Bursitis - causes, symptoms of the disease, diagnosis and treatment methods

What is this?

This is an inflammation of the periarticular bursae (from the Latin bursa - bag). Near some joints there are small cavities called bags that allow tissue to glide over the bones. Strictly speaking, the bursae are not directly related to the joints, are not connected to them, but are simply located nearby. From the inside, they are lined with a synovial membrane, which normally secretes a small amount of fluid, which is enough to lubricate and slide the tissues. When such a bursa becomes inflamed, the joint itself is not involved in the process.

Treatment of elbow bursitis

Treatment of bursitis of the elbow joint is determined exclusively on an individual basis, after a thorough diagnosis, taking into account the existing clinical picture and medical history of the patient.

As with any other ailment, the best results in the treatment process can only be achieved with an integrated approach, involving a combination of conservative agents and other techniques.

Let's look at the main methods of treating elbow bursitis in more detail.

Conservative treatment

Involves the use of medication. The impact can be provided by drugs of various forms, in particular, local effects.

Among the most prescribed groups of drugs are:

NSAIDs (non-steroidal anti-inflammatory drugs) – reduce inflammation and relieve pain;
antibiotics - help fight infections in the septic form;
corticosteroids - intra-articular injections are especially effective in situations where you need to quickly and effectively eliminate pain;
chondroprotectors – provide the opportunity to activate the process of tissue restoration.

Chondroprotectors are of particular importance in conservative treatment, promoting the restoration of affected tissues and improving functionality. Their use is also advisable during the period of remission, which gives additional confidence in maintaining a healthy elbow during a chronic disease. Artracam is considered to be one of the best drugs in this category.

Physiotherapy

The use of physiotherapeutic treatment methods accelerates the recovery of the functional abilities of the upper extremities and has a large number of other advantages. Among the most effective and widely used physiotherapeutic techniques are:

attending massage sessions (course);
exposure to the affected area with ultrasound/laser/electric current;
phonophoresis.

The duration of courses of physiotherapeutic treatment is determined by the attending physician, taking into account the characteristics of the patient’s recovery process and the characteristics of the pathology.

Radical methods

Despite the fact that most cases of elbow disease do not require surgical treatment, radical methods of its treatment still exist and are used in situations where conservative therapy and physical treatment do not give the necessary result (more than 2 months of starting treatment or in situations where secondary pathologies form).

The most effective and used method of radical therapy is endoscopic excision of inflamed tissue, which belongs to the category of minimally invasive surgical interventions.

What could be the reason?

Most often, damage or heavy load is necessary for the disease to develop. Less commonly, the disease is part of a symptom complex of another, more serious pathology. Therefore the main reasons are:

Trauma (bruise, awkward movement)
Physical overload
Friction (for example, constant support on the elbow (with inflammation of the olecranon bursa) or moving on all fours with damage to the patella
Some rheumatological diseases (gout, ankylosing spondylitis)

Sometimes the cause cannot be determined.

Causes of elbow bursitis

Like any other pathological condition of the human body, the disease in question is provoked by various types of reasons.

The causes of bursitis of the elbow joint can be determined by various types of factors and prerequisites, which are usually included:

previous injury (bruise)
– the negative impact of optimal force on the tip of the elbow can provoke fluid secretion, inflammation and local swelling;
Providing long-term impact (support on a hard surface, etc.)
– constant pressure can cause swelling, which will provoke the development of pathological processes;
infection
– in a situation where an infection enters the body through damage to the skin, certain consequences may occur, including inflammation of the joint cavity;
Read also: What to do if your shoulder blade is blown out: how and how to treat it
development of concomitant diseases
– illnesses associated with multiple lesions can cause an unwanted inflammatory process.

Symptoms

Symptoms are caused by inflammation - the walls of the periarticular bursa thicken, discharge accumulates in it, sometimes a significant amount, up to 15 - 20 ml. The liquid is usually clear and yellowish in color. In case of injury, it may be stained with blood due to hemorrhage. When an infection occurs, pus accumulates in the cavity.

Complaints and other manifestations of pathology depend on the location of the lesion. The most common are pain, redness of the skin, and swelling.

There are serous and purulent bursitis. In the first case, the inflammation is aseptic (without the participation of microbes) in nature. In this case, the general condition suffers little, body temperature does not rise, local inflammatory phenomena are not pronounced. If the process is purulent, you can almost always find an entry point for infection (trauma, abrasions, microcracks). There is always hyperemia (redness of the skin), swelling, and an increase in body temperature, sometimes to high levels. When diagnosing, it can be difficult to distinguish these two varieties; if there are difficulties, a diagnostic puncture is required.

In this article we will consider serous bursitis as the most common one.

Symptoms of elbow bursitis

Before understanding the type of disease present and forming an idea of the upcoming treatment plan, it is necessary to have an idea of the symptomatic picture.

