Elbow Bursitis

What is Elbow Bursitis?

Inflammation and swelling of the bursa at the base of the elbow are the symptoms of elbow bursitis, also referred to as olecranon bursitis. To lessen friction during movement, the bursa, a tiny sac filled with fluid, serves as a cushion between soft tissues and bones.

An elbow’s inflammatory bursa, which usually comes on by trauma or repetitive strain, can cause pain, swelling, and restricted range of motion. Numerous things, such as prolonged elbow flexion from repetitive motions, direct elbow trauma, or underlying medical conditions like Gout or arthritis, can contribute to this condition. People of all ages and activity levels, including office workers and athletes, can develop elbow bursitis.

Rest, ice therapy, and over-the-counter painkillers are common conservative treatments for elbow bursitis, despite the pain and irritation it can cause. Sometimes the only ways to lower inflammation and relieve symptoms are taking the bursa fluid or providing injections of corticosteroids. Rarely, surgical intervention may be necessary to treat severe or recurrent conditions.

People with elbow bursitis can return to their regular activities with minimal disruption if they diagnose and treat the condition early on. This will help to prevent complications and speed the healing process.

The Structure of the Elbow Joint:

Articulating Surfaces:

The elbow joint has two different articulations;

• The trochalla of Humerus and the trochallaar notch of Ulna.
• The head of the radius and the capitulum of Humerus.

Elbow joints, like all synovial joints, are surrounded by capsules. This strengthens the joint because it is firm and fibrous. Collateral ligaments form as the joint capsule extends laterally and medially, giving stability to arm flexion and extension.

Bursas are tiny sac-like structures that contain small volumes of synovial fluid. It works by reducing the amount of contact that results from skin, tendons, and bones moving. There are many bursae in the elbow, but only a small number of them have clinical significance;

• Intratendinous olecranon: The term refers to a tendon that is located inside the triceps brachii.

• Subtendinous olecranon: The subtendinous olecranon lessens friction between the olecranon and the triceps brachii tendon during arm flexion and extension.

• Subcutaneous olecranon bursa: This bursa, which lies between the olecranon and the surrounding connective tissue, is linked to olecranon bursitis.

Ligaments:

• The elbow joint capsule is supported and encouraged by the lateral and medial ligaments.

• On the lateral side of the joint, the radial collateral ligament extends from the lateral epicondyle and merges with the radius annular ligament, a ligament from the proximal radioulnar joint.

• After leaving the medial epicondyle, the ulnar collateral ligament attaches to the olecranon and coronoid process of the ulna.

Blood Supply:

• The surrounding network of vessels, which is made up of brachial artery branches, provides the elbow joint with a great arterial supply.

The nerve supply:

• There are branches of the ulnar, radial, musculocutaneous, and medial nerves that innervate the elbow joint.

Muscles:

Because of the bone orientation of the elbow joint, a hinge-type synovial joint that allows forearm flexion and extension is created;

• Flexion:  Brachioradialis, brachii, biceps, and brachialis

• Extension: The Anconeus and brachii triceps muscles

Surrounding the elbow joint muscles;

• The flexor carpi radialis, the palmaris longus (in the event that present), the humeroulnar head of the flexor digitorum superficialis, and the humeral head of the flexor carpi ulnaris are all attached to the medial epicondyle of the humerus anteriorly at the common flexor origin.
• Both the pronator teres and the flexor carpi ulnaris ulnar heads attach at the coronoid process and olecranon, respectively.
• The flexor digitorum superficialis comes into contact with the coronoid process through its humeroulnar head.
• The extensor carpi radialis longus proximal attachment is located on the posterior lateral supracondylar ridge.
• Extensor digitorum, extensor digiti minimi, and extensor carpi radialis brevis all have proximal attachment points at the lateral epicondyle of the humerus at the common extensor origin, and they all cross the joint.

In epidemiology:

The olecranon bursitis is a rather common problem. Write-related morbidity resulting from posterior elbow pain may limit certain functional activities. Many people experience bursitis in the olecranon. The death rate associated with this illness is zero. Pain at the posterior elbow can lead to morbidity and activity limitation. The typical affected age range for men is 30 to 60.

