Olecranon bursitis is swelling of the bursa, a thin fluid-filled sac that sits between the skin and the bony point of the elbow (the olecranon). It often looks like a soft, golf-ball-sized lump on the back of the elbow. It can follow a fall onto the elbow, leaning on the elbow for long periods, or gout, and sometimes the bursa becomes infected (septic bursitis). Most cases settle without surgery.1,2
- A soft swelling over the point of the elbow, sometimes painful, often painless
- Common after a bump or fall, or with pressure from leaning on the elbow
- Redness, warmth, increasing pain or fever can mean infection and need prompt evaluation
- Non-surgical care (protection, compression, time) resolves most cases
- Surgery to remove the bursa is reserved for persistent or recurrent cases
Symptoms
- A soft, sometimes fluctuant swelling at the back of the elbow
- Tenderness when leaning on the elbow
- Usually full elbow motion, unlike problems inside the joint
- Signs of infection: spreading redness, warmth, increasing pain, a skin wound or scrape over the elbow, fever or chills
Causes
- A direct blow or fall onto the elbow
- Repeated pressure, for example leaning on a desk or in certain jobs and sports
- Inflammatory conditions such as gout or rheumatoid arthritis
- Infection, usually from bacteria entering through a small break in the skin
Diagnosis
The diagnosis is usually made by examination. If infection is suspected, fluid may be drawn from the bursa with a needle and tested. An X-ray can show a bone spur at the tip of the elbow or rule out a fracture after a fall.
Treatment
Non-infected (aseptic) bursitis: avoiding pressure on the elbow, an elbow pad, compression, ice and anti-inflammatory medicine when appropriate. Draining the fluid can help in selected cases and did not increase the risk of infection in a large review.1 Cortisone injection can shorten symptoms but carries risks such as infection and skin thinning, so it is generally reserved for stubborn cases.1,2
Infected (septic) bursitis: treated with antibiotics, often with drainage of the bursa. Severe infections or those that do not respond may need surgical drainage.
Surgery: removing the bursa (bursectomy) is considered when bursitis keeps coming back or does not settle. A review found that non-surgical care was generally more effective and safer than surgery, with surgery linked to more wound problems.1 Endoscopic (keyhole) bursectomy uses small incisions; a case series reported no recurrences or wound complications and high satisfaction.3
Recovery
Aseptic bursitis often settles over several weeks with protection. After bursectomy, the elbow is padded and protected while the skin heals, typically for a few weeks, before a return to leaning on the elbow and sport.
Frequently asked questions
Should I drain the fluid myself?
No. Puncturing the bursa at home can introduce infection. If it needs draining, it should be done in clinic with sterile technique.
How do I know if it is infected?
Spreading redness, warmth, increasing pain, a cut or scrape over the elbow, or fever are warning signs. Get seen promptly if you notice these.
Will it go away on its own?
Many cases of non-infected bursitis settle over weeks with protection and avoiding pressure, although swelling can come back.
Is a cortisone shot a good idea?
It can shorten symptoms, but it carries a higher risk of infection and skin thinning, so it is usually reserved for bursitis that has not settled with other treatment.
When is surgery needed?
Surgery is considered for bursitis that keeps returning, does not settle, or for some infections that do not respond to antibiotics and drainage.
Research cited on this page
- Sayegh ET, Strauch RJ. Treatment of olecranon bursitis: a systematic review. Arch Orthop Trauma Surg. 2014;134(11):1517-1536. PubMed
Based mainly on lower-level evidence, non-surgical management was more effective and safer than surgery. Cortisone injection for aseptic bursitis increased complications and skin atrophy; aspiration did not increase infection risk. - Kaur IP, Mughal MS, Aslam F, et al. Non-surgical treatment of aseptic olecranon bursitis: a systematic review. Reumatol Clin (Engl Ed). 2023;19(9):482-487. PubMed
Cortisone injection shortened symptoms but caused more complications (infection, skin atrophy), so it should be reserved for cases that do not respond to other treatment. - Simpson JR, Fagerberg A, Toledo R, Joyner PW. No wound healing complications or recurrences were seen and a high level of satisfaction was reported in patients who underwent endoscopic olecranon bursectomy for recalcitrant olecranon bursitis. Arthrosc Sports Med Rehabil. 2024;6(1):100832. PubMed
Case series: after endoscopic bursectomy for persistent bursitis, there were no recurrences or wound complications needing further surgery, and average satisfaction was 9.9 out of 10.
Medically reviewed by Andrew P. Dold, MD, FAOA, FAAOS, FACS, FRCSC. Last reviewed October 2026. This page is general information, not medical advice. Your own diagnosis and treatment plan depend on your exam and imaging.
