- The skin over the back of your elbow and front of your knee is thin and supple so it can stretch when you bend your arm or leg.
- There’s a thin, flat, slippery sac of tissue called a bursa under the skin to help it glide over the pointy bone.
- Your body has bursae in many locations, wherever soft tissue moves over a bony prominence (like inside the shoulder or the side of the hip.)
- Normally, the bursa contains a few drops of fluid to lubricate it.
- The pointy bone on the back of the elbow is called the olecranon; it’s covered with the olecranon bursa.
- The kneecap is called the patella; it’s covered with the prepatellar bursa.
- These areas are vulnerable because there’s no fat, muscle or other soft tissue padding.
- If the bursa is irritated or inflamed (called bursitis), it tries to protect itself by filling with fluid to build a cushion.
Swollen Olecranon Bursa
Bone Spur on the Olecranon
Bursal Fluid Collection on back of elbow
Swollen Prepatellar Bursa
aka “Housemaid’s Knee
What causes Bursitis?
- Trauma: A hard blow to the area can cause bleeding within the bursa.
- Prolonged pressure: Leaning on the tip of the elbow or kneeling for long periods of time on hard surfaces could cause the bursa to swell because it thinks it has to build a cushion.
- Medical conditions: Rheumatoid arthritis and gout are associated with elbow bursitis.
- Infection: If an insect bite, scrape, or puncture wound breaks the skin, bacteria could get inside the bursa sac and cause an infection which produces fluid, redness, swelling, and pain. If the infection goes untreated, the fluid may turn to pus.
- History: How/when did it start? Is it getting worse? How does it affect your job or other tasks? How is your general health and what medicines do you take?
- Physical Exam: Swelling, tenderness; does it affect your movement or appear to be infected?
- Tests: X-rays define the bony structures underneath the bursa and condition of the joints. If fluid is drained from the bursa and looks like infection or gout, it might be sent to the lab.
- Unlike bursitis in the shoulder or hip, olecranon or prepatellar bursitis is usually not painful, unless it’s infected.
- If it’s not painful, red, hot or draining, you can live with it. It might go away on its own.
- The goal of treatment is to quiet inflammation and relieve swelling in the bursa, and prevent it from coming back.
- If you can take them: anti-inflammatory pills like Advil (ibuprofen) OR Aleve (naproxen) as needed.
- Wrap it to gently compress the bursa and help your body reabsorb the fluid. Try these sleeves that are easier to slip on and wear than an Ace bandage:
- A “Heelbo” is a knitted sleeve with a built-in elbow pad.
- An elastic or neoprene knee sleeve or wrap without the hole over the kneecap.
- There are many styles on the market; big drugstores and Wal-Mart have a good selection, or go online. If it’s comfortable and compresses/cushions the swollen area, it’s a good one. Not so tight that it causes swelling in your hand or foot!
- Wear it most of the time until the swelling is gone, even while sleeping.
- Ice pack applied over the wrap for 20 minutes, 3-4 times/day.
- Pad it when working on hard surfaces to prevent it from coming back.
- Make an appointment to have it drained if it looks infected or the swelling doesn’t go away after 2-3 weeks of compression.
- The area is cleaned with betadine and numbed with lidocaine.
- A needle is inserted into the swollen bursa to remove the fluid. It might be normal, clear, yellowish bursal fluid; blood; or pus. If it looks like infection or gout, the fluid will be sent to the lab and an antibiotic might be prescribed.
- Usually, this empties and flattens the bursa. The skin might still look a little puffy from being stretched; this will resolve.
- Unless it’s infected, cortisone will be injected into the bursa to quiet inflammation for the long-term.
- Keep your elbow/knee wrapped with the Ace bandage or sleeve for 5 days of compression after it’s drained (you can remove the wrap to shower, but wear it most of the time for 5 days to help it rest.)
- After 5 days, you can wrap it less often, but avoid leaning directly on the bursa.
- The drainage/cortisone can be repeated 1-2 times, but if it keeps coming back, it might be time for surgery.
- Outpatient, with general anesthesia (asleep), takes less than 1 hour. At Westfall or Rochester Ambulatory Surgery Centers.
- An incision is made over the bursa, which is removed (it looks like a little water balloon.) Any bone spurs on the olecranon or kneecap will be smoothed. The skin is closed with stitches and a thick gauze dressing is applied under an Ace bandage.
- It’s important that the surgical site stay quiet and protected for the first week to help it heal properly. Your elbow will be placed in a long-arm splint from armpit to palm; your knee in a long brace called an immobilizer to keep it straight. You can bear full weight on your straight knee in the immobilizer, but might find a cane or crutches handy to avoid limping.
- After 1 week, the initial dressing is removed and you can start to move your elbow/knee. Keep it wrapped for compression until about 6 weeks postop and avoid direct pressure for up to 3-6 months as the tissue heals.
- The bursa grows back as a non-inflamed, normally functioning bursa over several months. Recurrence after surgery is rare.
- Time out of work after surgery depends on the type of work that you do. Patients with a desk job can go back to the office within a few days if they can avoid using the surgical site. If you have a physically heavy job, or need to use your elbow or knee, you could be out for up to 6 weeks. Talk to your employer about this, and ask about returning to work with restrictions for the first few weeks.