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Olecranon Bursitus of the Elbow

In the elbow, several structures can be involved. The first is the olecranon bursa, which is right over the point of your elbow. The most common thing that I see is olecranon bursitus due to trauma. Stroke patients use their arms a lot, especially initially to get mobilized. A lot of times they lean on their elbows and about once a month we see a patient in the hospital with olecranon bursitis due to this type of activity. The history may be that the patient doesn’t even know it’s there or they notice that it’s swollen, doesn’t bother them. Sometimes the doctors are more concerned that there is a problem. Although there can be some pain and if it’s just due to trauma, not much warmth or anything else, you have to be concerned that there could be an infection there. Even in a patient with just trauma. Sometimes that can somehow "seed" it with staph, the most common bacteria. Or patients who have rheumatoid arthritis or gout can get inflammatory involvement of this bursa. In that case it will be quite red and swollen, tender. The main thing to remember though is that the range of motion of the elbow is intact. You have good rotation of the radial head, usually near normal extension. Sometimes if it is very swollen the patient won’t be able to extend it comfortably, because of the fact that you are putting pressure on the bursa. But otherwise the range of motion is normal. If you feel over the elbow joint it is pretty free of tenderness and there is no bursitus pain there.

Basically, treatment is just aspiration if it’s just a non-inflammatory situation. Occasionally if the patient has a lot of symptoms I will inject some corticosteroids. Sometimes in a patient who is having repetitive trauma, such as they are recovering from a stroke and I know they are going to continue using that elbow, just have the physiatrist prescribe elbow pads to protect a little bit. If you draw this fluid out and it looks a little bit cloudy, be concerned about an infection. I’ll send it off to the lab. If the white count is more than 1,000 I’ll be concerned. And of course, gram stain and culture. Unlike a septic arthritis, this is not necessarily something that needs to be treated aggressively with IV antibiotics. But you do want to make sure that you are on

Epicondylitis, I’m sure some people came here with the idea of playing either golf or tennis. I’m a tennis player - I guess 50/50 tennis and golf are both very popular. But lateral and medial epicondylitis are commonly associated with golf and tennis. Although, there are many other situations where you can get this disorder. Lateral epicondylitis is sometimes called "tennis elbow". Medial epicondylitis is sometimes called "golfers elbow." And that’s because the activity, the actual swing of the golf club and the stroke of the tennis racquet you put stress on these respective structures. Of course it’s a repetitive thing. If you go out and play golf or tennis you do this hundreds and hundreds of times. One thing that I’ve noticed is that if you have ever bought one of these computer desks or a cabinet from one of these furniture companies where it comes in a box and you have to put it together yourself. You figure you will just do it with your hand screwdriver and you turn and turn and turn. You know, hundreds of screws. And there’s always a big bag of parts left over and you don’t really know what they are for, but at the end of a day like that sometimes you will feel it in your elbow because of the constant pressure on the muscles where they insert on the elbow; either the ulna or the radius. One thing to remember, this is not a true tendonitis. The bellies of the muscles actually insert on the bone and what happens is there are sort of micro-evulsions and hemorrhage and that’s what causes the pain. Patients often complain of pain when they shake hands, when they try to open or close a door or a jar, or any repetitive motion like turning a screw, or if they are golfers or tennis players. Those are their biggest concerns. They want to get back on the court or the course and do the thing that they really like to do.

When you examine them you will find point tenderness over the respective epicondyle and also if you do certain maneuvers. For epicondylitis - and that’s what this is showing. In my experience that’s more common, and that’s not because my patients are big tennis players. I don’t know why it is but I think it’s just maybe the activities that they do at home cause it more. What you can see here is the forearm is supinated and the wrist is extended. You ask the patient to push up on your hand to fully extend that wrist and they will have a lot of pain right over the lateral epicondyle and if you do the exact opposite maneuver for

The treatment of these things is to refrain from these activities. If they are a tennis player or a golf player, tell the patient not to do it for a few weeks and give it a chance to heal up. If it’s like a one-time episode, it may not come back again. Antiinflammatory drugs are very helpful if the patient can tolerate them. Injections - now this is one instance where I prefer not to use an injection unless the more conservative measures don’t help. Because, if you just feel over your elbow, the lateral and medial epicondyle, there is hardly any soft tissue there. If you stick corticosteroids and lidocaine, corticosteroids can cause a little bit of a reaction. Sometimes it will even make the symptoms worse. So I don’t necessarily do this right off the bat. Again, there are other rheumatologists and orthopedists who, when they see a patient like this, they just give an injection. If you have a patient who has persistent or recurrent symptoms - say they play golf, and particularly with tennis - this forearm splint can help. What it does is it’s a tight, basically a Velcro band around your forearm and it just relieves the tension that you would normally put on the place where these muscles insert on the epicondyle. I don’t know if they work as well for golf. I haven’t seen many patients with what I would call "golfers elbow". What it does is the stress is put on the area where that band is placed. So you put it about two to

When a patient has epicondylitis related to an occupation, that’s a little more difficult problem, especially if their employer is hard-driving. Sometimes modifying what they do can help. If they can use their other hand for that activity - it depends on their job. What I would like is to rest them until they are symptom-free. Because if they still have symptoms that means there is still some hemorrhage and inflammation there. That might take a couple of weeks. On the other hand, employers might even be reluctant to have them go back because they don’t want to have a disability situation on their hands. Obviously, each employer is going to be different. Some of them will just try to find them a job where they don’t have to do the same exact thing. Others of them care a lot less and just make them go back again and