Elbow Bursitis

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The elbow joint is a synovial hinge joint, similar to the ankle and knee joints. The distal humerus and proximal ulna are the primary elbow joint bones. In addition, the hinge joint allows the elbow to bend and straighten. It also helps with hand motion by allowing the forearm to rotate.

The elbow consists of three articulations, which are:

  • The ulnohumeral joint.
  • The radioumeral joint.
  • The proximal radioulnar joint.

Stability comes primarily from the bony joints of the ulnar olecranon and the trochlea of the humerus. The olecranon appears as a wrench and has a landmark called the trochlea notch. The trochlea of the humerus fits in the trochlear notch. This is the main point where the elbow pivots while bending and straightening.

A bursa is a sac-like tissue that typically allows smooth movement around bony prominences, such as the point behind the elbow. When a bursa becomes inflamed, the sac fills with fluid. This can cause pain and a noticeable swelling behind the elbow. This is known as elbow bursitis. 

Elbow bursitis (also called olecranon bursitis or Popeye elbow) involves swelling at the tip of the elbow, most commonly on the back of the arm. The condition can be painless, or it can be painful at rest and when leaned on, as when writing with the arm pressing on a table. Elbow bursitis can have several causes, but the most common is trauma, whether a direct hit or smaller bumps or pressure applied over time. Elbow bursitis is commonly seen in students or office workers who lean their elbows on hard desks or armrests for long periods of time; however, its occurrence isn’t related to any particular age or ethnic group. The condition can also be caused by infection or autoimmune conditions. Sometimes, however, a specific cause cannot be determined.

Causes & Symptoms

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Elbow bursitis can have a variety of causes, ranging from an acute injury to the elbow to a systemic disease, such as rheumatoid arthritis. Here are some of the most common causes that are associated with this condition:

 

  • Trauma – A fall or a blow to the elbow can cause the bursa to fill with blood, which may irritate and inflame the bursa’s synovial membrane. Even though the body reabsorbs the blood, the membrane may stay inflamed, causing elbow bursitis symptoms.
  • Other conditions – Elbow bursitis is more likely to happen in people who have certain medical conditions, such as psoriasis, rheumatoid arthritis, gout, and pseudogout. Studies have shown that between 30-75% of patients with elbow bursitis tend to experience another associated medical condition.
  • Repetitive pressure – Bursitis can be caused by frequent mini-traumas which can cause the same problems as a single, more serious trauma. People who rest their elbows on hard surfaces are more likely to get elbows bursitis. Repeatedly resting weight on the elbows may especially increase risk.
  • Inflammation of the olecranon bursa – Once a bursa has been inflamed, it can become more easily inflamed again in the future. Therefore, patients who have had elbow bursitis in the past have an increased chance of developing it again.

Other signs and symptoms that play a role in elbow bursitis include:

 

  • Swelling – Usually the olecranon bursa is flat. An inflamed elbow bursa swells up with fluid, and this enlargement can be felt and seen through the skin. An olecranon bursa can swell up to 6 or 7cm long by 2.5cm wide, which may result in a bump in the affected area.
  • Elbow pain – The swelling may not be accompanied by pain, and some people with elbow bursitis never experience any sign of pain. However, as the olecranon bursa swells larger and larger, it can cause aching pain or discomfort, particularly during extreme bending or straightening.
  • Full range of motion – Elbow bursitis typically does not limit joint movement. In severe cases, the swollen bursa may make it very difficult to completely straighten or extremely flex the elbow.
  • Tenderness – Studies have shown that most people with non-septic bursitis report a sensation of tenderness located at the elbow.
  • Redness – The skin over the inflamed bursa may appear either pink or red, particularly in septic bursitis.
  • Warmth to the touch – The temperature of the skin over the inflamed bursa may be warmer than elsewhere.
  • Fever – A high fever or chills in addition to another elbow bursitis can be a sign of septic bursitis.

Who gets Elbow Bursitis?

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Overall, anyone can develop elbow bursitis, although certain risk factors can increase your risk, including the following below:

  • Age – Patients who are above the age of 50 have an increased likelihood of developing elbow bursitis due to general wear and tear.
  • Occupations – If your work or hobby requires repetitive elbow motion or pressure on the olecranon bursa, your risk of developing elbow bursitis increases higher than the regular rate. Some examples of occupations include carpenters, gardeners, machine operators, and painters.
  • Other medical conditions – Certain systemic diseases and conditions, such as rheumatoid arthritis, gout, and diabetes, can increase your risk of developing elbow bursitis.

How Does it Affect You? How Serious is it?

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Many types of bursitis involve an infection that is known as septic bursitis. Septic bursitis usually affects bursae that are located at the knee and elbow joints. Unlike non-septic bursitis, septic bursitis is a potentially serious medical condition and prompts medical attention as soon as you experience this type of infection. Generally, a bursa can become infected when bacteria or other microorganisms in the body enter the bursal sac and multiply. The microorganism may come from:

 

Outside the body

Microorganisms can enter the bursa through a cut, scrape, puncture, bug bite, or other means. Sometimes the infection occurs without an obvious entry point on the skin. People who may be more susceptible to getting septic bursitis this way are those who spend a lot of time on their knees and elbows, such as plumbers, carpenters, roofers, and athletes.

