A patient came in today complaining about a lump on her elbow and that is has been slightly painful for the last week. She is a student and spends many hours reading books and resting her elbow on a table while studying. This disorder called olecranon bursitis is a fairly common condition in which the bursa, which is a sac-like structure that protects the elbow from pressure injuries becomes inflamed.
Bursas are found all over the body including the shoulders, elbows, knees, feet and hips. They contain a lubricating fluid that fills the sac and decreases the friction between ligaments, bones and tendons.
Bursitis of the elbow can be caused from:
1) Prolonged pressure on a bursa (such as when leaning on the elbow while studying for long periods of time or resting the elbow on a car door during a long trip).
2) Repetitive motions that cause irritation (laying carpet is an example).
3) An injury or trauma
4) Medical conditions such as gout or rheumatoid arthritis or pseudogout
5) An infection within the bursa (called septic bursitis)
Usually a bursitis is not caused from an infection, but when there is redness and warmth to the skin there is a higher chance of infection. If the skin overlying the elbow becomes punctured or injured there is a higher chance of a septic elbow bursitis.
How would I know if I have bursitis or some other type of problem causing the elbow pain? A medial provider who has experience with joint conditions will likely be able to diagnose the problem after examining you and hearing about your symptoms. If there is redness or increased warmth to the area in addition to the swelling, a medical provider might ask to use a syringe and needle to remove a sample of fluid from the bursa to test for infection. The fluid from the elbow can also be tested for crystals that can be caused by gout or pseudogout. If you have uric acid crystals in your elbow, the medial provider will help you lower your uric acid levels to prevent worsening symptoms and decrease the chances of crystals forming in other joints. For more information about gout, please see my blog article on that topic.
Sometimes an x-ray, ultrasound or MRI is ordered if there is still some uncertainty about the cause of the elbow problem.
What can I do for the bursitis? Treatment of elbow bursitis involved decreasing the pressure or motion that is causing the inflammation. If there is infection, treating with antibiotics is important. If the bursitis is not due to an infection however, then draining the fluid usually is not very helpful because the bursa will create more fluid and only enlarge again. In addition, there is a risk of introducing infection into the joint if a needle is put poked through the skin and into the bursa. If there was not an infection already present within the bursa or joint, there is a greater chance of introducing infection by attempting to withdraw the fluid. It is important to rest the joint and apply ice. We also usually prescribe an anti-inflammatory medication such as naproxen or ibuprofen. Sometimes heat or a steroid injection is also used to help decrease the inflammation. Heat can be applied to the elbow with a hot pack, a heating pad or hot water bottle. Ice can be applied using a frozen gel pack or a bag of frozen peas. I usually don’t recommend using either ice or heat for more than 20 minutes at a time and recommend caution so you don’t burn the skin.
How can I prevent bursitis? Irritation to the small bursal sacs can be minimized by decreasing repetitive motions, using cushions or pads to reduce the pressure on joints and taking periodic short breaks from tasks that increase joint pressure. If you start having pain in a joint, this is a warning that there is too much stress and the activity should be modified or avoided.
I hope that you have found this information useful. Wishing you the best of health,
Scott Rennie, DO
Valeriano-Marcet J, Carter jD, Vasey FB. Soft tissue disease. Rheum Dis Clin North Am 2003; 29:77