Physical Therapy Guide to Elbow Bursitis
Elbow (olecranon) bursitis, commonly known as "baker's elbow," "student's elbow," or "Popeye elbow," involves swelling at the tip of the elbow, on the back of the arm. The condition can be painless, or it can be painful at rest and when leaned on, as when writing with the arm pressing on a table. Elbow bursitis can have many causes, but the most common is trauma, whether a direct hit, or smaller bumps or pressure applied over time. Elbow bursitis is commonly seen in students or office workers who lean their elbows on hard desks or armrests for long periods of time; however, its occurrence is not related to any particular age or ethnic group. The condition can also be caused by infection or autoimmune conditions. Sometimes, however, a specific cause cannot be determined. Physical therapists treat individuals with elbow bursitis to reduce their pain, swelling, stiffness, and any associated weakness in the elbow or upper extremity.
What is Elbow Bursitis?
Elbow bursitis (also called olecranon bursitis) occurs when the bursa (a fluid-filled sac on the tip of the elbow) becomes damaged, irritated, or inflamed. Normally, the bursa acts as a cushion for the tip of the elbow (ulna) bone. Certain types of pressure, traumatic blows, or repetitive motions can cause constant friction or irritation of the bursa, leading to the development of bursitis ("itis" means "inflammation of"). When the bursa becomes injured, it can swell and become painful.
Elbow bursitis can be caused by:
- Repetitive motions (playing sports, such as tennis or golf; prolonged leaning on the elbows, as when typing on a computer keyboard)
- Direct trauma (being hit or falling on the tip of the elbow)
- Elbow surgery or replacement
- Autoimmune conditions
How Does It Feel?
With elbow bursitis, you may experience:
- Swelling on the tip or back of the elbow
- Redness on the tip of the elbow
- Pain when you push with your fingers on the tip of the back of the elbow
- Pain when leaning on the arm, as when the arm is resting on an armrest or on the edge of a desk or table
- Stiffness in the elbow joint, and difficulty bending the elbow
How Is It Diagnosed?
If you see your physical therapist first, your physical therapist will conduct a thorough evaluation that includes taking your health history. Your physical therapist will also ask you detailed questions about your injury, such as:
- How and when did you notice the swelling and/or pain?
- Have you been performing any repetitive activity?
- Did you receive a direct hit to the elbow, fall on it, or lean on it for a long period of time?
Your physical therapist also will perform special tests to help determine the likelihood that you have elbow bursitis. Your physical therapist will gently press on the back side of the elbow to see if it is painful to the touch, and may use additional tests to determine if other parts of your elbow are injured. Your therapist also will observe how you can move your elbow and arm, and test your strength and flexibility.
Your physical therapist will test and screen for other, more serious conditions that could cause elbow pain or swelling. To provide a definitive diagnosis, your physical therapist may collaborate with an orthopedic physician or other health care provider, who may order further tests, such as an x-ray to confirm the diagnosis and to rule out other damage to the elbow, such as a fracture or infection.
How Can a Physical Therapist Help?
Your physical therapist will work with you to design a specific treatment program that will speed your recovery, including exercises and treatments that you can do at home. Physical therapy will help you return to your normal lifestyle and activities. The time it takes to heal the condition varies, but results can be achieved in 2 to 8 weeks or less, when a proper swelling management, stretching, and strengthening program is implemented.
During the first 24 to 48 hours following your diagnosis, your physical therapist may advise you to:
- Apply light compression by wrapping the elbow a specific way, using a compressive wrap.
- Rest the area by avoiding any activity that causes pressure or pain on the elbow.
- Apply ice packs to the area for 15 to 20 minutes every 2 hours.
- Consult with a physician for further services, such as medication or diagnostic tests.
Your physical therapist will work with you to:
Reduce Pain and Swelling. If repetitive activities have caused the elbow bursitis, your physical therapist will help you understand how to avoid or modify the activities, to allow healing to begin. Your physical therapist may use different types of treatments and electrothermal modalities to control and reduce your pain and swelling
Improve Motion. Your physical therapist will choose specific activities and treatments to help restore normal movement in the elbow and arm. These might begin with "passive" motions that the therapist performs for you to gently move your elbow joint, and progress to active exercises and stretches that you do yourself.
Improve Flexibility. Your physical therapist will determine if any of your arm muscles are tight, start helping you to stretch them, and teach you how to stretch them.
Improve Strength. If your physical therapist finds any weak or injured elbow muscles, your therapist will choose, and teach you, the correct exercises and equipment to steadily restore your strength and agility.
Improve Endurance. Restoring your arm's muscular endurance is important after an injury. Your physical therapist will develop a program of activities to help you regain the endurance you had before the injury, so you can return to doing the things you like to do.
Learn a Home Program. Your physical therapist will teach you strengthening and stretching exercises to perform at home. These exercises will be specific for your needs; if you do them as prescribed by your physical therapist, you can speed your recovery.
Return to Activities. Your physical therapist will discuss your activity goals with you and use them to set your work, sport, and home-life recovery goals. Your treatment program will help you reach your goals in the safest, fastest, and most effective way possible. Your physical therapist will teach you exercises, work retraining activities, and sport-specific techniques and drills to help you achieve your goals.
Speed Recovery Time. Your physical therapist is trained and experienced in choosing the best treatments and exercises to help you safely heal, return to your normal lifestyle, and reach your goals faster than you are likely to do on your own.
If Surgery Is Necessary
Surgery is not commonly required for elbow bursitis, but if surgery is needed, you will follow a recovery program over several weeks, guided by your physical therapist. Your physical therapist will help you minimize swelling and pain, regain motion and strength, and return to normal activities in the safest and speediest manner possible.
