It may help if we explain a bit about elbow bursitis (also known as olecranon bursitis). A bursa is a sac made of thin, slippery tissue. Bursae (plural) occur in the body wherever skin, muscles, or tendons need to slide over bone. Bursae are lubricated with a small amount of fluid inside that helps reduce friction from the sliding parts.
The olecranon bursa is located between the tip, or point, of the elbow (called the olecranon) and the overlying skin. This bursa allows the elbow to bend and straighten freely underneath the skin. Treatment may depend on what is causing the bursitis.
In some cases, a direct blow or a fall onto the elbow can damage the bursa. This usually causes bleeding into the bursa sac, because the blood vessels in the tissues that make up the bursa are damaged and torn. In the skin this would simply form a bruise, but in a bursa blood may actually fill the bursa sac. This causes the bursa to swell up like a rubber balloon filled with water.
The blood in the bursa is thought to cause an inflammatory reaction. The walls of the bursa may thicken and remain thickened and tender even after the blood has been absorbed by the body. This thickening and swelling of the bursa is referred to as (acute) olecranon bursitis.
Chronic olecranon bursitis can also occur over a longer period of time. If you have had this problem for months to years, then it’s likely you have chronic elbow bursitis. People who constantly put their elbows on a hard surface as part of their activities or job can repeatedly injure the bursa.
This repeated injury can lead to irritation and thickening of the bursa over time. The chronic irritation leads to the same condition in the end: olecranon bursitis but there may no longer be an active inflammatory process going on.
Surgeons don’t rush in to treat chronic bursitis with aggressive treatment such as steroid injections or surgery. The risk of infection, skin problems, or creating a chronic draining opening outweighs the benefit of the treatment.
Aspirating (withdrawing fluid from) the joint can cause similar problems. Aspiration reduces the swelling and improves motion and function but the fluid may build up again, so it’s often a temporary solution.
Most patients are given advice about how to manage the problem with conservative (nonoperative) measures. It’s not likely you will hear anything different from another source. But seeking a second opinion often helps patients feel confident that everything possible is being done for their problem.