Bursae are thin, slippery sacs located throughout the body that act as cushions between bones and soft tissues. They contain a small amount of lubricating fluid that allows the skin to move freely over the underlying bone.
The olecranon bursa lies between the loose skin and the pointy bone at the back of the elbow called the olecranon.
Normally, the olecranon bursa is flat. If it becomes irritated or inflamed, more fluid will accumulate in the bursa and bursitis will develop.
Elbow bursitis can occur for a number of reasons.
Swelling is often the first symptom. The skin on the back of the elbow is loose, which means that a small amount of swelling may not be noticed right away.
In many cases, the first sign of bursitis is swelling at the elbow.
As the swelling continues, the bursa begins to stretch, which causes pain. The pain often worsens with direct pressure on the elbow or with bending the elbow. The swelling may grow large enough to restrict elbow motion.
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. This can cause serious illness.
Occasionally, an infected bursa will open spontaneously and drain pus.
If your physician suspects that bursitis is due to an infection, he or she may recommend aspirating (removing the fluid from) the bursa with a needle. This is commonly performed as an office procedure. Fluid removal helps relieve symptoms and gives your doctor a sample that can be looked at in a laboratory to identify if any bacteria are growing. This also lets your doctor know if a specific antibiotic is needed to fight the infection.
He or she may prescribe antibiotics before the exact type of infection is identified. This is done to prevent the infection from progressing. The antibiotic that your doctor prescribes at this point will treat a number of possible infections.
If the bursitis is not from an infection, it is treated with a number of options.
If swelling and pain do not respond to these measures after 3 to 4 weeks, your doctor may recommend removing fluid from the bursa and injecting a corticosteroid medication into the bursa. The steroid medication is an anti-inflammatory drug that is stronger than the medication that can be taken by mouth. Corticosteroid injections usually work well to relieve pain and swelling. However, symptoms can return.
Surgery for infected bursa. If the bursa is infected and it does not improve with antibiotics or by removing fluid from the elbow, surgery to remove the entire bursa may be needed. This is often an inpatient procedure, meaning you will need to stay overnight in the hospital. This surgery may be combined with further use of oral or intravenous antibiotics.
The bursa usually grows back as a non-inflamed, normally functioning bursa over a period of several months.
Surgery for noninfected bursa. If elbow bursitis is not a result of infection, surgery may still be needed if nonsurgical treatments do not work. In this case, surgery to remove the bursa is usually performed as an outpatient procedure. The surgery does not disturb any muscle, ligament, or joint structures.