Can This Injury or Condition Be Prevented?
Your physical therapist can recommend a home program to help prevent elbow bursitis. It may include strength and flexibility exercises for the arm muscles.
To help prevent a recurrence of the injury, your physical therapist may advise you to:
- Avoid leaning on your elbow as much as possible.
- Use a wrist guard/pad on your desk to cushion your elbow when you do lean on it.
- Use a proper typing arm position that does not involve leaning on the elbows.
- Avoid hard hits or prolonged pressure to the tip of the elbow.
- Use elbow pads during sports or other physically challenging activities to protect your elbow.
- Follow a consistent flexibility and strengthening exercise program, especially for the elbow muscles, to maintain good physical conditioning, even in a sport's off-season.
- Always warm up before starting a sport or heavy physical activity.
- Gradually increase any athletic activity, rather than suddenly increasing the activity amount or intensity.
Real Life Experiences
Betsy is a 50-year-old administrative assistant. Recently, she received a particularly long data-entry assignment on short notice. She focused on finishing it in 2 long days of typing. At the end of the first day, the tips of her elbows were hurting a bit, especially when she leaned on the wooden arm rests on her chair. She chose to ignore the pain, and completed her assignment on time. When she got up the next morning, however, she noticed that the tip of her right elbow was quite swollen. She tried rubbing it and found it was tender to the touch. She called her physical therapist.
Betsy's physical therapist asked her if she had recently fallen or been hit on her elbow. She said no, but told him how she had leaned her elbows on her hardwood desk and chair for 2 solid days, while getting the data-entry project done.
He gently felt the swollen area and measured it. He tested the motion of the elbow, and the strength and flexibility of the muscles of the arm. He concluded that Betsy had elbow (olecranon) bursitis, an inflamed bursa on the elbow that was irritated from the prolonged pressure of leaning on it on a hard surface. Betsy also had some muscle weakness and loss of motion around the same area.
Betsy's physical therapist asked her about her goals. She replied that she wanted to get rid of the swelling and pain, and be able to fit her arm in the narrow sleeve of a gown she planned to wear in 2 weeks for a formal dinner. She also wanted to learn how to prevent the swelling from happening again.
Betsy’s physical therapist began her treatment by gently massaging the swollen area in a specific way to help reduce the swelling. He applied a short course of ultrasound therapy to the swollen area. Next, he applied ice and electrical stimulation to the area to help halt and reverse the inflammation process. He discussed with Betsy the importance of “relative rest” for the elbow area, meaning she should avoid leaning on the elbow, or bumping it against any hard objects, until the swelling had resolved. Before Betsy left the office, he applied a tubular elastic compressive bandage that provided general compression to the entire elbow area. He instructed her to wear it day and night, except when showering.
When Betsy returned for her next treatment a couple of days later, the swelling was reduced by half. Her physical therapist noted that her elbow movement was improved as well. He started teaching Betsy strengthening exercises for the muscle weakness he had found in her arm muscles. Only stretch bands were used at first, but as Betsy improved, hand weights were added and their weight steadily increased. He also taught Betsy some simple stretches to do at home. He continued to apply the ultrasound, electrical stimulation, and ice for 1 week. Betsy continued to use the compressive bandage most of the day. At her physical therapist's suggestion, Betsy purchased a long wrist pad for her desk, which she could lean her elbows on. She also learned to not lean on her elbows as much while typing throughout the day.
Two weeks after the swelling started, Betsy’s elbow looked almost normal, and her pain was infrequent. Her physical therapist instructed her to stop using the tubular compressive bandage. He said he would see her 1 more time the following week to check on her progress, and then would discharge her from clinical care.
On the evening of her big formal dinner, Betsy was able to wear her gown with no difficulties or pain. She was happy to tell her friends that, thanks to her physical therapist's guidance, she was now able to work at her keyboard without causing any pain or swelling in her elbow.
What Kind of Physical Therapist Do I Need?
All physical therapists are prepared through education and experience to treat elbow bursitis. However, you may want to consider:
- A physical therapist who is experienced in treating people with orthopedic injuries. Some physical therapists have a practice with an orthopedic focus.
- A physical therapist who is a board-certified clinical specialist, or who completed a residency or fellowship in orthopedic or sports physical therapy. This therapist has advanced knowledge, experience, and skills that may apply to your condition.
You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.
General tips when you're looking for a physical therapist (or any other health care provider):
- Get recommendations from family and friends or from other health care providers.
- When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping people who have your type of injury.
- During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.
The American Physical Therapy Association (APTA) believes that consumers should have access to information that could help them make health care decisions and also prepare them for their visit with their health care provider.
The following articles provide some of the best scientific evidence related to physical therapy treatment of elbow bursitis. The articles report recent research and give an overview of the standards of practice both in the United States and internationally. The article titles are linked either to a PubMed* abstract of the article or to free full text, so that you can read it or print out a copy to bring with you to your health care provider.
Blackwell JR, Hay BA, Bolt AM, Hay SM. Olecranon bursitis: a systematic overview. Shoulder & Elbow. 2014;6(3):182–190. Free Article.
Sayegh ET, Strach RJ. Treatment of olecranon bursitis: a systematic review. Arch Orthop Trauma Surg. 2014;134(11):1517–1536. Article Summary in PubMed.
Herrera FA, Meals RA. Chronic olecranon bursitis. J Hand Surg Am. 2011;36(4):708–709. Article Summary in PubMed.
* PubMed is a free online resource developed by the National Center for Biotechnology Information (NCBI). PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine’s MEDLINE database.
Authored by Andrea Avruskin, PT, DPT. Reviewed by the editorial board.