Elbow bursitis is an aseptic or infectious inflammatory process in the periarticular synovial sac. It can occur acutely, subacutely or chronically. A soft local seal appears in the area of the elbow joint. In the acute period, there is pain and signs of local inflammation. Chronic bursitis is characterized by minor or moderate pain and difficulty in movement in the absence of inflammation. With suppuration, swelling, sharp pains and signs of general intoxication appear. The diagnosis is made on the basis of clinical signs, if necessary, puncture, MRI and radiography are performed. Treatment of acute bursitis is conservative, chronic and purulent – operative.
Elbow bursitis is the most common type of bursitis. It can be aseptic or purulent, acute or chronic. It develops more often due to overload and microtrauma of the elbow joint. It is observed in athletes and people of heavy physical labor (miners), as well as in workers who are often forced to lean their elbows on the table. Mainly affects young and middle-aged patients, men suffer more often than women. Orthopedic traumatologists are engaged in the treatment of chronic aseptic bursitis, surgeons are engaged in the treatment of acute aseptic bursitis and purulent bursitis.
Elbow bursitis causes
The cause of chronic elbow bursitis is permanent microtrauma due to increased load or body position. Localization of inflammation in a particular bag is due to the peculiarities of the load. So, wrestlers, miners and office workers are more often affected by the subcutaneous ulnar bag, tennis players have a ray–elbow bag, etc. In rheumatoid arthritis, gout and some other diseases, bursitis develops as a reaction to the deposition of salts in the synovial sac.
Infection is possible with the introduction of microbes through a small wound, abrasion, pustule or boil in the elbow area. With erysipelas, boils, carbuncles, bedsores, osteomyelitis and purulent wounds, infection can enter the bursa with blood or lymph flow. Risk factors that increase the likelihood of developing purulent bursitis are the general weakening of the body as a result of past diseases, metabolic disorders, diabetes mellitus, immune disorders and taking steroid medications.
Bursa is a slit–like formation containing a small amount of fluid and located near the protruding areas of the bone. Performs the function of a shock absorber, protects the surrounding tissues from excessive pressure or friction. With overload or repeated microtrauma, aseptic inflammation occurs in the bag, the inner shell of the bursa begins to actively produce fluid. As a result, the bag takes the form of a tightly filled pouch and begins to bulge.
Subsequently, the liquid gradually stretches the bag, it increases and can reach significant sizes. With a prolonged course, adhesions form with the surrounding tissues, foci of fibrosis appear in the capsule and sometimes calcification areas. When an infection enters the bursa, purulent inflammation develops, which can spread to neighboring organs and tissues.
There are three bursae in the area of the elbow joint: ulnar subcutaneous, interosseous ulnar and radial. Most often (in about 70-80% of cases), the subcutaneous sac is affected, which is located on the back surface of the joint in the area of the ulnar process.
In surgery, traumatology and orthopedics, the following classifications of elbow bursitis are used:
- By localization, bursitis of the subcutaneous ulnar, radioloctal and interosseous ulnar sac are isolated.
- There are acute, subacute and chronic bursitis downstream
- By the nature of the inflammatory fluid, all bursitis are divided into serous, hemorrhagic, fibrinous and purulent.
- Taking into account the type of pathogenic microorganisms, nonspecific (usually caused by staphylococcus or streptococcus) and specific (may be caused by pale spirochete, Mycobacterium tuberculosis, gonococci and other pathogens of specific infections) infected bursitis are isolated.
Elbow bursitis symptoms
With acute serous or serous-hemorrhagic bursitis, swelling appears in the area of the elbow joint, there are indistinct or moderately pronounced pains. There is local edema, restriction of movements, local hyperemia and an increase in skin temperature in the affected area. The general condition of the patient, as a rule, worsens slightly. Possible malaise and subfebrile temperature. When palpation in the area of the elbow joint, a limited painful fluctuating formation of elastic-elastic consistency is determined. Subsequently, two outcomes are possible: recovery (inflammation subsides, excess fluid resolves) or the transition of acute bursitis to chronic.
