Elbow bursitis: Causes, Symptoms, and Treatment

Elbow bursitis is a painful inflammation of the bursa located just under the skin in the area of the elbow, which can be either septic, i.e., with bacterial colonization, or aseptic.

The diagnosis is usually made based on the clinical symptoms; the chances of recovery are very good with adequate therapy.

Causes of elbow bursitis

In more frequent cases, bursitis olecrani, i.e., an inflammation of the bursa protecting the olecranon, develops due to mechanical irritation from the outside. This form of bursitis is, therefore, atraumatic, i.e., without open injury from the outside.

The colloquial term “students elbow” suggests a common cause of irritation: Repeated prolonged resting on the elbow during desk work can trigger an inflammation of the bursa.

But an open injury can also be the cause. Bursitis caused by a stab, cut, or another open injury is usually septic (purulent), as the injury creates an entry point for bacteria.

In patients with reduced resistance, for example, those whose immune system is weakened (suppressed) by chemotherapy or certain diseases, septic bursitis can also occur without an open injury or through a minimal injury.

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Bursitis after a fall

After falling on the elbow, the bursa there may be irritated by being squeezed but remaining closed. This stimulus causes a serous, i.e., serum-like, effusion in the bursa, which can be felt or even seen on the elbow, depending on its size.

The effusion presses on the bursa wall, causing pain and sensitivity to touch. As a result of the irritation of the bursa, aseptic bursitis can occur in the further course of the fall. Therapeutically, the elbow should be immobilized, and pain-relieving or anti-inflammatory medication should be given to relieve the symptoms.

After a fall, the effusion is usually absorbed by the surface cells in the bursa. As the effusion decreases, the symptoms and the bursitis are reduced.

If the fall is a one-time event that irritates the bursa and if it is not stressed otherwise, for example, by the elbow resting on the bursa, no chronification of the symptoms and permanent changes in the bursa tissue are to be expected.

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Symptoms of elbow bursitis

In both the septic and aseptic forms, the main symptom is a painful, burning swelling over the olecranon, which is usually very sensitive to touch.

The swelling is caused by an effusion, i.e., an accumulation of fluid in the bursa as part of the inflammatory reaction; it can reach hen’s egg size. The septic form is usually accompanied by redness and overheating, and is often more sensitive to touch. With this form of inflammation, the inflammation values in the blood are also conspicuous (increase in the number of white blood cells = leukocytosis and increase in an inflammation parameter, the C-reactive protein = CRP). Besides, wounds located in the area of the elbow indicate bacterial genesis.

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Pus in the bursa

The bursa at the elbow is a closed unit that is filled with a so-called synovial fluid which the bursa itself produces and breaks down again.

Usually, this fluid is clear and free of germs. If germs nevertheless penetrate the bursa from the outside, for example, in the case of an open injury, they can then trigger bacterial bursitis. This is accompanied by a bulging, pain-sensitive, and reddened elbow. As a result, the body makes white blood cells available for defense against this inflammation. One form of white blood cells, the “neutrophil granulocytes,” can then form pus, which consists of sunk cells. If the bursa is punctured, the pus emerges as a cloudy, yellowish liquid of varying consistency. In the case of bursitis with pus, it should always be removed to release the pressure and prevent further spreading of the infection.

The therapy is, therefore, either to puncture the bursa first and remove it entirely during surgery if necessary. This should be done as quickly as possible to prevent the germs from spreading into the bloodstream and the risk of blood poisoning. A targeted antibiotic therapy (see also: antibiotics) can be used to accompany bacterial contamination of the surrounding tissue.

Diagnosis

The diagnosis is made clinically, i.e., based on the symptoms described above. An X-ray is usually taken to exclude bony affections, otherwise, the use of further imaging procedures is not the rule.

Therapy of elbow bursitis

The aseptic form is usually treated conservatively, i.e., non-surgically. Cooling, local or systemic administration of anti-inflammatory drugs (antiphlogistics) and, if necessary, temporary immobilization are the means of choice here.

If there is no significant improvement, the bursa is surgically removed (bursectomy).

In the case of septic bursitis, surgical removal is always performed. Also, antibiotics are usually given or inserted into the area of inflammation and removed a few days again after the operation.

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Operation

If recurrent bursitis of the elbow occurs frequently, or if there is a severe bacterial inflammation, surgery may be considered to treat the symptoms. Causes of recurrent bursitis can be, for example, increased strain on the elbow due to movement or may be caused by immunological processes in the body. The bursa is located exactly between the elbow bone and the skin. It has a cushioning and friction-reducing function that is useful but not essential to life. Therefore, if it does more harm than good to the person affected by inflammation and pain, it can be removed. If there is an acute inflammation of the bursa with a bacterial component, it is recommended first to puncture the bursa in a small operation to drain the infectious fluid and reduce the pressure with the associated pain of the bursa.

This slightly smaller procedure is usually followed by an open surgery in which the bursa is completely removed. Even if the bursa has been opened by an accident, surgery with removal of the corresponding tissue should be performed in the same way as for chronic bursitis of the elbow.

