The elbow joint is a synovial hinge joint, similar to the ankle and knee joints. Two or more bones form hinge joints that move along an axis, rather than rotate like the hip joint. 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.
Bursitis is a common, painful condition that affects many patients within the population. Our bodies are filled with small fluid-filled sacs called bursae that are located at certain friction points, such as joints or bony prominences. These bursa help cushion and protect the bone from friction as tendons and muscles cross over bone during movement, especially in places like elbows, knees, and hips.
In cases of Olecranon bursitis (also referred to as elbow bursitis or ‘Popeye elbow’), occurs in the olecranon bursa, which is part of the ulna bone at the elbow. It is the boney prominence or pointy tip that can be felt best with a bent elbow. Olecranon bursitis happens when the olecranon’s bursa’s synovial membrane becomes irritated and inflamed.
The inflamed membrane may produce excess synovial fluid, causing the bursa to swell. A severe case of olecranon bursitis can make it appear as if there is a small egg or golf ball under the skin. Because it can be caused by repeatedly resting weight on the elbow, olecranon bursitis has included other nicknames, such as student’s elbow or miner’s elbow.
Causes & Symptoms of Olecranon Bursitis
Olecranon bursitis can occur for various reasons, such as:
Olecranon bursitis can be the result of a hard blow to the tip of the elbow that may cause the bursa to produce excess fluid and swell rapidly
Leaning on the tip of the elbow for an extended period of time on hard surfaces, such as a tabletop, may cause the bursa to swell. Usually, this type of bursitis develops over several months. People in certain occupations are especially vulnerable, particularly plumbers or air conditioning technicians who have to crawl on their knees in tight spaces and lean on their elbows. In addition, athletic activities may also prompt the development of olecranon bursitis, such as long holds of the plank position.
Other medical conditions
Olecranon bursitis is more likely to occur in patients who have certain medical conditions, such as psoriasis, rheumatoid arthritis, gout, and pseudogout. Additionally, studies have shown that anywhere from 30% to 75% of patients with olecranon bursitis have a secondary medical condition present. The increased risk may be related to a condition itself or to medications used to treat a condition.
Generally, a bursa can become inflamed when it is infected. When bursitis is caused by an infection, it is called septic bursitis. The infected bursa may eventually fill with pus and the infection may spread to other areas of the body. Septic bursitis requires immediate medical attention before experiencing further complications.
Many individuals tend to develop olecranon bursitis without knowing; the swelling may happen unnoticed because the back of the elbow is very difficult to see. Also, the skin over the elbow is loose, so swelling may not cause discomfort. Other symptoms linked to olecranon bursitis include:
Typically, the olecranon bursa is flat. An inflamed olecranon bursa swells up with fluid, and this enlargement can be easily felt and seen through the skin. An olecranon bursa can swell to 6 or 7 cm long, resulting in an obvious bump. It is possible for septic bursitis to cause additional swelling within the elbow joint itself. If the inflamed, aseptic bursa ruptures, it may cause swelling extending all the way to the forearm.
Lack of range-of-motion
Olecranon bursitis usually does not limit joint movement. In more severe cases, the swollen bursa may make it difficult to completely straighten or extremely flex the elbow.
Initially, the swelling may not be accompanied by pain, and some people with olecranon bursitis never experience any pain. However, as the olecranon bursa swells larger and larger it may cause aching pain or discomfort, particularly during extreme bending or straightening.
- Tenderness – Studies show that approximately 80% of patients with septic elbow bursitis report tenderness at the affected elbow.
- Redness – The skin over the inflamed bursa will be pink or red, particularly in cases of septic bursitis.
- Warmth to the touch – The temperature of the skin over the inflamed bursa will be much warmer than elsewhere.
- Fever – A high fever or chills in addition to other bursitis symptoms can be a sign of septic bursitis. Septic bursitis warrants prompt medical care to treat the infection, so it is advisable to see a doctor if there is any concern that one’s elbow bursitis may be infected.
Who gets Olecranon Bursitis?
Anyone can develop olecranon bursitis, although, certain risk factors can increase your risk, including the following below:
- Age – People who are older than the age of 50 have an increased likelihood of developing olecranon bursitis due to general wear and tear.
- Occupational laborers – If your occupation requires repetitive elbow motion or pressure on the olecranon bursa, your risk of developing the condition increases higher than the regular rate. Some examples of occupations include carpenters, gardeners, painters, and machine operators.
How Does Olecranon Bursitis Affect You? How Serious is it?
As mentioned earlier, many types of bursitis involve an infection that is known as septic bursitis. Septic bursitis typically 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 for Olecranon Bursitis
During a diagnosis of olecranon bursitis, significantly, may be quite easy to help identify the condition. Nonetheless, your doctor must first 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:
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.
Your doctor will examine your joint, noting swelling at the elbow, tenderness and pain trigger points, and range of motion.
If there hasn’t been much information about olecranon bursitis and 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 olecranon 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 done 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 own:
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 for Olecranon Bursitis
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 olecranon 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 olecranon bursitis.
- Pain-relieving cream – Applying pain-relieving cream that contains anti-inflammatory properties may help reduce swelling and inflammation.