress the elbow to help manage the swelling. If, or when possible, elevate the elbow above the heart to also help.
In the case where symptoms are significant and impacting daily functional activities, it is recommended you seek treatment from a physical therapist (PT) or an occupational therapist (OT).
The first goal is for your therapist to reduce swelling and pain. He or she may instruct you on activity modification, apply a cushioned pad to protect the olecranon, and may apply an electrothermal modality to manage swelling.
Over time as the swelling and pain are managed, your range of motion will too. Your therapist will teach you how to improve your mobility, flexibility, and strength safely. When symptoms begin to subside, and range of motion and strength improve, you may return to functional activities. Your therapist will guide your through on how to safely complete activities such as sports, hobbies, and other daily activities.
In rare cases, an injection or surgery may be needed. In some cases, swelling is stubborn and conservative treatment alone will not help. In conjunction with PT or OT, your physician may inject a steroid into the area to help manage the swelling.
For an infected bursa that does not respond to antibiotics, a surgeon may need to remove the bursa sac. Your physician will continue to keep you on antibiotics immediately after surgery to ensure the infection does not return.
In rare cases where the bursitis is stubborn and not healing, a surgeon may remove the sac. The surgery is minimally invasive, so recovery is minimal. After surgery, your surgeon will provide you with a splint to protect the elbow. In about 10-14 days the area is healed, and in about one month you can begin to return to activities.
PT or OT is recommended after surgery. Your therapist will safely begin range of motion and strengthening exercises based on protocols. He or she will guide you through healing until you are ready to return to functional activities.
In some cases, elbow bursitis will heal on its own. If you suspect an infection, visit with your physician. Otherwise, get started with conservative care today. As a health care consumer, you have a choice in finding a health care provider that is right for you. Do your homework and find a PT or OT with excellent outcomes, great customer feedback, and is able to provide services at a reasonable cost.
Find a highly qualified PT or OT in your area; please click on Find A Clinic. This link will help you find a PT or OT that has top national rankings for treating the elbow.