• Sports injuries or repeated trauma result in bursa hemorrhage or the release of inflammatory mediators in two-thirds of nonseptic cases.
• It is not a hereditary or ethnic trait.
• Both children and adults can develop olecranon bursitis.
• In tight spaces, technicians who crawl on their knees and lean on their elbows are especially vulnerable.

The causes:

• Health issues

There is a connection between gout and rheumatoid arthritis and elbow bursitis.

• Injury

A hard hit to the elbow tip could cause the bursa to overproduce fluid and swell.

• Extended pressure

When someone rests their elbow on hard surfaces for extended periods of time, such as a tabletop or the armrest of a car or truck, bursa swelling may result. The typical time for this kind of bursitis to manifest is several months.

Those who work in professions like plumbing or air conditioning, where one must crawl on one’s knees and rely on one’s elbows, are especially vulnerable.

• Infection

An infection could result from bacteria getting into the bursa sac if there is a skin break near the elbow’s tip, such as from an insect bite, scrape, or puncture wound.

An inflamed bursa displays fluid, redness, swelling, and pain. If the infection is not treated, the fluid could turn into pus.

Signs and symptoms:

Heat or redness

• An infection can occasionally occur in the bursa of the olecranon. A typical reaction to an olecranon bursa infection is redness and warmth.
• A fever may also be a symptom of an olecranon bursa infection.

Swelling

• Olecranon bursitis often manifests as swelling at the back of the elbow.

Pain

• The most frequent cause of pain in the elbow is direct pressure, such as when the elbow is resting on a hard surface.
• There are instances when bending the elbow hurts. For some people, swelling is the only feeling they get.

Medical Examination:

After discussing your symptoms and medical history with you, your doctor will examine your elbow and arm.

• X-rays

Your doctor might recommend an X-ray to look for a foreign body or bone spur. Bone spurs on the ulna, the point of the elbow bone, are often found in patients with recurrent episodes of elbow bursitis.

• Fluid examination

Your doctor may need to take a small bursal fluid sample with a needle in order to diagnose whether your bursitis is caused by an infection or gout.

Treatment:

There are both non-surgical and surgical treatments available to help you fully recover from elbow bursitis. Should your elbow bursitis not get better, surgery might be necessary.

Non-Surgical Treatment:

If your doctor believes that your bursitis is being caused by an infection, they may suggest aspirating or using a needle to remove the bursa’s fluid.

In addition to relieving pain, draining fluid gives your doctor a sample that can be tested in a lab to check for bacteria. This lets your doctor know whether an antibiotic in particular is needed to treat the infection.

Your physician may recommend antibiotics before determining the precise type of infection. This will prevent the infection from spreading. Nowadays, an antibiotic may be prescribed by your doctor to treat a number of possible infections.

Treatment of a non-infected bursa without surgery: There are several treatment options available if an infection is not the cause of the bursitis.

• Elbow pads: If you want to protect your elbows a little, you can use elbow pads.

• Activity change: Avoid engaging in any activities that directly press on your swollen elbow.

• Split: Apart from maintaining the straightness of your elbow, a splint can help prevent the skin surrounding your bent elbow from getting too tight.

• Pharmacies: Ibuprofen and other non-steroidal anti-inflammatory medicines (NSAIDs) are examples of oral therapies that can be used to treat your symptoms and minimize swelling.

The surgical procedure:

Surgery to heal an infection in the bursa;

• If clearing the infection with medicine or by draining fluid from the elbow is not possible, surgery to remove the entire bursa might be necessary.

• Further intravenous or oral antibiotic use may be combined with this procedure. A normally functioning, non-inflammatory bursa is what emerges after a few months of bursa regeneration.

The protocol for a non-infected bursa;

• Even though elbow bursitis is not the result of an infection, surgery may still be recommended if nonsurgical therapy fails. In this instance, the bursa removal procedure is typically carried out as an outpatient procedure.

• The procedure has no effect on any single muscle, ligament, or joint structure.

Physiotherapy management:

While they are frequently recommended for speeding the healing process, physiotherapy and occupational therapy are not always required. Patients are recommended to have olecranon bursitis if they regularly stick to the RICE treatment protocol. The words “rice” have for elevation, compression, rest, and ice. In order to reduce pain and inflammation, additional physiotherapy methods might be helpful. Take electrical stimulation and the method, for example.

