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Elbow Bursitis

Elbow Bursitis

What is Olecranon Bursa?

The Elbow Bursa or the Olecranon Bursa is a fluid filled sac, a swelling located at the boney tip of the elbow( the olecranon) presents as a soft lump. The Olecranon is the bony prominence of the ulna, which is the long bone at the back of the elbow. The primary function of the elbow bursa is to allow smooth gliding of the olecranon bone along with the soft tissues as the individual flexes or extend their elbow. When this bursa gets inflamed, it is known as Olecranon Bursitis. As this bursa is located superficially, it is more susceptible to trauma or injury caused by direct pressure. This condition may also be referred to as tennis elbow, student’s elbow, Popeye elbow, or plumbers elbow. (1) (2) (3)

Common Causes of Olecranon Bursa?

Infection usually causes elbow (Olecranon) Bursitis. Additionally, hard blow, overuse, or elbow bone smashing across a hard surface also causes elbow bursitis. When the bursal sac is exposed to an injury or trauma, swelling can occur and swollen bursa can release inflammatory mediators in the body; the bursa that is inflamed also has a higher chance of recurrence.

Moreover, the certain medical conditions and lifestyle choices that may increase the risk of Olecranon Bursitis include rheumatoid arthritis, Gout, Diabetes, Alcohol Use, HIV, and Psoriatic Arthritis.

Additionally, leaning your elbow against hard surfaces over time can irritate the bursa due to increased pressure. This condition is more prevalent among air conditioning technicians, plumbers, and those who must work on their elbows. Moreover, Olecranon bursitis, often known as “student’s elbow,” can occur in people who rest their elbows on a hard surface for an extended period such as when typing on a computer keyboard.

Furthermore, bacteria may enter the bursa sac and result in an infection if the bony tip of the elbow gets injured and breaks the skin, such as a puncture skin wound,  insect bite, or scrape.  The infected bursa can cause inflammation, pain, and redness over the skin.  If this condition is left untreated, the extra fluid can become pus (4). On rare occasions, the bursal sac might get infected without visible skin damage.

The infectious causes of elbow bursitis usually spread through a transcutaneous route, rather than being spread by blood.

If you discover new symptoms in or around your elbow joints, no matter what is causing pain or swelling, consult a healthcare professional.

The Symptoms of Olecranon( elbow) Bursitis

The common symptoms associated with elbow (Olecranon) Bursitis include elbow joint pain radiating to the back of the elbow, pain radiation to the tip of the elbow, limited range of motion due to joint pain, and increasing inflammation over the period of time. The appearance of the bursa in the elbow joints is like a golf ball due to the accumulated synovial fluid. In the case of septic elbow bursitis, the individual may experience redness and tenderness over the ligaments and affected bursa. Systemic spread of the infection as a result of the infected bursa may also lead to fever. (5) (6)

A diagram of olecranon bursitis

How is Olecranon Bursitis Diagnosed?

The healthcare professionals and experts specializing in orthopedics may diagnose the Olecranon Bursitis by conducting a detailed medical history and physical examination. The differentiation between infection and noninfectious forms of Bursitis may be made using imaging modalities like X-rays or blood tests. However, the gold standard for Olecranon Bursitis includes Bursal Analysis and Aspiration studies. This is particularly important for septal Bursitis. When the fluid is extracted from the bursal swelling, the fluid sample is sent to the lab to rule out the risk of infection. This is done by conducting gram stain cultures, cell counts, sensitivity tests, crystal examinations, and other tests. (7)

Treatment Options for Olecranon Bursitis

The treatment options for Elbow Olecranon Bursitis are planned according to the nature of the condition –infectious or noninfectious. The healthcare professionals may start by recommending oral medications such as ibuprofen( for mild or high temperature or to relieve swelling of inflamed bursa) or other anti-inflammatories, ice packs, splints, physical therapy, and topical anesthetics. Additionally, the steroid medication is a stronger anti-inflammatory drug that can be taken orally. In some people, corticosteroid injections effectively reduce pain and inflammation. However, for some people, corticosteroid injections provide no symptom alleviation. Moreover, while corticosteroid injections may be recommended for their ability to cause efficient relief from symptoms, They may also prove to be a cause of infection transmission.

