Olecranon bursitis is a relatively common condition that affects the back of the elbow. It occurs when the olecranon bursa, a small fluid-filled sac that sits over the bony tip of the elbow, becomes inflamed and swollen. This inflammation is often triggered by repeated leaning, prolonged pressure, or direct trauma to the elbow, although it can also develop due to infection or underlying medical conditions.
The role of the bursa is to reduce friction and act as a cushion between the skin, soft tissues, and the olecranon process of the ulna (the pointy bone you can feel at the back of your elbow). When this bursa becomes irritated, it can fill with excess fluid, leading to visible swelling that is often described as looking like an “egg” sitting on the elbow.
Olecranon bursitis can affect people of all ages and activity levels. It is seen in office workers who lean on desks, tradespeople who work in confined spaces, and athletes involved in contact sports or activities that place repeated load through the elbows. Physiotherapy for olecranon bursitis plays a key role in reducing pain and swelling, restoring elbow movement, and preventing recurrence by addressing contributing factors such as pressure, movement patterns, and strength deficits.
Key Facts
- Olecranon bursitis accounts for a significant proportion of superficial bursitis cases due to the exposed position of the elbow tip.
- Most cases of non-infectious olecranon bursitis resolve with conservative management, including physiotherapy, within 3–6 weeks.
- Olecranon bursitis is associated with systemic inflammatory conditions such as gout and rheumatoid arthritis.
Risk Factors
- Prolonged pressure on the elbows during work or study
- Occupations requiring leaning on elbows in confined spaces
- Contact or collision sports
- Repetitive floor-based exercises such as planks
- History of elbow trauma
- Gout or rheumatoid arthritis
- Skin breaks or wounds near the elbow
Symptoms
- Visible swelling over the tip of the elbow
- A soft or firm lump that may resemble an egg over the elbow
- Localised tenderness when pressure is applied
- Redness and warmth if inflammation is significant
- Pain, particularly when leaning on the elbow
- Reduced range of motion of the elbow in more severe cases
- Increased pain, heat, or redness if infection is present
Aggravating Factors
- Leaning on the elbows on hard surfaces such as desks or tables
- Repetitive pressure through the elbow during work or study
- Direct impact or falls onto the elbow
- Prolonged plank holds or floor-based exercises
- Contact sports involving collisions or tackles
- Poor protective strategies during kneeling or crawling tasks
Causes
Olecranon bursitis develops when the elbow bursa becomes irritated and produces excess fluid. The most common cause is prolonged or repetitive pressure, such as resting the elbows on a hard surface for extended periods. Over time, this repeated compression leads to inflammation of the bursa.
Acute trauma is another frequent cause. A direct blow or fall onto the back of the elbow can trigger a rapid inflammatory response, causing the bursa to swell as it attempts to protect the underlying bone. Sports injuries, collisions, or accidental impacts are common examples.
In some cases, olecranon bursitis is linked to systemic medical conditions such as gout or rheumatoid arthritis, where crystal deposition or inflammatory processes increase the risk of bursal irritation. Infection can also cause olecranon bursitis when bacteria enter the bursa through a cut, abrasion, or skin breakdown, leading to redness, warmth, pain, and sometimes pus formation.
Physiotherapists assess these contributing causes carefully, as identifying whether the bursitis is pressure-related, traumatic, inflammatory, or infectious guides appropriate management and referral.
How Is It Diagnosed?
Olecranon bursitis is primarily diagnosed through a clinical assessment. A physiotherapist or doctor will take a detailed history to understand the onset, aggravating factors, and any recent trauma or repetitive pressure. Visual inspection often reveals a localised swelling directly over the tip of the elbow, commonly described as an egg-shaped lump.
Palpation may identify tenderness, warmth, or fluctuance of the swelling. Range of motion testing assesses whether elbow movement is restricted due to pain or swelling. Signs such as redness, heat, and increasing pain raise suspicion of infection and require prompt medical review.
