Elbow bursitis: treatment, how long it lasts and symptoms

Patient.info says that in many cases olecranon bursitis clears up on its own with simple care such as resting the elbow, avoiding pressure on it and applying ice packs, and that some people find a compression bandage makes the elbow more comfortable. The NHS lists the same measures for bursitis in general: rest the joint and avoid activities that put pressure on it, use ice wrapped in a tea towel for around 10 minutes at a time every few hours, and take painkillers such as paracetamol or ibuprofen. Extra cushions around the joint while you sleep can help protect it.

NHS Dorset's musculoskeletal service describes the same approach for olecranon bursitis: rest, compression bandaging, avoiding trauma to the elbows and simple painkillers. It says paracetamol needs to be taken regularly to control pain, and that anti-inflammatories like ibuprofen can help with swelling, though you should not take ibuprofen for 48 hours after an initial injury as it may slow healing. It advises discussing with your GP if you need ibuprofen for more than 10 days.

Other treatments can be used in some cases. The NHS says these include antibiotics (usually for at least 7 days if bursitis is caused by infection), a steroid injection into the affected joint to reduce swelling (not done if the bursitis is caused by infection), and taking fluid from the joint with a needle (aspiration) to ease symptoms. If bursitis is severe or keeps coming back, the inflamed bursa may need to be surgically drained or even removed, but this is rare. Patient.info notes that fluid tends to build up again after being drained, so a tight pressure bandage may be advised; that steroid injections sometimes cause infection in the bursa; and that surgery to remove the bursa is an option if other measures do not work.

The NHS Tayside referral guide for olecranon bursitis, written for clinicians, lists initial management as advice and reassurance, analgesia and NSAIDs as appropriate, compression bandage, elbow padding, ice, rest and avoiding aggravating activity, and managing associated conditions such as gout, rheumatoid arthritis or cellulitis. It suggests referral to orthopaedics should be considered if non-septic bursitis does not respond after 2 months of conservative measures.

The NHS says bursitis can usually be treated at home and should go away in a few weeks. Patient.info says that as long as there is no infection, over time most cases of olecranon bursitis will settle on their own. NHS Dorset and the Tayside guide both say most cases of olecranon bursitis resolve without complications, although recurrent episodes may occur, especially after repeated minor trauma. Dorset suggests discussing with your GP if you have not responded to simple advice after 2 months.

Versus Arthritis says that if simple measures such as rest, NSAIDs and support work, pain should improve within a couple of weeks, though swelling may last a while afterwards. Because swelling can persist after the pain has settled, a small, painless thickening over the elbow is not unusual.

The NHS says bursitis may cause a joint to be painful (usually a dull, achy pain), tender or warmer than surrounding skin, swollen, and more painful when you move it or press on it. The area may also be red, which can be harder to see on brown or black skin. Patient.info explains that in non-infected olecranon bursitis, most cases are painless or only mildly painful, elbow movement is not affected, and it may hurt to lean on your elbow or slightly when you bend it. The swelling looks the same colour as the skin or slightly pink, feels soft and the fluid may move when you press on it.

NHS Dorset describes swelling that appears over several hours to several days, which may be tender or warm (or painless), with painless elbow movement except at full bend when the swollen bursa is compressed.

Patient.info says mild but repeated injury is thought to be the common cause, for example people who lean on their elbows a lot, and repeated elbow movements in some athletes such as cricket or baseball players, javelin throwers and weightlifters. A one-off blow to the back of the elbow can set off inflammation. Arthritis such as rheumatoid arthritis, gout and ankylosing spondylitis can also be associated, though most cases are not. A cut in the skin over a bursa allows bacteria in to cause infection, and some illnesses such as diabetes or conditions where the immune system does not work as well make infection more likely. Many cases have no obvious cause.

The Tayside guide says non-septic bursitis is the most common type and that olecranon bursitis is more common in young or middle-aged men, and in people in jobs with regular elbow trauma or pressure, for example gardeners and mechanics.

NHS Dorset says if there are any signs of infection (redness, heat, swelling and tenderness worsening, or feeling unwell) it needs to be treated immediately, and to seek the advice of your GP urgently. The Tayside guide says to seek urgent referral or specialist advice for septic bursitis, severe infection or systemic toxicity, extensive cellulitis, or a suspected septic joint, which presents with limited range of movement of the elbow joint unlike septic bursitis.

Patient.info says antibiotics are needed if the cause is infection, usually flucloxacillin or erythromycin until the results of tests on the aspirated fluid are available, after which the choice can be adjusted. The Tayside guide also describes aspiration and treating empirically with antibiotics until culture results are known. The NHS says antibiotics are usually taken for at least 7 days.

Patient.info says that in a straightforward case the doctor may be able to diagnose olecranon bursitis without tests, because the swelling is typical and the elbow is close to the skin. Blood tests and an ultrasound scan may be needed to rule out other causes of elbow swelling such as septic arthritis, gout or rheumatoid arthritis, and an X-ray if there has been a significant injury or to look for a bony spur after repeated episodes. If infection is suspected, the fluid may be drained and sent to the lab. The NHS adds that fluid may also be tested for gout, and that aspiration may help your symptoms.

The NHS suggests padding when putting a lot of pressure on joints, taking regular breaks from activities that put pressure on a joint, not knocking or banging your joints, cleaning any cuts on the joints to prevent infection, warming up before exercise and keeping a healthy weight. Patient.info says protecting the elbow from excessive friction, for example using elbow pads if you need to lean on your elbows while working, may prevent further bouts. Versus Arthritis suggests ice packs for 10 minutes every 2 to 3 hours and, for people who lean on their elbows to work or study, reducing the pressure on the area.

The NHS says to see a GP if symptoms have not improved or are getting worse after treating it yourself for 1 to 2 weeks, if you have a high temperature or feel hot, cold or shivery, if you cannot move the affected joint, or if you have very severe, sharp or shooting pains in the joint. Versus Arthritis adds that you should see your GP if the skin over the swollen area is broken. Get urgent help (NHS 111 or A&E) if you feel very unwell, the redness is spreading quickly, or you have a fever with a hot, red, swollen elbow.

Most elbow bursitis is managed by a GP, urgent treatment centre or musculoskeletal service. Patient.info says your GP may often diagnose and treat you without referral, but may refer you if there is doubt about the diagnosis, you have an associated condition such as rheumatoid arthritis, or your GP is not practised at aspirating these swellings. Private orthopaedic or sports medicine appointments are available for quicker aspiration, injection or surgery, and the same principles apply; keep your GP informed.