Bursitis in The Elbow

Anatomy of the elbow

The elbow is a hinging joint that joins together the upper arm and the forearm.¹ Structurally speaking the elbow is made of varying ligaments, muscles and tendons. Four groups of muscles which are: elbows flexors, elbow extensors, forearm flexor-pronators and forearm extensors all work simultaneously together to extend and protract the elbow.¹ There is a multitude of ligaments in the elbow of which the collateral ligament and transverse ligament aid in stabilisation.¹ 

Two important joints in the elbow are the humeroradial joint and the proximal radioulnar joint.² The humeroradial joint is formed where the radius and humerus (the bone that connects the elbow to the shoulder joint) meet and its function is to rotate the hand in supination (palm up) and pronation (palm down) positions.² The proximal radioulnar joint is formed where the radius (small bone in the forearm) and ulna (bone in the forearm) meet and its function is to allow full rotation of the arm.² 

In terms of kinetics, the elbow which has a relatively constrained range of motion helps, with the shoulder, to move the hand. 1 A normal elbow motion in flexion is between 0-140° whilst for daily activities it can range anywhere between 30-130 °.¹ 

Common causes of elbow pain

The most common injuries in the elbow are elbow dislocation, tennis elbow, bicep tendon rupture, elbow bursitis and golfer's elbow.³ Tennis elbow is characterised by pain over the humerus and when flexing the wrist, middle finger or both.⁴ An elbow dislocation is the second most commonly dislocated joint on the human body and occurs when any of the elbow bones that meet at the elbow move out of place.⁵  

Another frequent injury is Golfer’s elbow which occurs due to the overuse of the flexor tendon in the elbow, usually from playing golf, with the most common symptom being a weakness in grip strength.⁶ In the case that you feel any pain in the elbow, forearm or upper arm, a doctor should be consulted who will most likely perform a series of diagnostic tests and imaging using ultrasounds or MRI depending on the severity of the injury.

What is elbow (olecranon) bursitis?

Elbow bursitis occurs in a fluid-filled sac called the olecranon bursa, which is located at the boney tip of the elbow, known asthe olecranon.⁷ The sac is usually flat but will become swollen upon more fluid entering it.⁷  

A number of factors can be accounted for development of this injury, notably trauma, prolonged pressure, infection and other medical conditions. A potential trigger to this injury can be trauma caused by hitting the tip of the elbow which then provokes the bursa to produce excess fluid.⁷ Prolonged pressure such as leaning the tip of the elbow on hard surfaces can typically last over several months and provoke over time the bursa to start swelling.⁷ Another cause for developing this injury is an insect bite or any other infection on the olecranon that breaks the skin and causes bacteria to develop inside the bursa.⁷ If you have arthritis or gout, your muscles weaken and you are more susceptible to developing elbow bursitis.⁷ 

Is it septic bursitis?

This type of bursitis occurs due to an infection of the blood or joints that causes the bursa to inflame.⁸ In a clinical setting it can prove to be difficult to distinguish between diagnosing the injury as septic or noninfectious bursitis which is why typically blood samples are also taken. A high white blood cell count would indicate that an infection is also present.⁹ Treatment options vary depending on the severity of the injury because, in mild bursitis, a course of oral antibiotics is recommended for two weeks, whereas for more severe cases you may be admitted to hospital where the antibiotics are administered intravenously.⁹ 

Signs and symptoms

Signs/ symptoms can be classified as follows:^10,11

• Swelling of the elbow
• Elbow feels warm touch
• Pain when flexing the elbow
• Tenderness around elbow
• Fever

It’s important to understand that the above are the most common symptoms observed amongst people who have this injury. If you have any of the symptoms outlined then it is advisable to seek out the correct medical attention from a GP or medical professional in order to obtain a treatment plan.  

Causes and risk factors

Causes of elbow bursitis can be trauma or an infection at the tip of the elbow (olecranon). In a study, it was concluded that two third of the cases are non-septic and due to repeated trauma or sports injury to the elbow.¹² Another cause of bursitis is from either a blood or joint infection and this type is infectious and given the name of septic bursitis. 

There are no predispositions to developing the injury in terms of age, sex or race. However, risk factors for this injury are:

• Long-term haemodialysis treatment¹²
• Crawling in tight spaces¹²
• Rheumatoid arthritis¹²
• Gout¹²
• Crystal deposition disease¹²
• A side effect of sunitinib (used to treat renal cell carcinoma)¹² 

A weakened immune system as a result of autoimmune diseases can increase the risk of developing elbow bursitis . 

Diagnosis

Diagnosis of this injury should only be performed by a medical professional. Clinical features can be presented as swelling of the olecranon and it feeling hot to touch.¹³ In some cases it is possible to feel a small lump along the olecranon.¹³ Around half of the people who obtain this injury also have a fever that can be measured using a thermometer.¹³ The above clinical features should in most cases help with diagnosing this injury, but additional diagnostic tools can include MRI scans when symptoms are severe in order to highlight potential tissue damage.¹³ 

Treatments

Treatment options vary considerably according to the exact cause of the bursitis. For people with underlying health conditions such as rheumatoid arthritis, it is advisable to follow the RICE method whereby the area is iced and rested alongside anti-inflammatory drugs as a form of pain management.¹³ 

Most commonly anti-inflammatory drugs are recommended for acute cases in addition to an elastic bandage and hydrocortisone steroid injections to reduce the inflammation rate.¹³ In more severe cases of elbow bursitis, surgery by an orthopedic surgeon will be performed along with a physiotherapist outlining strengthening exercises as a form of rehabilitation.¹³ Because septic bursitis is infectious, a bacterial culture will be taken to conclude the exact strain of bacteria that causes it in order to prescribe appropriate antibiotics.¹³ A doctor should be consulted for both diagnosis and in order to develop a proper treatment plan in order to optimize recovery.  

Summary

To conclude, this article looked at the injury of elbow bursitis which occurs at the tip of the elbow and its causes can be either infectious or a repetitive strain to this part of the elbow. Symptoms for this injury include swelling of the elbow and it feeling tender to touch. With regards to risk factors, the most notable ones are underlying autoimmune conditions which increase the risk of developing elbow bursitis. Diagnostic tools that are performed by a doctor were also discussed together with a treatment plan that depends on the severity of the injury. In most cases, it is recommended to rest the elbow and take anti-inflammatory drugs to manage the pain levels.