Olecranon bursitis, commonly called “fluid on the elbow,” results from the inflammation of the olecranon bursa. This bursa is a small, fluid-filled sac situated over the bony point of the elbow (the olecranon), acting as a cushion to allow the skin to glide smoothly over the bone. When irritated, the sac produces excess fluid, leading to noticeable swelling and discomfort at the back of the elbow joint. Although generally not serious, the resulting swelling can range from mild to large, sometimes restricting the full range of motion.
Identifying the Cause of Elbow Fluid Build-up
Olecranon bursitis is broadly classified into three main types, and the underlying cause determines the appropriate management approach. The most frequent cause is mechanical trauma, resulting either from a single, sharp blow to the elbow or, more commonly, from repeated, minor pressure. This chronic irritation, often seen in individuals who rest their elbows on hard surfaces for extended periods, is commonly referred to as “Student’s Elbow.”
Inflammatory bursitis is the second category, linked to systemic medical conditions like gout or rheumatoid arthritis. These issues cause body-wide inflammation that can manifest in the olecranon bursa. Treatment must address both the local elbow inflammation and the primary systemic disease.
The third and most concerning cause is infectious, or septic, bursitis, which occurs when bacteria enter the bursa, often through a break in the skin. Septic bursitis presents with signs of localized infection, including warmth, redness (erythema), increased tenderness, and possibly a fever. Distinguishing this type is paramount, as it requires immediate medical intervention to prevent the infection from spreading.
Non-Invasive Management and Home Care
For most cases of non-septic olecranon bursitis, initial treatment focuses on self-management strategies aimed at reducing inflammation and preventing further irritation. This involves a modified R.I.C.E. protocol, starting with resting the affected arm and avoiding any activity that places direct pressure on the inflamed bursa.
Applying ice helps constrict blood vessels, minimizing swelling and dulling pain. Use a cold pack or ice wrapped in a thin towel for 10 to 20 minutes, repeating three or more times daily during the acute phase. Gentle compression using an elastic bandage can then help prevent further fluid accumulation and reduce existing edema.
Ensure the compression wrap is snug enough to provide support without causing throbbing or numbness in the hand or arm. Elevation is another helpful component, using gravity to encourage fluid drainage away from the elbow by keeping it propped up above heart level when possible. For chronic cases, protective padding, such as an open-backed elbow sleeve, can cushion the area and prevent recurrence by shielding the bursa from contact pressure.
Over-the-counter Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) can be used alongside these physical measures to manage both pain and inflammation. Medications like naproxen are typically started with a specific dose. Adhere to package instructions, using the lowest effective dose for the shortest necessary duration to minimize potential side effects. Topical NSAID gels offer localized relief with fewer systemic risks.
Professional Medical Treatment Pathways
When home care fails to resolve non-septic bursitis after several weeks, or if infection is suspected, professional medical treatment is necessary. Marked warmth, redness, significant tenderness, or a fever signals septic bursitis, requiring immediate medical attention. A healthcare provider will perform fluid aspiration, using a sterile needle to draw a sample of the bursal fluid for diagnosis.
The fluid is analyzed in a laboratory via cell count and bacterial culture to determine if infection or crystals (like those causing gout) are present. For confirmed septic bursitis, the primary treatment is antibiotic therapy, typically targeting common skin bacteria like Staphylococcus aureus and streptococci, lasting at least 14 days. Untreated infection can spread beyond the elbow.
For persistent, non-septic cases, aspiration may be used to physically reduce swelling and alleviate discomfort. Corticosteroid injections are sometimes considered for chronic inflammation that resists other treatments, but they are used cautiously due to risks like skin atrophy or secondary infection. Surgery, known as a bursectomy, is reserved as a last resort for severe, chronic, or recurrent cases. During this outpatient procedure, the inflamed bursa sac is surgically removed, followed by a period of immobilization for healing.