Physiotherapists play an important role in identifying mechanical and postural contributors while screening for red flags that may require further investigation or referral.
Investigations & Imaging
- Ultrasound
- Confirms the presence of a swollen bursa and helps distinguish bursitis from other soft tissue lumps.
- MRI
- Provides detailed imaging of the bursa and surrounding tissues if diagnosis is unclear or symptoms persist.
- X-ray
- Rules out fractures, bone spurs, or other bony abnormalities around the elbow.
- Blood tests
- Used to assess for infection or inflammatory markers if systemic involvement is suspected.
- Bursal aspiration
- A fluid sample may be taken to identify infection or crystal-related conditions such as gout.
Physiotherapy Management
Exercise
Physiotherapy for olecranon bursitis initially focuses on protecting the inflamed bursa, but as swelling settles, exercise becomes important. Gentle range of motion exercises help prevent elbow stiffness, particularly after periods of rest or immobilisation. Progressive strengthening of the forearm, upper arm, and shoulder muscles is introduced to support normal arm function and reduce excessive load through the elbow during daily tasks.
Activity Modification
Physiotherapists provide specific advice on avoiding prolonged elbow pressure, such as changing desk setup, using padded supports, and modifying exercise positions. For olecranon bursitis, reducing direct compression is critical for recovery and preventing recurrence.
Manual Therapy
Hands-on techniques may be used to address surrounding muscle tightness and joint stiffness that develop due to protective movement patterns. Manual therapy is carefully applied to avoid further irritation of the bursa.
Postural Retraining
Poor upper limb and desk posture can increase elbow loading. Physiotherapy addresses sitting, working, and exercise posture to minimise repeated pressure on the olecranon region.
Bracing & Taping
Elbow padding or compression supports may be recommended to protect the bursa from further trauma and provide gentle compression to manage swelling during activity.
Dry Needling
If surrounding muscle tension is contributing to altered elbow mechanics, dry needling may be used as part of physiotherapy management, ensuring it is applied away from the inflamed bursa.
Heat & Ice
Ice is commonly used in the early stages of olecranon bursitis to reduce pain and swelling. Physiotherapists provide guidance on safe application.
Education
Education is central to olecranon bursitis rehab. Patients are taught how to offload the elbow, recognise early signs of flare-ups, and gradually return to normal activities safely.
Other Treatments
Medical management may include aspiration of the bursa to reduce swelling and pain. If infection is confirmed, antibiotics are prescribed by a general practitioner or specialist. Corticosteroid injections are used cautiously due to the superficial nature of the bursa and infection risk.
Surgery
Surgery is rarely required for olecranon bursitis. It may be considered if symptoms persist despite appropriate conservative care or in recurrent cases. A bursectomy involves removing the inflamed bursa. Post-surgical physiotherapy is essential to restore elbow range of motion, rebuild strength, and prevent stiffness or functional limitations.
Prognosis & Return to Activity
The prognosis for olecranon bursitis is generally good. Most non-infectious cases resolve within 3–6 weeks with appropriate physiotherapy management and activity modification. Return to work and sport depends on symptom resolution and the ability to avoid aggravating pressure. Physiotherapy supports a graded return to activity while minimising recurrence risk.
Complications
- Infection of the bursa
- Chronic swelling
- Reduced elbow mobility
- Recurrent bursitis
- Pain with weight-bearing through the elbow
Preventing Recurrence
- Avoid prolonged leaning on hard surfaces with the elbows
- Use padded supports at desks or workstations
- Modify exercises to reduce direct elbow pressure
- Gradually return to sport after elbow injuries
- Manage underlying conditions such as gout with medical support
- Follow physiotherapy advice for load management and strengthening
When to See a Physio
- Swelling over the elbow that does not settle
- Pain when leaning on or moving the elbow
- Reduced elbow movement
- Recurrent episodes of elbow swelling
- Return to sport or work after elbow injury
- Ongoing discomfort despite rest