The bursa is a slippery sac between the loose skin and the bones of the elbow. It is located at the tip of the elbow. The bursa allows the skin to move freely over the underlying bone. Normally, the bursa is flat. If it becomes irritated or inflamed, a condition known as bursitis develops.

Elbow bursitis can occur for a number of reasons.

• Trauma: A hard blow to the tip of the elbow could cause the bursa to produce excess fluid and swell.
• Prolonged Pressure: Leaning on the tip of the elbow for long periods of time on hard surfaces, such as a tabletop, may cause the bursa to swell. Typically, this type of bursitis would develop over several months.
• Infection: If the tip of the elbow has an injury that breaks the skin, such as an insect bite or a scrape, bacteria may get inside the bursa and cause an infection. The infected bursa produces fluid, redness, and swelling. If the infection goes untreated, the fluid may turn to pus.
• Medical Conditions: Certain conditions such as rheumatoid arthritis and gout are associated with development of elbow bursitis.

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. As the swelling continues, the bursa grows. This causes pain as the bursa is stretched, because the bursa contains nerve endings. The swelling may grow large enough to restrict motion of the elbow.

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.

An X-ray may be taken to look for a foreign body or a bone spur. Bone spurs are often found on the tip of the bone of the elbow in patients who repeatedly have elbow bursitis.

Nonsurgical Treatment

Elbow bursitis due to infection.

If the doctor suspects that bursitis is due to an infection, he or she may remove fluid (aspirate) from the swollen area. This is commonly performed as an office procedure. Fluid removal helps relieve symptoms and gives the doctor a sample that can be looked at in a laboratory to identify if any bacteria are growing. This also lets the doctor know if a specific antibiotic is needed to fight the infection.

Often, the doctor may prescribe antibiotics before the exact bacterium can be identified. This is done to prevent infection from progressing. The antibiotic that the doctor uses at this point will cover a number of possible infections.

If the bursitis is not from an infection, it is treated through a number of options. The elbow is elevated and ice is applied. An elbow pad may be used to cushion the elbow. Direct pressure to the swollen elbow should be avoided. Oral medications such as ibuprofen or other anti-inflammatories may also be used.

If swelling and pain do not respond to these measures, the doctor may recommend removing fluid from the bursa and inject a corticosteroid medication into the bursa. The steroid medication is an anti-inflammatory drug that is stronger than the medication that can be taken without a prescription.

Physical therapy after surgery is not always needed. Postoperative casting or prolonged immobilization is not typically required.