Have you ever heard of the term ” Students elbow? “

Student’s elbow, also known as elbow bursitis, is a condition characterized by the inflammation of the olecranon bursa. This bursa is a small, fluid-filled sac located at the bony prominence (olecranon process) at the back of the elbow. It acts as a cushion, to facilitate smooth movement between the skin and the olecranon during bending and straightening of the arm.

The term “student’s elbow” stems from the common practice among students of resting their elbows on hard surfaces for prolonged periods while studying or writing. This repetitive pressure will irritate the olecranon bursa, leading to the condition. However, it’s not exclusive to students; individuals in occupations or activities that involve frequent elbow pressure—such as miners, plumbers, mechanics, and athletes—are also at risk.

When the olecranon bursa becomes irritated and inflamed, it leads to noticeable swelling at the back of the elbow, accompanied by mild to significant pain. If the bursa becomes infected by bacteria entering through a cut, scrape or insect bite, it will lead to an infection and cause redness and warmth at the back of the elbow.

To understand elbow bursitis, it’s helpful to review the anatomy of the elbow. The elbow is a hinge joint that allows you to bend and straighten your arm.

The elbow is formed by the articulation of three bones:

• Humerus – The bone of the upper arm.
• Radius – The forearm bone, located on the thumb side.
• Ulna – The forearm bone, located on the pinky side.

At the back of the elbow is the Olecranon, the prominent pointy bone you can feel when your elbow is bent. The Triceps Brachii Tendon, which helps straighten the arm, attaches to the Olecranon. Surrounding the elbow joint are several bursae—small, fluid-filled sacs that act as cushions to reduce friction between soft tissue structures. The most clinically significant of these is the olecranon bursa, located between the olecranon process and the overlying skin.

Other, less commonly affected bursae around the elbow include:

• Bicipitoradial bursa – Located between the Biceps Brachii Tendon and the Radial Tuberosity.
• Interosseous bursa – Located between the Radius and Ulna near their upper connection. It rarely causes clinical problems.
• Sub-tendinous bursa– Located between the Triceps Brachii Tendon and the Olecranon.

Among all these, the olecranon bursa is the most frequently affected due to its superficial location and vulnerability to trauma.

The bursa located at your elbow joint play a key role in reducing friction between the bones and surrounding soft tissue structures, such as skin, muscles, ligaments, and tendons to enable efficient and pain-free joint movement. By acting as cushions, they allow these tissues to glide smoothly over the hard surfaces of bones, helping to absorb shock and prevent injury during movement or impact. They help distribute pressure and absorb impacts, protecting underlying tissues from mechanical stress.

The term bursitis implies that their is inflammation inside the bursa. When the bursa gets irritated, the sac fills up with additional fluid. This leads to pain, swelling, and limited movement of your elbow joint.

Aseptic (Non-infected) bursitis

The process begins with some form of trauma, repetitive pressure or overuse. The body responds to an injury by increasing blood flow to the affected area. The walls of the small blood vessels in the bursa become more permeable. This allows fluid and proteins to leak out of the blood vessels and into the bursa itself. The bursa, which normally contains a minimal amount of fluid, expands significantly. This causes the visible swelling at the back of the elbow. The swelling itself will cause pressure on nerve endings, and the chemical mediators released during inflammation directly stimulate pain receptors. This results in the tenderness and pain associated with bursitis, especially when pressure is applied or the elbow is moved. The combination of pain and swelling can limit the range of motion of the elbow joint. The discomfort makes it difficult to bend or straighten the arm fully, thus impairing its normal function.

Chronic bursitis

When inflammation persists or recurs frequently, the bursa becomes chronic . This prolonged inflammation will lead to thickening of the bursa walls, reduced joint mobility, and muscle weakness. If left untreated, chronic bursitis can result in lasting joint stiffness and increased susceptibility to further flare-ups.

Septic (Infected) bursitis

Septic bursitis occurs when a bursa becomes infected with bacteria entering through an injury (cut, scape, insect bite) leading to intensified inflammation and swelling. This condition is potentially serious and requires prompt medical attention. Treatment typically involves the use of antibiotics to combat the infection, and in some cases, procedures such as aspiration to remove infected fluid or surgical drainage may be necessary to prevent complications.