 

Inside the body

While this is less common, it is still possible for infectious microorganisms anywhere else in the body to enter the bursa. For instance, it is possible for the bacteria causing septic arthritis or tuberculosis to infect a bursa.

Recommended Treatment & Rehabilitation

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During diagnosis your doctor will likely first want to rule out other possible elbow problems, such as arthritis, tendonitis, and a fracture, before making a diagnosis of olecranon bursitis. In order to do this, your doctor will use a group of diagnostic tools to rule out all possible conditions.

A healthcare provider may conduct some of the following diagnostic methods, such as:

  • Medical history – Your doctor will ask you to describe the onset of symptoms and any previous pain and swelling. Additionally, information about your medical history, occupation, and hobbies may provide important clues about the elbow’s bursa being infected.
  • Physical examination – Your doctor will examine your joint, noting swelling at the elbow, tenderness and pain trigger points, and range of motion.

If it isn’t clear whether symptoms are caused by elbow bursitis or another condition, your doctor may order the following equipment for a deeper diagnosis:

  • Magnetic Resonance Imaging (MRI) – MRI can show detailed images of bone tissue as well as soft tissues near the elbow joint, including the triceps tendon.
  • Ultrasound – Ultrasounds can detect areas of fluid, such as the excess synovial fluid found in a swollen bursa.
  • X-ray – X-rays are capable of showing visible broken bones and signs of elbow osteoarthritis.

Once your diagnosis has been done and your doctor has successfully discovered that you have elbow bursitis, physiotherapy will be advised for further treatment. A physiotherapist will work with you to help create a treatment program that will boost your olecranon bursa recovery, including exercises and treatments that you can do in your own time. The regular amount of time it takes to heal the condition varies, but results can be achieved in 2-8 weeks or even less.

During your first 48 hours following your elbow diagnosis, your physiotherapist will perform the following treatment programs below:

  • Improve your motion – Your physiotherapist may decide which activities and treatments can help restore regular movements in the affected elbow and arm. These might start with passive motions that your physiotherapist performs for you to gently move your elbow joint, and progress to active exercise and stretches that you can do yourself.
  • Reduce your swelling – If repetitive activities have caused the condition, your physiotherapist will help you learn how to avoid or modify certain activities to allow healing to take its course. Your therapist may also use different types of treatments and electrothermal modalities to manage and reduce your pain and swelling.
  • Improve your strength – If your physiotherapist discovers any weak or injured elbow muscles, he or she will choose, and teach you, the most proper exercises and equipment to steadily restore your strength and agility.
  • Improve your endurance – Restoring your arm’s endurance is highly recommended after an injury. Therefore, your physiotherapist will develop a specific program of activities to help you regain the endurance you had before your injury.
  • Home program education – Your therapist may teach you a combination of strengthening and stretching exercises that you can perform at home or elsewhere.
  • Return to your regular occupations / hobbies – Finally, your physiotherapist may discuss your activity goals with you and use them to set your work, sport, and homeopathic recovery goals.

Here are some exercise examples you can try on your personal time:

 

Elbow extension stretch

Begin by extending your affected arm in front of you with your palm facing away from you. Next, bend back your wrist, pointing your hand up toward the ceiling. With your other hand, gently bend your wrist farther until you feel a mild to moderate stretch in your forearm. Hold for 15-30 seconds, then repeat this method 2-4 times a day.

Elbow flexion stretch

Lift your affected arm, and bend the elbow. Your palm should be facing toward you. With your other hand, gently push on the back of your affected forearm. Then, press your hand toward your shoulder until you feel a good stretch in the back of your upper arm. Repeat this exercise 2-4 times a day.

Hand flips exercise

While you are seated, place your affected forearm on your thigh, with your palm facing down. Next, flip your hand over so the back of your hand rests on your thigh and your palm is up. Alternate between palm up and down while keeping your forearm on your thigh. Repeat this exercise 8-12 times a day.

Alternative & Homeopathic Treatment

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Homeopathic treatments will be focused on eliminating activities or positions that are aggravating the olecranon bursa and reducing local inflammation. Here are some treatments you can do at home:

  • Rest – Patients who are living with elbow bursitis should avoid activities that can irritate and inflame the bursa and avoid leaning on the elbows or putting any pressure on them. The use of elbow pads may also help protect the elbow bursa from pressure.
  • Ice application – Applying a cold compress to the swollen elbow two or three times a day can help alleviate symptoms and decrease further swelling.
  • Compression – An elastic bandage wrapped around the affected elbow joint can help control swelling.
  • Elevation – Keeping your elbow above the height of the chest can help reduce blood flow to the area, thereby reducing inflammation.
  • Non-steroidal anti-inflammatory medications (NSAIDs) – such as aspirin or ibuprofen can help reduce swelling and inflammation and relieve pain associated with elbow bursitis.
  • Pain-relieving cream – Applying pain-relieving cream that contains anti-inflammatory properties may help reduce swelling and inflammation.