Background & Etiology

The elbow joint is a connection point between the humerus (arm bone) and the radius and ulna (forearm bones.) A bursa is a fluid filled sac that decreases friction between two tissues. The olecranon bursa covers the olecranon process, the pointed part of the elbow formed by an extension of the ulna (forearm) where it meets the humerus. It is located between the loose skin that covers the elbow joint and the forearm bones. The bursa decreases friction and protects the olecranon process from injury, however the bursa can become inflamed causing an elbow bursitis.

Bursitis is often the result of repetitive injury to the bursa or surrounding tendons. Common causes of bursitis include:

  • Participating in athletic activities like tennis, that place repetitive strain on the elbow
  • Repetitive strain injuries (RSI) are overuse activities at work, common in people who have jobs that require performing activities of a repetitive nature like working on an assembly line.
  • Sudden trauma or an accident like falling on the elbow
  • Patients with rheumatoid arthritis, gout, calcific bodies, or infection
  • Overload injuries like lifting heavy objects or weight training that can cause strain and irritation
  • Prolonged pressure from leaning on the elbow, which can range from repeatedly sitting at the kitchen table with your head in your hand, to working in tight spaces where you have to lean on your elbow (like plumbing or electrical work.)
  • Pain or a burning sensation in the elbow
  • Moderate to severe loss of elbow motion
  • Pain with moving the arm or when sleeping on the effected side
  • Difficulty dressing and performing daily activities
  • Weakness, especially as the inflammation and pain get worse
  • A feeling of tightness or loss of motion due to discomfort
  • Localized swelling or redness of the elbow

If one suspects they have bursitis, initial treatment should consist of first avoiding the positions and activities that produce the pain. A course of conservative treatment, including rest, ice, physical therapy, and non-steroidal medications to reduce inflammation is recommended. If persistent, treatment by a physician may include steroidal medication or injections, in conjunction with therapy. If there is excessive swelling your physician may drain the fluid. In more severe cases surgical intervention may be indicated to correct any mechanical causes.

Physical Therapists are professionals, educated and trained to administer interventions. As defined by The Guide to Physical Therapist Practice, interventions are the skilled and purposeful use of physical therapy methods and techniques to produce changes consistent with the diagnosis, prognosis and the patient or client’s goals.

Common Physical Therapy interventions in the treatment of Elbow Bursitis include:

  • Manual Therapeutic Technique (MTT): hands on care including soft tissue massage, deep friction massage and joint mobilization by a physical therapist to regain mobility and range of motion of the elbow and tendon. Use of mobilization techniques also help to modulate pain at the elbow joint.
  • Therapeutic Exercises (TE) including stretching and strengthening exercises to regain range of motion.
  • Neuromuscular Reeducation (NMR) to restore stability, retrain the upper extremity, and improve movement techniques and mechanics (for example, throwing) of the involved upper extremity in daily activities.
  • Modalities including the use of ultrasound, electrical stimulation, ice, cold, laser and others to decrease pain, swelling and inflammation of the elbow bursa.
  • Home programs including strengthening, stretching and stabilization exercises in addition to instructions to help the person perform daily tasks and advance to the next functional level.

These are procedures that your physician may recommend and perform in addition to physical therapy.

  • REST and ICE
  • The use of NSAIDS (Non Steroidal Anti-Inflammatory Drugs)
  • Steroidal injections to reduce inflammation
  • Pain medication to reduce discomfort and allow the patient to perform recommended exercises
  • Draining the fluid in the bursa, and injection of a corticosteroid medication, if the condition does not improve within 3-4 weeks.
  • Surgery to remove the effected bursa

Prognosis

In general, patients respond well to conservative treatment of elbow bursitis. It is important that once the pain and inflammation is reduced, and motion and strength are restored, that the patient gradually returns to full activities. Instruction in daily activities or sport performance is helpful to reduce the chance of a reoccurrence of the bursitis. In most cases full return to activity will take from 2-6 weeks, depending on the severity of the condition.

To prevent elbow bursitis or a reoccurrence of the condition individuals should:

  • Make modifications in work or daily activities to avoid putting pressure on the elbow
  • Avoid highly repetitive activities when possible.
  • Use an elbow-pad to cushion the elbow when activities that strain the elbow cannot be avoided.

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