To avoid infections caused by the operation, local antibiotic therapy can be used as a precautionary measure during the surgery in the form of a so-called antibiotic chain. Furthermore, sterile work during the surgery of the bursitis is, as always, of great importance to avoid postoperative problems.

The approach to the operation is a straight incision directly above the elbow, which is about 6 cm long, if necessary, and is made in a bent arm position. Then the bursa is prepared freely, detached from the surrounding tissue, and removed. It is then examined again by the surgeon for any abnormalities.

Afterward, the wound is closed, and a plaster splint is applied to immobilize and protect the joint and promote problem-free healing. After the operation, the patient should continue to protect the arm. This surgery for bursitis can be performed on an outpatient basis.

Since the procedure is relatively small and has few complications, it can be performed under plexus anesthesia. This means that the pain sensation of the arm is specifically switched off for the operation, and the patient remains awake.

Nevertheless, the procedure of the operation is adapted to the needs of the patient and the severity of the bursitis. Pain therapy in the form of medication can be administered afterward, as required.

In addition to the risk of infection, there is also the possibility of injuring the ulnar nerve (nervus ulnaris), which anatomically lies close to the bursa.

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Taping

To treat a simple, i.e., non-bacterial, bursitis of the elbow, taping the corresponding joint can help.

As the special adhesive tape lifts the underlying tissue, a specific stimulus and sometimes also a massaging effect is triggered. This activates the tissue around the bursa and the bursa itself and promotes the body’s self-healing process at the site.

Among other things, this is caused by an increased blood and lymph flow and thus an increased metabolism, which in total should reduce the inflammation.

The tape is applied directly to the elbow with the arm bent and then fixed in a stretched position with a certain amount of tension. The joint mustn’t be restricted in its freedom of movement, because the movement is part of the therapy concept.

The advantage of taping is that it is easy to apply and correct if the tape is not correctly positioned. Also, its flat nature makes it very comfortable to wear, it can be worn without slipping even when swimming and showering, and at the same time, it effectively stimulates the bursa sac.

After taping, the tape can be left in place for about seven days, after which it should be renewed until it is free of symptoms to maintain its effect.

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What helps?

Usually, bursitis heals on its own after a few weeks. Nevertheless, some aids can provide relief. In general: Cooling before warmth. Heat treatment should not be used in the case of bursitis. Cold, on the other hand, can improve the pain, for example, by putting on cooling packs. These should be wrapped in a tea towel or similar beforehand, otherwise, they are too cold and can lead to frostbite. There are also cooling ointments that can also help to relieve the pain.

Immobilization: Splints and bandages can be purchased at the pharmacy to immobilize the joint temporarily. However, this should not be permanent, as targeted movements, for example, during physiotherapy, promote faster healing of the inflammation and maintain mobility. Otherwise, functional losses may occur.

Home remedies: Quark wraps have proven to be the most effective home remedy for bursitis. Quark cools, has an anti-inflammatory effect, and relieves pain. The cooled quark is placed on a tea towel and spread out a little. The cloth is then wrapped and placed with the curd side on the elbow. The whole process can be repeated several times a day for about half an hour to three-quarters of an hour (until the curd is warm). Linseed wraps can also provide relief. Boil the linseed until it begins to become slimy. After it has cooled down, it can be applied to a cotton cloth and wrapped around the aching elbow. It is best to apply this compress in the evening so that it can work overnight. Temporary immobilization of the elbow is recommended in any case, but the joint should be re-mobilized early so that its functionality is not permanently impaired.

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Homeopathy: Potassium chloratum can be used in homeopathy to treat bursitis. This is a preparation of the alkali metal potassium chloride. It is available as Schüssler salt No.4 or in the form of globules of various potencies. It is recommended to take potassium chloratum in the potency D4, D6 or D12 three times a day á five globules. In the case of acute complaints, the preparation can also be taken every two hours. However, this should only be done until the symptoms have improved. A higher dosage is not advisable in self-medication. Potassium chloratum is also available as an ointment of Schuessler Salt No. 4 and can be applied directly to the inflamed area. However, in case of persistent or worsening symptoms, a doctor should be consulted for further clarification.

Ointment: Some ointments can also alleviate the symptoms. Cooling ointments alleviate the pain, ointments with anti-inflammatory drugs relieve the inflammation. There are various suitable preparations, such as ointments with diclofenac (Voltaren gel), acetylsalicylic acid, or ibuprofen.

However, if the pain persists or increases, self-medication should be avoided, and a doctor should be consulted for clarification, who will then decide on further therapy.

Sports: Especially during sports activities that require a substantial strain on the elbow, an inflammation of the bursa can occur. Sports, where this happens more frequently, include golf, tennis, baseball, and handball. In the case of acute bursitis, the primary aim should be to avoid more strenuous activities.

The therapy is initially carried out by immobilizing the elbow and pain-relieving medication. However, after the acute symptoms have subsided, it is advisable to maintain mobility in the affected joint with targeted mobilization, e.g., by instruction from a physiotherapist. For this reason, doctors often prescribe physiotherapy for bursitis.

Prognosis of elbow bursitis

The therapeutic procedure promises good chances of recovery, but recurring complaints (relapses) due to newly formed bursae can occur.

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