Most cases of elbow bursitis can be resolved with self-care focused on eliminating activities or positions that aggravate the bursa and reducing the inflammation. Some cases, however, may become more serious and require more medical interventions. Rarely surgery is needed.

Following the R.I.C.E. formula, Rest, Ice, Compression, and Elevation, is often sufficient to treat aseptic bursitis:

    Rest and activity modification. People with elbow bursitis should avoid activities that will aggravate and inflame the bursa and avoid leaning on the elbows or putting any direct pressure on them. Wearing elbow pads can also help protect the elbow bursa from pressure or additional irritation.

    Ice. Applying a cold compress to the swollen elbow for about 20 minutes two or three times a day may help alleviate symptoms and decrease swelling.

    Compression. An elastic compression bandage (e.g. Ace™ bandage) wrapped around the affected joint can help control swelling.

    Elevation. Keeping the affected elbow at or above the height of the heart can help reduce blood flow to the area, thereby reducing inflammation.

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In addition to R.I.C.E., there are a number of treatments to reduce the swelling and any associated pain or discomfort.

    Non-steroidal anti-inflammatory drugs, or NSAIDs. Anti-inflammatory medications, such as aspirin, ibuprofen (e.g. Advil), naproxen (e.g. Aleve), and cox-2 inhibitors (e.g. prescription medication Celebrex) can reduce swelling and inflammation and relieve pain associated with elbow bursitis.

    Aspiration. An aspiration of the swollen bursa with a needle and syringe will immediately relieve pressure. This may be done in conjunction with getting a fluid sample to test for an infection. (A positive test would indicate septic bursitis.)

    Corticosteroid injections. Bursitis symptoms may be quickly relieved with corticosteroid injections. A corticosteroid is a powerful anti-inflammatory medication, and injecting it directly into the inflamed bursa is usually effective in relieving pain and swelling. However, corticosteroid injections have potential side effects, such as infection and degeneration of the skin at the elbow.7,8 Therefore these injections are usually reserved for intractable cases of elbow bursitis that are not responding to other treatment.

    Antibiotics. Septic olecranon bursitis requires treatment with antibiotics. The choice of antibiotic may be influenced by what microorganism is causing the infection (often Staphylococcus Aureus). Most people with septic bursitis are effectively treated with oral antibiotics. More challenging cases may require hospitalization and antibiotics delivered intravenously.

    Surgery. Rarely, a challenging case of chronic elbow bursitis or septic elbow bursitis may warrant surgery. In a traditional bursectomy an incision is made at the elbow and the troublesome bursa is removed. Since the olecranon bursa is located just inside the skin, the surgery to remove it does not include surgery on any part of the elbow joint.

    Complications of surgery include trouble with skin healing at the incision site and tenderness. Several months following the bursectomy surgery, a new normal bursa will usually grow back in place of the one that was removed.

    After surgery, patients may be told to wear a sling to keep their arms bent at 90 degrees while healing.

    Physical therapy. After the bursitis symptoms have abated, a doctor may assign stretches or strengthening activities to help restore normal range of motion and muscle tone.

It is important to wait until all pain and swelling around the elbow is gone before resuming activities. Returning to activities that cause friction or stress on the bursa before it is healed will likely cause bursitis symptoms to flare up again.

Physicians who commonly treat elbow bursitis include primary care physicians, physiatrists, sports medicine physicians, and orthopedic surgeons.

If a patient suspects that the bursitis is caused by infection (e.g. if bacteria could have entered the elbow through a bug bite or cut, if the affected area is warm to touch or accompanied by fever), then it is important to seek prompt medical attention.

References:

  1. Weinstein PS, Canoso JJ, Wohlgethan JR, "Long-term follow-up of corticosteroid injection for traumatic olecranon bursitis," Ann Rheum Dis, 1984 Feb;43(1):44-6. PubMed PMID: 6696516; PubMed Central PMCID: PMC1001216.
  2. Brinks A, Koes BW, Volkers AC, Verhaar JA, Bierma-Zeinstra SM, "Adverse effects of extra-articular corticosteroid injections: a systematic review," BMC Musculoskelet Disord, 2010 Sep 13;11:206. Review. PubMed PMID: 20836867; PubMed Central PMCID: PMC2945953.
Further Reading: Steroid Injections
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