Elbow pain caused by bursitis and tendinitis is fairly common. Luckily, in most cases, the pain and dysfunction improve with a minimum amount of help. It is important to know, though, that these conditions need some patience, as improvement is usually gradual and happens over several weeks or months.
The olecranon is the tip of the forearm bone (the ulna) in the back of the elbow. It is a pressure point, and it is an area where the skin moves freely over the edge of the bone. The olecranon bursa is there to allow that motion without sloughing the skin. Too much friction, though, can irritate the bursa, and olecranon bursitis becomes a problem.
When present, the patient develops a swollen area on the back of the elbow. The patient may recognize that is a fluid filled sac. This sac may be painful. Many patient simply do not like the way it looks. It may get infected, in which case it becomes very painful, tender, red, and hot.
Treatment may consist of just leaving it alone, protecting the area with an elbow pad hoping that the fluid with absorb spontaneously, or trying anti-inflammatory medicines (NSAIDs). By the time the patient shows in an orthopedic clinic, he probably have already tried the above and failed to get it better. In this case, I would offer to drain the bursa, removing as much fluid as possible, and maybe inject some steroids in it. This may have to be repeated more than once, and sometimes I may try to scar the bursa on the inside using a sclerosing (scarring) agent. If all else fails, surgical removal may be necessary. In case the bursa is already infected, treatment usually involve immediate surgical removal as well and antibiotic treatment. Overall, olecranon bursitis is a benign condition. It is very important, though, to distinguish it from the less common triceps tendinitis, as the latter should not be treated with injections ( see below).
Tennis Elbow / Lateral Epicondylitis/ Extensor Tendinitis
Tennis elbow, also known as lateral epicondylitis, is truly tendonosis of the outer (lateral) side of the elbow, where the wrist and fingers muscles originate. This is a classic over-use condition. Also the name suggests a direct link to tennis players, most patients do not necessarily play tennis.
The main problem is a degenerative condition of the tendon/muscle origin. With repetitive micro-injury, and inability of the tendon to keep up, the tendon tissue simply degenerates, and become painful. Pain mostly occurs with gripping, lifting, and any activity that requires forceful wrist motion and grip. The resulting pain limits motion and may cause apparent weakness. The pain starts gradually and increases over several weeks.
Treatment consists of several parts. First, activity modification, when appropriate, is important to prevent further damage and control the pain. Second, I offer a forearm strap, to be applied just further down from the sore area, to shield it from the forces coming from the wrist. Anti-inflammatories can be helpful, although the condition is not really inflammatory. Physical therapy, including home-exercises, has been shown to be very useful as well. It aims at stretching and strengthening the muscle-tendon unit and control pain. Last, injections can very useful when indicated. In rare situations, surgery may be necessary when all options have been exhausted. It consists of removing the damaged part and repairing the rest of the tendon origin back together.
Golfer’s Elbow/ Medial Epicondylitis is a very similar, yet a lot less common condition that occurs on the opposite side (flexor side) of the elbow. The problem and the treatment plan is very similar as well.
Biceps and Triceps Tendinitis
Biceps tendinitis at the elbow should not be confused with that in the shoulder. It is a lot less common than the latter. It occurs more commonly in weight lifters and manual workers. The biceps tendon crosses in front of the elbow and, when irritated, causes deep pain especially when bending the elbow. Treatment consists of anti-inflammatories, activity modification, stretching/strengthening and sometimes physical therapy. There is no role for injections.
Triceps tendinitis is also not very common. The tendon lies on the back of the elbow and helps stretch out the elbow against a load, such as with lifting an object over head or pushing a load in front of you. Sometimes it is confused with olecranon bursitis. Treatment consists of anti-inflammatories, activity modification, stretching/strengthening and sometimes physical therapy. There is no role for injections. There has been reports of injections given for ‘bursitis’ causing triceps tendon rupture.