Student’s Elbow - Causes, Symptoms, and Treatment

What Is a Student's Elbow?

Student's elbow, also called olecranon bursitis, is characterized by pain, swelling, and redness around the olecranon caused by inflammation of the elbow's bursa (a small sack between the bone and the skin). The olecranon bursa is located over the tip of the elbow. It contains fluid that lubricates tissues gliding under the skin.

The fluid is easily prone to develop injury and then becomes prominent. Damage can occur due to a single injury to the elbow or, more commonly, repeated minor injuries. Also, repetitive movement to the joint can be a possibility of developing the condition in the older population. In some people, this condition is seen as associated with gout and can be caused by the inflammation occurring in gout when fluid is produced.

An infection of the olecranon bursa, known as an infected bursa, differs significantly from an uninfected olecranon bursa. It appears as a large sac of fluid that may be annoying due to the weight of the lump and its appearance. In infected conditions, the whole arm can get quite red and be painful, which requires antibiotics, rest, and elevation. In severe cases, hospitalization may also be needed.

What Is the Cause of a Student's Elbow?

Student's elbow may be caused due to multiple causes like,

• Repeated Injury - Minor, repeated injury is one of the major causes of olecranon bursitis; people who lean on their elbows often can produce repeated mild injury and friction over the olecranon.

• Over Training or Use of Elbow - Olecranon bursitis is commonly seen in athletes due to repetitive elbow movements during sports activity. For instance, it is common in athletes involved in sports like throwing by raising the arm above the head, such as weightlifters and cricketers.

• Arthritis - Due to generalized arthritis, bursae may become inflamed. Types of arthritis associated with bursitis include rheumatoid arthritis, ankylosing spondylitis, and gout.

• Infection of a Bursa - A wound or cut in the skin over a bursa can cause infection of the bursa when there is a germs involvement. Some conditions can worsen the infection, such as diabetes, or when the immune system does not work as well as expected.

Injuries such as a blow to the back of the elbow can lead to bursitis inflammation.

• Occupational - This condition is noted in some people involved in gardening, carpentry, painting, shoveling, and skiing.

• Idiopathic or Unknown Causes - No apparent reason is known in many cases of olecranon bursitis. However, it can be due to a mild injury that has been forgotten.

What Are the Symptoms of a Student's Elbow?

• Patients usually present with a focal swelling at the posterior elbow, which is mostly painless.

• A typical symptom of a student's elbow is the frequent bumping of the swollen elbow as it protrudes further than normal.

• The pain usually will be aggravated by pressure, like the elbow rubbing against a table, while activities like writing or leaning on the elbow exacerbate the pain.

• Tenderness on palpation at the affected site. If the infection is present, it may show a red affected area and warmth in the elbow.

• If the student's elbow occurs due to the trauma that has recently happened, the skin over the elbow may reveal an abrasion or contusion.

• Typically, the range of motion of the affected elbow remains within the normal range; however, in some instances, there may be a slight limitation in the end range of elbow flexion as a result of pain.

• Also, in patients with elbow pain during active or passive range of motion with a history of trauma, it may increase the clinical suspicion of a fracture in the olecranon process.

• In patients with conditions like rheumatoid arthritis, gout or pseudogout may also show focal inflammation at other sites. Such as, rheumatoid arthritis patients may present with rheumatoid nodules on inspection.

• Patients presenting with an advanced infection can have a fever.

How Is Student's Elbow Diagnosed?

Generally, a student's elbow is very evident in its appearance. However, thorough examinations and history are required to differentiate from other conditions. Laboratory tests are necessary to determine septic from non-septic bursitis, so the aspirate collected should be sent for microscopy and culture. In cases where the diagnosis is uncertain, it is advisable to administer treatment similar to that for a septic case until the culture results become available.

What Is the Treatment for a Student's Elbow?

In most cases, a student's elbow does not require any treatment, as it resolves independently with simple care, like providing adequate rest to the elbow, avoiding pressure on the elbow, and applying ice packs. A compression bandage on the elbow is also beneficial and makes it more comfortable. If there is no infection, then over time, most cases of student's elbow will settle on their own. Treatment options for advanced cases include:

1) Non-Surgical Treatment:

• Anti-inflammatory Medication - To reduce pain, discomfort, and swelling, medications such as Ibuprofen, Diclofenac, or Paracetamol may be prescribed.

• Antibiotics - In case of infection of bursitis, antibiotics may be prescribed. Generally, an antibiotic such as Flucloxacillin or Erythromycin, till the aspirated fluids test results are available. After getting the test results, the treatment choice may be changed depending on the causative bacteria.

• Aspiration of the Bursa - The fluid in the bursa is drained by professionals using an 18-gauge needle. A mixture of 80 mg (milligram) Methylprednisolone and 2 percent Lidocaine is injected into the elbow joint and drained. After the procedure, a gauze dressing is done, followed by applying an elbow brace or tensor bandage for 3 to 6 months.

• Steroid Injection - A steroid injection into the bursa helps reduce the pain and inflammation in the elbow. However, it sometimes causes infection in the bursa.

2) Surgical Treatment

• Surgery for Infected Bursa - If there is no improvement with antibiotics or by removing fluid from the elbow in the infected bursa patients, then surgery may be recommended to remove the entire bursa. The bursa usually grows back, and the patient can perform normal functions after a few months.

• Surgery for Non-Infected Bursa - If nonsurgical treatments did not work in patients with noninfected students' elbows, then surgical options should be considered. In such cases, surgery to remove the bursa is usually recommended. The surgery does not disturb any muscle, joint structures, or ligaments.

Conclusion:

Student's elbow, also called olecranon bursitis, is a condition caused by the inflammation of the elbow bursa. The symptoms involve mild pain and swelling of the elbow joint. In some severe cases, the range of motion may be affected. Infection of the joint may occur, leading to severe pain. The treatment involves rest, cold compression, and avoiding pressure on the elbow region. However, in some cases, medical attention and surgery may be needed, thus improving the patients condition.