Ice

• If your bursa is irritated, your therapist might cool your body with ice.
• Ice has been shown to decrease localized blood flow, which may lessen bursa inflammation and the pain that goes along with it.
• Keep in mind that while applying ice to your bursitis may help you feel better and less painful, there is no guarantee that doing so will make your condition better in the long run.

Heat

• For chronic pain resulting from bursa irritation, heat treatment is one option.
• Heat can help injured bursa tissues receive much-needed blood and oxygen since it increases circulation.
• Use caution when applying heat and follow your physiotherapist’s instructions to avoid burns on your skin.
• Like with ice, there’s no evidence that using heat to treat bursitis will improve patients’ condition more than not using it at all.

Ultrasound

• One deep-heating method used in timely rehabilitation is ultrasound.
• Ultrasound therapy heats your inflamed bursa, which draws in oxygen, improves blood flow, and eliminates inflammatory cells.

Any treatment that a physiotherapist recommends should be added with exercises created especially to help you. After your bursitis has been effectively treated, your therapist should instruct you on how to prevent recurrence of the condition and provide you with the necessary resources to learn how to self-manage it with a proper home exercise plan.

Prevention:

• Although you cannot stop bursitis entirely, you can lessen its severity. It is possible to lower the likelihood of outbreaks in the future.
• Avoid lifting large objects to try to reduce the amount of stress you put on the joint.
• On the other hand, regular exercise and muscle building can help prevent future injuries.
• Always warm up and stretch before engaging in any exercise or activity that could strain your joints if you have bursitis or are at risk for developing it.
• See a doctor if you’re not sure which exercises to perform.

Recovery:

If proper rest and therapy are given, elbow bursitis typically resolves in a few weeks. When your doctor performs surgery, your arm will probably be immobilized with a splint. We’ll ask you to rest and follow your doctor’s instructions. While it usually only takes three or four weeks to regain elbow function, a doctor’s approval is required. The recovery process time may reach eight weeks for certain individuals.

Summary:

In the back of the arm, between the skin and the bony elbow tip, is a thin sac filled with fluid that is called the elbow bursa, also referred to as the olecranon bursa. As a cushion for the point of the elbow, the bursa is a sac that typically contains very little liquid. That being said, the bursa may swell and fill with extra fluid if it becomes irritated or inflammatory.

A painful condition known as elbow bursitis causes the bursa, a tiny fluid-filled lubricating pouch, to overflow and swell. Infections, trauma, sustained pressure, or an underlying medical condition can all contribute to this condition. Both surgical and non-surgical options can help you eliminate symptoms and get back to your normal activities. The most common are usually the non-surgical procedures that work well. A full recovery usually takes a few weeks, though depending on how bad your condition is, surgery may be necessary.

FAQ:

References:

• February 12, 2024a; Bariya, D. The causes, signs, and treatment of elbow bursitis. The website for Mobile Physiotherapy Clinic provides information about elbow bursitis.

• Davis and Weerakkody (2018) 19 January. bursitis in the elbow. (doi.org/10.53347/rid-57880) Radiology Wiki. Citation within the text: Davis & Weerakkody (2018)

• Professional, C. C. M. (n.d.). elbow osteotendin bursitis. Elbow olecranon bursitis at Cleveland Medical Center: https://my.clevelandclinic.org/health/diseases/22553 Textual reference: (Professional, n.d.)

• Elbow bursitis at the Mayo Clinic Orthopedics & Sports Medicine (September 11, 2019). Sports Medicine & Orthopedics at Mayo Clinic. bursitis in the elbow: /condition/sportsmedicine.mayoclinic.org (Mayo Clinic Orthopedics & Sports Medicine, 2019) is cited in the text. Bursitis in the elbow

• February 22, 2019; Gotter, A. Treatment Options for Elbow Bursitis. Wellline. https://www.healthline.com/health/sports-injuries is a resource on elbow bursitis. Gotter, 2019 is cited in the text.

• Image 2, The White House Clinic, “Anatomy, Pathology, and Treatment of the Elbow Joint: Articles and Advice,” n.d. How the anatomy, pathology, and treatment of the elbow joint are related to each other?