The acute cases of Bursitis are usually self-limiting and symptoms such as swelling may be managed by only practicing adequate rest, avoiding pressure, and icing the affected area. In the cases of inflammation, which is interfering with the individual’s range of motion, they may also be recommended Elastic Bandages. Furthermore, if your hobbies or job require you to frequently use your elbows make sure you’re using all the necessary protective gear, such as wearing elbow pads. However, conservative therapy may not be effective for everyone. Individuals with persistent severe symptoms that last for more than six months may require surgery by orthopaedic surgeons. The most commonly recommended surgical procedure for these patients includes Bursectomy, which is conducted to remove any bone spurs of the broken bone present – that promote its recurrence. (8) (9)Additionally, it’s crucial to treat any underlying condition that may have been related to your swollen bursa.

Elbow bursitis surgery

Surgery is rarely required for elbow bursitis. If your symptoms do not respond to non-surgical treatments, or if you have a severe infection that does not improve with antibiotics, you may require surgery.

Your olecranon bursa removal is an outpatient procedure, it means you will be able to return home the same day. You will require a splint or brace to hold your elbow in place while it recovers after the surgical procedure. It will take approximately a month to recover.

Prolotherapy

Some of the structures around the elbow have a poor blood supply, which is why they can struggle to heal on their own. The oxygen and nutrients in our blood supply help to heal these structures.

Prolotherapy involves the injection of a regenerative solution into these structures to provide a direct supply of what is required to heal and repair.

As the treatment is helping to treat the root cause of the problem, it is deemed to be a permanent fix.

Septic Bursitis treatment

Your doctor will prescribe antibiotics if you have septic bursitis. you must take the medicines for about a week. Make sure you take your antibiotics as your doctor prescribes.   You must continue taking antibiotics for the full duration of the prescription even if your symptoms get better. You need to complete the treatment duration to completely eradicate the infection that might be still present in your body. Your doctor could aspirate your swollen bursa to get rid of as much of the diseased excess fluid as possible.

In severe cases, a surgical procedure may be required to remove the entire bursa if the infection in the bursa is serious and does not respond to medications or fluid is draining to other areas from a fluid-filled sac.

Frequently Asked Questions

How long does elbow bursitis take to heal?

The majority of the cases of Elbow Bursitis are usually resolved by rest and self-care due to their self-limiting nature. The time it usually takes for Elbow Bursitis to heal using at-home remedies like icing is between three weeks to six weeks. However, as seen in septic elbow bursitis, individuals with infection may require antibiotics to see improvements in their symptoms. These improvements may be seen once the entire course of antibiotics as recommended by the doctor is completed.

What happens if Bursitis is left untreated?

Even though Bursitis is considered self-limiting in most cases and may improve by taking adequate rest and icing the affected area – some cases may become chronic. These cases of Chronic Bursitis are often associated with thickening of the bursa lining, enlargement of the bursa, constant pain in movement, and limited range of movement. The limited range of movement may eventually lead to muscle atrophy of the affected arm, severely interfering with an individual ability to carry out physical activity and everyday functions.

What can be mistaken for elbow Bursitis?

Elbow bursitis may be mistaken for several medical conditions, including gout, ligament rupture, elbow fracture, tendon rupture, olecranon fracture, cellulitis, cutaneous abscess neoplasm, and other causes that may cause swelling and tenderness of the elbow. (10)

What does Elbow Bursitis pain feel like?

Bursitis of the elbow is associated with swelling, which is also among the first symptom of this condition. This swelling due to the buildup of synovial fluid in the irritated bursa eventually leads to its stretching, which may lead to significant pain. Moreover, according to peer review studies and systematic overview, this pain is described to worsen every time the individual flexes or extends their arm(11).

References

Blackwell, J. R., Hay, B. A., Bolt, A. M., & Hay, S. M. (2014). Olecranon bursitis: a systematic overview. Shoulder & elbow, 6(3), 182–190. https://doi.org/10.1177/1758573214532787

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