• Falling on your elbow

• Hitting your elbow on a hard surface.
• Frequent bumping of the elbow.
• Repetitive pressure added to the elbow when rubbing it against a table while writing.
• Leaning for a prolonged period on your elbow.
• History of repetitive microtrauma to the elbow.
• Repetitive flexion / extension movement of the elbow.
• Infection due to bacteria entering the skin when you cut or scrape yourself.
• Medical conditions, such as Rheumatoid Arthritis or Gout.

The severity of your elbow bursitis can range from mild to severe, depending on several factors:

Cause

Aseptic ( Non-infected) bursitis is generally milder, especially in the early stages, but it can worsen with repeated trauma or prolonged irritation. Septic (Infected) bursitis is considered more serious if left untreated, due to the risk of the infection spreading to nearby joints, soft tissues, and even the bloodstream. Therefore, it requires immediate medical attention.

Symptoms

Mild bursitis involves minimal swelling and discomfort, with no restriction in elbow movement. Moderate cases present with noticeable swelling and pain, especially when pressure is applied or the elbow is bent, often accompanied by some movement limitations. Severe bursitis is characterized by intense pain, significant swelling and considerable restriction in elbow mobility. Septic bursitis may also include fever and other signs of systemic infection.

Progression

Elbow bursitis can result from a single traumatic event or develop gradually over time due to repetitive stress or ongoing inflammation. In cases where infection is involved, symptoms tend to progress more rapidly and require urgent care.

Our physiotherapists are confident, proficient, and highly trained in diagnosing and managing elbow bursitis. We conduct thorough musculoskeletal assessments, beginning with a detailed patient history. This includes questions about how your symptoms began, any prior injuries, activities that aggravate or relieve your pain, and the specific nature of your symptoms—such as pain, swelling, or stiffness.

A comprehensive physical examination follows, during which we assess your elbow for signs of muscle weakness, neurological involvement, and other contributing factors. Our experienced clinicians are skilled at ruling out related conditions such as elbow fractures, tendinitis, ligament sprains, or referred pain from the neck.

We follow a structured diagnostic process to determine the severity of your condition and prioritize your treatment needs. This includes evaluating potential injuries to surrounding structures such as ligaments, muscles, nerves, cartilage, or the joint itself—ensuring no underlying issue goes undetected.

Understanding the stages of physiological healing allows us to create a personalized treatment plan tailored to your recovery. By accurately identifying the extent of tissue damage, we guide you through a safe, effective rehabilitation program—helping you heal faster and return confidently to the activities you love.

This level of care is what sets our physiotherapists apart in diagnosing and treating elbow bursitis with precision and compassion.

X-rays are not typically required to diagnose elbow bursitis, as it is a soft tissue structure.

However, your Physiotherapist may recommend one if there is a suspicion of a fracture, concerns about bone spurs, calcifications, or to rule out other elbow joint issues.

Diagnostic Ultrasound is the preferred imaging modality for evaluating elbow bursitis due to visualizing the bursa and surrounding soft tissues itself.

If you need an ultrasound, your physio will refer you.

MRI provides detailed images of soft tissues and bones in your elbow. It is generally not the first-line imaging study for typical elbow bursitis due to its higher cost and longer acquisition time.

If your physiotherapist suspects anything more than just a Bursitis, you will be referred to the right specialist.

It’s frustrating when your elbow bursitis doesn’t go away as expected. Several reasons could explain why you’re still experiencing symptoms:

Inadequate rest:

The bursa needs time to heal. If you’re not sufficiently resting your elbow and avoiding activities that put pressure on it, the inflammation will persist. Returning to normal activities before the bursa has fully recovered will re-aggravate the condition.

Persistent irritation:

You are engaging in activities that continue to irritate the bursa, such as leaning on your elbow frequently. Repetitive pressure on the elbow will keep the bursa inflamed.

Underlying medical conditions:

Rheumatoid Arthritis or Gout causes inflammation in various bursae, including the elbow bursa. If the underlying arthritis isn’t well-managed, the bursitis will persist.

Infection:

If the bursitis is due to an infection, it won’t resolve with rest alone. It requires Antibiotics to clear the infection and It’s crucial to complete the entire course of antibiotics to ensure the infection is fully cleared.

