Elbow (Olecranon) Bursitis: Signs and Treatments

Elbow bursitis, also called olecranon bursitis, causes fluid to collect in a sac that lies behind the elbow, called the olecranon bursa. People may notice elbow bursitis as a squishy lump on the back of their elbow. Often this seemingly appears out of nowhere, or they may remember something that led to the onset of their symptoms. Elbow bursitis is more common as people get older, seen more frequently an men, and more often on their dominant arm.

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 6cm 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.

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.

About 20 percent 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. 

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.

Elbow bursitis is likely to cause discomfort, but know that people with elbow bursitis usually improve with simple treatment. Sometimes the cause of the bursitis will be clear, well other times it seemingly appears out of nowhere. Most patients are more bothered by the appearance of the lump on the back of their elbow, rather than the severity of symptoms. However, when the symptoms become bothersome there are effective treatments that can help reduce the swelling. Invasive treatments and surgery should be approached with caution as elbow bursitis can get infected, and can become recurrent. Simple treatments should be tried if possible.