Symptoms of elbow bursitis include:

local swelling and increased skin temperature
– the first and one of the main symptoms of pathology (“bump” the size of a goose egg);
pain syndrome of varying degrees of intensity
– the stronger the swelling, the brighter and more intense the pain, which intensifies with pressure on the inflamed area or flexion/extension of the limb;
visual changes
– with the development of an active inflammatory process, the affected area acquires a reddish tint;
limited mobility
– the range of motion does not change, but performing a number of them may be difficult due to pain.

It is important to note that acute forms can cause severe pain in a situation where the articulation cavity is transformed in the process of movement. Symptoms may be vague.

When a relapse occurs, there is pain and limited mobility for a period of several days to several weeks.

Bursitis of the knee joint

In the projection of the patella (kneecap), swelling, moderate pain, and less commonly, redness appear. There are several bursae - prepatellar, infrapatellar, etc. Depending on which of them is inflamed, the symptoms may differ in location and severity. With prepatellar bursitis, there is swelling immediately above the patella (photo below), there is practically no swelling, pain, or redness of the skin. In the case of infrapatellar inflammation, on the contrary, pain predominates.

Diagnostics

In simple cases, the diagnosis is made on the basis of symptoms; a simple examination by a doctor is sufficient. The easiest way to diagnose the disease is in the area of the elbow and patella. With the shoulder and hip, the situation is more complicated; here, as a rule, additional research methods are needed - ultrasound, X-ray, MRI. Most often, one or less often two of these methods are sufficient to make a correct diagnosis. If it is impossible to differentiate between serous and purulent bursitis, a diagnostic puncture is performed - the cavity is pierced with a needle and syringe. With serous inflammation, a clear yellowish or reddish liquid is obtained, with purulent inflammation, pus is obtained.

Laboratory tests are of little value. If no obvious causative factor is identified (trauma, etc.), then rheumatological tests are prescribed to exclude systemic diseases.

Diagnosis of bursitis

Accurate diagnostic methods will help confirm the diagnosis of bursitis:

X-ray to identify pathologies in the joint - osteophyte deposits or others.
MRI.
Puncture and analysis of synovial fluid to look for a possible infectious cause of inflammation.
A blood test for antibodies to look for possible causes of bursitis such as rheumatoid arthritis, diabetes and others.

The doctor will need to not only conduct a careful examination of the affected joint and find out all the complaints in detail, but also ask many questions. How long ago and when did the symptoms appear? What other diseases are there? Is the patient taking any medications for a long time? All this is needed to understand the causes of bursitis and distinguish it from other diseases with similar symptoms.

Treatment

In most cases it is conservative. Restriction of physical activity is recommended, sometimes immobilization bandages are applied for this purpose. A quick and good result is obtained by puncture of the bursa with evacuation of the contents and administration of a powerful anti-inflammatory drug (see video below). In complex therapy, non-steroidal anti-inflammatory drugs (Voltaren, Nimesil, etc.), physiotherapy, and kinesiotaping are used. If fluid accumulates again, repeat punctures are performed.

If the disease persists and repeated punctures are ineffective, surgical treatment is indicated - excision of the affected bursa. The intervention is performed under anesthesia in orthopedic hospitals.

With the development of purulent bursitis, surgery is also necessary - the abscess is opened from a small incision under local anesthesia and sanitized with antiseptics. Antibiotics are indicated. Hospitalization is not required; the procedure is performed on an outpatient basis.

Elbow bursitis

To reduce frictional forces, there is a special sac of fluid, the so-called ulnar bursa, which is located between the bone and the skin above it.

We begin to talk about elbow bursitis when pressure on the bursa becomes so intense that it becomes inflamed or the overlying tissue is damaged. This inflammation can occur for several reasons. For example, one of the most common reasons is a strong blow to the bag. The second scenario is triceps. These muscles work primarily to extend the elbow, placing pressure directly on the bursa.

Causes

Elbow bursitis can occur for several reasons. Here are some of them:

A minor, but regularly recurring injury to the elbow joint. Minor injuries occur with regular, prolonged emphasis on the elbows, as a result of which the tissues located above the olecranon process are injured. Injuries caused by resting the elbows most often cause bursitis.
A strong straight blow to the back of the elbow.
Arthritis. The ulnar bursa sometimes becomes inflamed due to arthritis, but this is the least common cause.
Infection. If the tissues above the bursa are damaged, they can become infected, which leads to inflammation of the bursa.
There are many cases in which bursitis occurs without any apparent reason. However, later it turns out that this was influenced by injuries received earlier and long forgotten.

Symptoms

Under normal conditions, it is difficult for a person to notice the bursa. When the bursa becomes inflamed, the skin on the elbow thickens and there is slight swelling. Bursitis is not accompanied by pain or it is not severe. The ability of the elbow to move is not impaired. If the bursa fills with fluid, a small soft ball may form. However, all these symptoms appear provided that the elbow bursitis is not infected and is not associated with arthritis.

If there is an infection in the bursa or in the tissue above it, there may be pain in the elbow and redness of the skin on its back.

