Overview
Elbow bursitis develops at the boney tip of the elbow called the olecranon. There are bursae throughout our body, lubricating fluid-filled sacs that cushion bones and soft tissues to allow free movement over the underlying bone. In the olecranon, it is called the olecranon bursa and is usually flat. When it becomes inflamed, fluid will accumulate there and bursitis will develop, causing pain and limiting movement.
Elbow & Forearm
Elbow bursitis develops at the boney tip of the elbow called the olecranon.
Causes of Elbow Bursitis Include:
- Trauma – a traumatic blow to the elbow can cause the bursa to make excess fluid.
- Prolonged pressure – leaning on the elbow for long periods of time over several months on hard surfaces can cause the bursa to swell. Certain occupations like plumbers or heating and air conditioning technicians must crawl tight spaces and lean on their elbows while working. Long holds of the plank position in some athletic activities also promote olecranon bursitis.
- Infection – If the tip of the elbow is injured and exposes the skin, bacteria may get inside the bursa sac and become infected. When left untreated, the infected bursa’s fluid turns to pus. In rare cases, the bursa sac becomes infected without any injury.
- Medical conditions – rheumatoid arthritis and gout are associated with elbow bursitis.
Symptoms of elbow bursitis include swelling, pain, and redness with warmth to the touch. If the bursa is infected, it must be treated immediately as the risk of infection spreading to the arm or moving into the bloodstream can occur, causing serious illness. Sometimes, an infected bursa will open and drain pus by itself.
Treatment
Dr. Stowell will examine your arm and elbow and may recommend an X-ray to look for a bone spur or other foreign body. He may also take a small sample of bursal fluid with a needle to diagnose whether the bursitis is caused by an infection or gout.
If Dr. Stowell determines that the bursitis is due to an infection, he may recommend aspirating the bursa with a needle, which simply means removing the fluid. In doing so, it will help relieve symptoms and allow the sample to be further investigated in a laboratory for the presence of other bacteria. Dr. Stowell can use this data to determine a specific antibiotic to fight the infection. Even without the exact type of infection identified, Dr. Stowell may prescribe antibiotics to prevent the infection from progressing.
Several options exist to manage elbow bursitis if it is not from an infection:
- Elbow pads – used to cushion your elbow.
- Activity modification – avoid activities that cause direct pressure to your affected elbow.
- Medications – orals medications such as ibuprofen and other anti-inflammatory medications may be used to relieve symptoms.
Surgery may be considered if the infected bursa does not improve with antibiotics or fluid removal. Dr. Stowell may remove the entire bursa. The bursa then grows back normally over a period of several months. Removal of the bursa is usually an outpatient procedure. Dr. Stowell will apply a splint to your arm so that your skin is protected after surgery. Dr. Stowell will recommend specific exercises to improve your range of motion after a few days of the surgery. Your skin will typically heal withing 16 days after surgery and you may be able to use your elbow fully after 4 weeks.
Complications
Complications exist for both non-surgical and surgical treatments of adult forearm fractures including:
- Tearing of surrounding blood vessels or nerves due to the sharpness of the broken bone fragments.
- Excessive bleeding and swelling that leads to compartment syndrome, a condition that cuts off blood supply to the hand and forearm due to swelling. Compartment syndrome requires emergency surgery once diagnosed so that the skin and muscle coverings are exposed and left open to relieve pressure and help the return of blood flow.
- Bone infection may occur even with good surgical cleaning. It often requires multiple surgery and long-term antibiotics.
- Synostosis, a rare complication where a bridge of bone forms that heals between the two bones of the forearm, decreasing the rotation of the bones and preventing full movement.
- Nonunion may occur if the fracture fails to heal. Surgery does not guarantee healing of the fracture.
- Plates, screws, or rods may shift or break due to the patient’s lack of following directions after surgery or other health conditions that slow healing like diabetes or smoking.
- Stiffness and inability to fully rotate your palm up and down.
- Cumbersome or painful implants from plates placed on bones during surgery.
Recovery
Forearm bones typically take 3 to 6 months to fully heal; however, the more severe your injury, the longer it may take to recover. Dr. Stowell will work with you to reduce pain. He may prescribe short-term pain relief options and minimize the need for opioids.
Physical therapy will help with rehabilitation. With nonsurgical treatment of a forearm fracture, after a few weeks being in a cast or brace, Dr. Stowell may recommend physical therapy to help increase range of motion and strengthen your arm. After surgical treatment, the length of time in a cast or brace may be 2 to 6 weeks, so gentle early motion will help prevent stiffness. Dr. Stowell may prescribe visits to the physical therapist to help move along your rehabilitation.