Waiting too long to seek medical assistance

Waiting too long to seek medical assistance for your condition will delay the healing process and time. It will lead to worsening of the condition and become harder to treat. Without early intervention, the body may have persistent flare- ups and this will lead to thickening of the bursa wall, causing chronic bursitis. Early diagnosis and treatment will lead to faster healing, prevent secondary issues, and support a quicker return to normal function.

Trying out other forms of treatment

Initially, anti-inflammatory medications or cortisone injections may help reduce swelling and ease your pain during the acute phase. However, these treatments only mask the symptoms and may delay true healing. To effectively address your elbow bursitis, it’s important to take a broader approach and identify the underlying factors contributing to the condition.

Resting too much or too little

The key is to find balance between rest and activity. Staying immobile for too long will cause the affected joint to become stiff and weaker. Excessive movement will increase friction between the bursa and surrounding soft tissues, potentially worsening and prolonging your symptoms.

We as Physiotherapists play a vital role in the conservative management of both Aseptic (non- infected) and Septic (Infected) elbow bursitis. Our primary goal is to reduce pain and swelling, restore normal movement and function, and prevent future flare-ups. We provide the most effective treatments for elbow bursitis. With a well-structured and comprehensive treatment plan, we target your recovery goals to ensure the best possible outcome.

Elbow bursitis is typically treated conservatively. In the initial stages, we recommend applying the POLICE method—Protect, Optimal loading, Ice, Compression, and Elevation—to manage symptoms. During treatment sessions, we use electrotherapy modalities such as ultrasound, TENS (Transcutaneous Electrical Nerve Stimulation), and interferential therapy to help reduce pain and inflammation.

We incorporate gentle soft tissue techniques around the elbow and forearm to reduce stiffness and improve fluid drainage. Additionally, we guide you through both active and passive exercises to restore full elbow mobility.

As part of your recovery, we’ll provide stretching and strengthening exercises tailored to your phase of healing, targeting muscle tightness, limited movement, stability, and support.

As experts, we also help you identify activities that may be contributing to your bursitis and offer guidance on how to modify them. We work to prevent future episodes of olecranon bursitis by helping you understand what to avoid and how to protect your elbow.

The healing time for elbow bursitis varies depending on the cause, severity, and treatment approach:

Aseptic (Non-infected) bursitis:

You can expect to improve significantly within 3-6 weeks with proper rest and conservative treatment if your bursitis is considered mild. However, If the aggravating factors are not eliminated, it will take weeks to months for the swelling and pain to fully subside. Aspiration and/or corticosteroid injection can provide more rapid relief, and improvement will be seen within a few days to a couple of weeks. However, it’s crucial to continue with activity modification and avoid re-irritation. Chronic elbow bursitis can be a recurring issue and may take weeks to months to manage with conservative treatment. Sometimes, the fluid may come and go with activity levels.

Septic (Infected) bursitis:

The healing time depends on how quickly the infection is diagnosed and treated with antibiotics. You will start feeling better as soon as you begin taking antibiotics. It’s crucial to complete the entire course of antibiotics (usually around a week) to ensure the infection is fully cleared. Healing can still take several weeks even after the infection is under control, as the inflammation needs to resolve.

Bursectomy:

A Bursectomy is the removal of the bursa. Recovery after a Bursectomy typically takes about a month. The skin heals within 12 to 16 days. By 3 to 4 weeks post-surgery, most patients will resume normal elbow function. A splint or brace is often required during the initial recovery period to support the joint, followed by a structured rehabilitation program to restore strength and mobility. Over the next few months, a new, healthy bursa generally forms.

Aseptic (Non-infected) bursitis:

When the bursa becomes infected and doesn’t get better with antibiotics or fluid drainage, surgery is often required to completely remove your bursa (a procedure called a Bursectomy). This surgery is usually an inpatient procedure and requires staying overnight in the hospital. After the procedure, additional antibiotics may be prescribed, to fully treat the infection. After the surgery, Physiotherapy is necessary to help restore movement and strength in the elbow. Over the next few months, the bursa grows back and begins to function normally again, without inflammation.

Septic (Infected) bursitis:

If your elbow bursitis is not due to an infection, surgery may still be needed if nonsurgical treatments do not work. In this case, surgery to remove the bursa is performed as an outpatient procedure and does not require overnight hospital stay.