Elbow Bursitis Treatment, Olecranon Bursitis

Olecranon bursitis produces one of the more startling appearances in orthopedics. A fluid filled swelling develops at the point of the elbow, sometimes to the size of a golf ball, and it frequently does not hurt at all. Patients arrive alarmed by how it looks rather than by how it feels, and in most cases the appearance is the worst part of it.

Steven Struhl, MD is board certified in orthopedic surgery and separately in sports medicine, has practiced in New York since 1991, and serves on the faculty of NYU School of Medicine. The one question that matters in elbow bursitis is whether it is infected, because that changes the treatment completely and it is not always obvious.

What the Olecranon Bursa Does

A bursa is a thin sac of fluid that lets tissue glide over bone. The olecranon bursa sits between the skin and the point of the elbow, and because the elbow is a place people lean on constantly and land on when they fall, it is exposed. When it becomes irritated it produces excess fluid, which is the swelling.

Elbow Bursitis Symptoms

• A Soft Swelling at the Point of the Elbow: well defined and often described as feeling like a water balloon.
• Minimal or No Pain: in the common non infected form, which is why patients delay coming in.
• Preserved Motion: the elbow bends and straightens normally, since the bursa sits outside the joint.
• Discomfort Leaning on It: the most common functional complaint.
• Redness and Warmth: which raises the question of infection.
• Fever, Spreading Redness, and Severe Pain: which answer it, since these indicate septic bursitis requiring prompt treatment.

Causes of Olecranon Bursitis

• Repeated Pressure: leaning on the elbow at a desk, which is the single most common cause.
• A Direct Blow: a fall onto the point of the elbow.
• Occupational Kneeling and Leaning: trades that rest weight on the elbows.
• Infection: bacteria entering through a scrape or cut over the elbow, which is common enough that a break in the skin is always looked for.
• Gout and Inflammatory Arthritis: crystal deposition or systemic inflammation within the bursa.
• Prior Bursitis: since a bursa that has been inflamed once tends to recur.

Distinguishing Infected From Non Infected Bursitis

This is the whole of the diagnosis, and it is not always straightforward, since both forms produce swelling and both can produce redness. Infection is more likely where there is a break in the skin, marked warmth, spreading redness, significant pain, fever, or rapid onset. Where any doubt exists, Dr. Struhl aspirates fluid from the bursa and sends it for cell count, Gram stain, culture, and crystal analysis, which settles the question and simultaneously relieves the swelling. Radiographs are taken where there has been trauma or where a bone spur at the tip of the olecranon may be irritating the bursa.

Treatment for Non Infected Elbow Bursitis

• Elbow Padding: a compressive sleeve or pad, which both protects the bursa and discourages the leaning that caused it.
• Avoiding Pressure: the single most important measure, and the one most often disregarded.
• Ice and Anti Inflammatory Medication: for comfort.
• Aspiration: drawing off the fluid, which relieves the swelling and has a recurrence rate high enough that it is rarely definitive on its own.
• Corticosteroid Injection: occasionally used after aspiration in persistent cases, and used cautiously because of skin thinning and infection risk over a superficial area.

Most non infected bursitis resolves over weeks with padding and pressure avoidance. The recurrence rate is meaningful, and recurrence almost always traces to the elbow going back onto the desk.

Treatment for Septic Bursitis

Infected bursitis is treated with aspiration and antibiotics, guided by the culture result, and it usually resolves without surgery. Where the infection does not settle, where there is a collection that will not clear, or where the process has been present a long time, Dr. Struhl performs surgical drainage and, in some cases, removal of the bursa. Recovery from bursal excision involves wound protection for a few weeks, since the skin over the elbow is thin and heals slowly.

When Elbow Bursitis Needs Surgery

Surgical excision of the bursa is reserved for chronic bursitis that has recurred repeatedly despite proper treatment, for infection that has not cleared, and for cases where a bone spur at the tip of the olecranon keeps irritating the bursa, in which case the spur is removed at the same time. It is a straightforward procedure with one caveat worth knowing, which is that wound healing at the point of the elbow is slower than most patients expect and the arm needs protecting during it.

Schedule an Elbow Bursitis Evaluation in New York City

A swelling at the point of the elbow that is warm, red, or genuinely painful should be seen promptly rather than watched, because infected bursitis is treated differently and is easier to clear early. Dr. Struhl evaluates elbow conditions at his Manhattan and Westchester offices. Contact us to schedule an appointment.