Chronic elbow bursitis can both become the outcome of an acute process, and develop initially, without previous acute inflammation. In the first case, the inflammatory phenomena gradually subside, the skin acquires a normal color (in some cases, slight cyanosis or local darkening of the skin is possible), the temperature normalizes. The pain decreases, however, continues to bother with physical exertion, contact with surfaces, etc. There is a slight limitation of the volume of movements. Palpation reveals a painless fluctuating formation. The consistency of the formation can vary significantly – from elastic, tight-elastic to soft and even flabby. With long-standing bursitis, seals (“rice corpuscles”) can be determined.
With wounds in the area of the elbow joint, suppuration of the bursa may develop initially, without prior bursitis. In other cases, the purulent process usually occurs against the background of an already existing acute or chronic bursitis. Intense twitching or bursting pains appear in the affected area. The elbow joint is edematous, hyperemic, sharply painful on palpation, hot to the touch. Movements are limited. Regional lymph nodes are enlarged. Symptoms of general intoxication are revealed: fever, headache, weakness, bruising. With the spread of the process, the formation of fistulas, the development of an abscess, phlegmon, osteomyelitis or purulent arthritis is possible.
When the subcutaneous bursa is affected, the diagnosis of elbow bursitis does not cause difficulties. Suspicion of nonspecific and specific infected bursitis is an indication for puncture of the bursa with subsequent examination of the punctate. In purulent processes, the sensitivity of isolated infectious agents to antibiotics is determined. In case of specific inflammation, special serological and bacteriological studies are performed. The lesion of the radiocarpal and interosseous synovial bags is sometimes more difficult to diagnose due to their deep location. In doubtful cases, MRI of the joints is performed. If a specific bursitis is suspected, the patient is referred for consultation to a venereologist or a phthisiologist. If gout and rheumatic arthritis are suspected, a rheumatologist’s consultation is prescribed.
Elbow bursitis treatment
Treatment of acute bursitis is carried out on an outpatient basis in a surgical office. A tight bandage is applied to the elbow joint, anti-inflammatory drugs are prescribed, it is recommended to observe rest and apply cold to the affected area. In some cases, a puncture of the synovial sac is performed. With purulent bursitis, treatment is carried out in a polyclinic or in a surgical hospital, depending on the severity of the process. The patient is prescribed antibiotics, anti-inflammatory and painkillers. Perform a therapeutic puncture of the bursa, followed by washing and administration of antibiotics. In severe cases, the synovial sac is opened and drained.
Traumatologists are engaged in the treatment of chronic aseptic bursitis. Conservative therapy in such cases is ineffective. Punctures also do not bring the desired result, because after removal, the fluid accumulates again. The best result is provided by surgical excision of the bursa. The operation is carried out as planned in the conditions of the traumatology department. Local anesthesia is used.
The doctor performs an arcuate incision along the edge of the bag, introduces novocaine into the tissues for better visibility of the border between the bursa and surrounding tissues. Then stupidly (with a clip) peels off the bag all over and excises, making sure that there are no capsule pieces left in the wound cavity. Then he sutures the skin and drains the wound with one or two rubber graduates. When excising large bursae, a rubber half-tube can be used. The arm is bent at the elbow joint and tightly bandaged to exclude the formation of a cavity and ensure skin contact with the underlying tissues. In the postoperative period, UHF is prescribed. The stitches are removed on the tenth day, after which the patient is discharged for outpatient follow-up in the emergency room.
Prognosis and prevention
With timely treatment, the prognosis for all types of elbow bursitis is favorable. With purulent bursitis with the spread of infection to the surrounding tissues (especially into the joint cavity), the prognosis worsens. The outcome in such cases may be contractures and joint stiffness. Prevention includes limiting the load on the joint, preventing infection.