If the cause of bursitis is arthritis, then there are several scenarios. The inflammation can be painless, but most often the patient feels pain and swelling in the back of the elbow. The pain becomes stronger when bending and straightening the elbow, as well as leaning on it or carrying a bag. At the first stage of the disease, pain may occur when using a hammer, push-ups, and bending/extending the elbow with a heavy object in the hands.

Often, patients with bursitis feel pain in the event of contact at the location of the olecranon process; sometimes small balls are felt at the location of the bursa. Depending on the severity of the disease, pain and swelling may occur during or after sports exercises.

Diagnostics

Almost always, elbow bursitis is quite easy to detect and only a physical examination by a doctor is enough. However, special tests or x-rays may be needed to prevent arthritis or microorganisms. In special variants of the development of the disease, magnetic resonance imaging of the joints (MRI) or computed tomography (CT) is prescribed to prevent tumorigenesis.

Treatment

Most often, curing bursitis is quite simple and it all comes down to reducing the pressure on the elbow. This conservative method includes:

Calmness and/or a change in the type of work that will not apply reduced pressure to the ulnar bursa. This can also be facilitated by wearing special elbow pads, which will relieve the bursa from unnecessary irritation and prevent additional injuries.
Applying something cold. A cold compress should be applied to the site of swelling for twenty minutes, 2 or 3 times a week. Helps relieve swelling.
Wrapping with a bandage. Using an elastic bandage will also help relieve swelling. Just wrap your elbow with a special elastic bandage.
Elbow raise. This action reduces blood flow to the elbow, as a result of which inflammation decreases. Raise your elbow to heart level or higher.

Drug treatment. Also, for this disease, various medications are used, for example, aspirin, various ibuprofens, etc. to relieve swelling and reduce inflammation, as well as for severe pain.

Aspiration. To check the fluid in the bursa for infection, a method such as aspiration is used, which is carried out using a needle or syringe. If the result is positive, an infection has entered the site of inflammation (called septic bursitis). This method also helps relieve bursa pressure.

Corticosteroid injections. Corticosteroids are powerful anti-inflammatory drugs, the administration of which significantly reduces swelling and pain. They are used only for persistent bursitis due to the ineffectiveness of other treatment. However, they have their side effects. This is usually the introduction of harmful bacteria and degeneration of the skin.

Antibiotics. They are used exclusively for septic (infected) bursitis. But the choice of antibiotic depends on the bacterium that caused the infection. The most common bacterium is Staphylococcus aureus. Antibiotics will almost always clear up the infection; however, in the most severe cases, it may be necessary to be taken to a hospital and given intravenous antibiotics.

Sometimes, for some types of bursitis, surgery is performed to remove the bursa. Surgeon intervention may be necessary for chronic bursitis or infection. In this case, the inflamed bag is cut out, and after a while a new one grows in its place. In this case, no joints are damaged, so the entire operation and rehabilitation are easy. Possible complications include problems with healing of the skin at the incision site.

After the operation, for a speedy recovery, wear a special bandage that will hold the elbow at an angle of 90 degrees. After the symptoms of elbow bursitis disappear, physical therapy is recommended.

Forecast

In general, as mentioned above, elbow bursitis is a disease that is quite easy to diagnose and treat.
The rehabilitation period after inflammation is most often two to three weeks. If the illness lasted a long time and occurred with complications (for example, septic bursitis), rehabilitation can last from one to several months. Therefore, early detection and treatment of the disease is the key to a speedy recovery and quick rehabilitation. Author: K.M.N., Academician of the Russian Academy of Medical Sciences M.A. Bobyr

Advantages of Dr. Elshansky I.V.

Our clinic, located in the center of Moscow, traditionally deals with bursitis of various types and locations.

Main competitive advantages:

Doctor with extensive (over 25 years) experience, Ph.D.
The ability to perform all necessary manipulations immediately, on the day of treatment, incl. ultrasound guided punctures
If necessary, an ultrasound scan is performed immediately during the appointment and is included in the cost.
We do not prescribe unnecessary tests and examinations, and if there is still a need for them, we do not require them to be done exclusively in our clinic
Qualified, polite staff
No queues - we plan the time and accept appointments strictly by appointment
Convenient transport accessibility - 5 minutes walk from Turgenevskaya metro station, Chisty Prudy, Sretensky Boulevard

Which doctor should I contact if symptoms of elbow bursitis appear?

In a situation where one or several symptoms of elbow bursitis are observed, the time comes to find the answer to the question “Who should I turn to for help?”

Diagnosis and treatment can be carried out by several specialists, which include:

therapist (primary superficial diagnosis and referral to a specialist);
orthopedist-traumatologist (initial examination and development of a treatment plan);
rheumatologist (providing professional assistance if clinical data consistent with inflammatory arthropathy);
orthopedic surgeon (if, in parallel with the inflammatory process, there is a crack or immediate surgical intervention is required).

Based on the results of seeking medical help, the need for hospitalization in a hospital is determined, indications for which may include exacerbation of septic bursitis, aggravation of the pathology by concomitant infections, as well as the lack of a positive effect from the treatment already completed.