The bursa is a slippery sac between the loose skin and the bones of your elbow. The bursa allows the skin to move freely over the underlying bone and is normally flat and it’s hard to tell it is even there. However, if the bursa becomes irritated or inflamed, a condition known as elbow bursitis develops.

Symptoms

Swelling is often the first symptom. The skin on the back of the elbow is loose, so you may not notice small amounts of swelling right away. As the swelling continues, the bursa gets larger causing pain. The swelling may get large enough to restrict motion in the elbow.

If the bursitis is infected, the skin becomes red and warm. If the infection is not treated right away, it may spread to other parts of the arm or move into the bloodstream which can result in serious illness.

See your doctor to diagnose elbow bursitis. Non-surgical and surgical options are available.

Common Causes

Trauma, prolonged pressure, infection and certain medical conditions can cause bursitis in the elbow.

Trauma: A hard blow to the tip of the elbow could cause the bursa to produce excess fluid and swell.

Prolonged pressure: Leaning on the tip of the elbow for long periods of time on hard surfaces such as a tabletop may cause the bursa to swell. Typically, this type of bursitis develops over several months.

Infection: If the tip of the elbow has an injury that breaks the skin, such as an insect bite or a scrape, bacteria may get inside the bursa and cause an infection. The infected bursa produces fluid, redness and swelling. If the infection goes untreated, the fluid may turn to pus.

Medical conditions: Certain conditions such as rheumatoid arthritis and gout are associated with development of elbow bursitis.

Excerpted from AAOS

Repairing Elbow Bursitis

Treatment Options: Nonsurgical

First, the doctor must determine whether the bursitis is due to an infection. If infection is suspected, the doctor may recommend removing fluid from the swollen area (aspiration). This is performed in the office at the time of your visit. Fluid removal helps relieve symptoms and gives the doctor a sample that can be looked at in a laboratory to identify if any bacteria are growing. Often, the doctor may start you on antibiotics before the exact bacteria can be identified to prevent the infection from progressing.

If the bursitis is not from an infection, you will be sent home with instructions on how to alleviate the symptoms. Elevation, ice, using an elbow pad and avoidance of direct pressure on the swollen elbow are recommended. If needed, anti-inflammatory medication such as ibuprofen may also be used. If the swelling and pain do not respond to these measures, your doctor may recommend removing fluid from the bursa and injecting a corticosteroid medication into the bursa. The steroid medication is an anti-inflammatory that is stronger than the medication that can be taken by mouth.

Treatment Options: Surgical

Surgery may be required if the bursa does not improve after using the non-surgical measures described above. Surgery to remove the bursa is usually performed as an outpatient procedure. The surgery does not disturb any muscle, ligament or joint structure. Physical therapy after surgery is not always needed. Postoperative casting or prolonged immobilization is not typically required.

If you have recurrent problems with bursitis you may have a bone spur or some other foreign body which is causing the irritation. An X-ray may be needed.

January 2006, AAOS